What Do New Yorkers Think is Fair Vaccine Distribution?

NYAM and NYC Health Department partnered on innovative study that determined underlying health conditions and neighborhoods matter most.

NEW YORK (February 19, 2021)—In the fall of 2020, the New York City Department of Health and Mental Hygiene (NYC Health Department) and The New York Academy of Medicine (NYAM) partnered on an innovative project to understand New Yorkers’ points of view on equitable COVID-19 vaccine distribution. Discussions with a diverse cross-section of city residents, using a public deliberation approach, yielded a wealth of information on what is most important to New Yorkers when considering fair vaccine distribution.

With funding provided by New York State Health Foundation, United Hospital Fund and the Altman Foundation, NYAM’s Center for Evaluation and Applied Research led five English- and Spanish-language public deliberations with over 90 New Yorkers in December 2020 and January 2021. Public deliberation is an innovative method for eliciting community members’ input on decisions that affect them. Participants receive relevant and unbiased information and work together to make recommendations in response to questions regarding policies that affect their community. The goal of these public deliberations was to gain informed input with respect to New Yorkers’ priorities for vaccinating six subcategories of essential workers and four risk factors.

“As the city continues to grapple with the devastation and stark inequities of the pandemic, it is critical to hear from New Yorkers as to where they believe priorities should be placed in vaccine distribution,” said NYAM President Judith A. Salerno, MD, MS. “In partnership with the NYC Health Department, we’ve deployed a method that facilitates informed decisions, putting science to work for the health of all New Yorkers.”

“Policies, both large and small, are too often driven by powerful individuals and institutions without the input of the constituents who will be affected by their implementation,” said Marthe Gold, MD, MPH, Senior Scholar-in-Residence at NYAM. “Key decisions in areas where there is no ‘right’ technical solution are often best grounded in the informed guidance of people who will feel their effect. Public deliberation, a process based on shared information and reasoned discussion, is an effective means to assure that the public's views and values are elicited and brought forward.”

The study found broad consensus on the priority factors for vaccine distribution: underlying conditions should be of primary consideration and neighborhoods were the second most important factor in equitable distribution. Participants favored ”equity” approaches—assuring that people were prioritized based on their vulnerability and exposures—rather than on a lottery or “first come first served” basis. These priorities are reflected in the City’s recent update of its Vaccine for All effort with a focus on equity, as detailed in a press release on January 31. The next phase of its plan prioritizes signups for local residents in the 33 neighborhoods identified by the Taskforce on Racial Inclusion and Equity. It also includes six new neighborhoods that were selected based on a range of factors including high prevalence of chronic illness, presence of overcrowded housing, the number of individuals experiencing poverty, and other preexisting health disparities.

“Developing an equitable vaccine plan is crucial in responding to a large public health challenge like the COVID-19 pandemic. The public deliberation process ensures that New Yorkers have a voice in that planning,” said Dr. Torian Easterling, First Deputy Commissioner at the NYC Health Department. “NYAM's results reaffirm the Health Department's commitment to prioritizing neighborhoods hardest hit by the COVID-19 pandemic.”

Among the risk factors discussed, 69% of participants ranked underlying health conditions as the top priority, and 93% included this factor in their top two. Many participants saw underlying conditions as a risk factor for COVID-19 that was more prevalent in less advantaged populations; in that sense, this factor could also serve as a proxy for several others including race, ethnicity, neighborhood and occupation. 

While race was identified as a critical risk factor in all of the deliberations, participants noted that in identifying underlying conditions and neighborhood jeopardy as most important, persons of color would be given de facto greater priority due to their typically higher burden of chronic conditions and generally poorer living circumstances. Participants described the impacts of structural inequality rather than individual susceptibility to the virus as an underlying reason for the higher risk experienced by Black and Latinx individuals.

Based on this pilot study in NYC, NYAM has created a digital guide for local municipalities to utilize as they determine priorities in their own jurisdictions. The guide, "Conducting a Virtual Public Deliberation on COVID-19 Vaccine Distribution: Sample Guidance & Tools," was funded by the de Beaumont Foundation and is available on the foundation’s website. NYAM’s Center for Evaluation and Applied Research is a leader in conducting public deliberations for both healthcare institutions and public agencies; more information on this research method and past studies are available on its website. 

About The New York Academy of Medicine 
The New York Academy of Medicine (NYAM) tackles the barriers that prevent every individual from living a healthy life. NYAM generates the knowledge needed to change the systems that prevent people from accessing what they need to be healthy such as safe and affordable housing, healthy food, healthcare, and more. Through its high-profile programming for the general public, focused symposia for health professionals, and its base of dedicated Fellows and Members, NYAM engages the minds and hearts of those who also value advancing health equity to maximize health for all. For more information, visit nyam.org and follow @nyamnyc on social media.