By 8 p.m. on Friday, a crowd had started to form at New Orleans’ first Shots for Shots event at the Dragon’s Den on Frenchman Street.

There, the neighborhood health clinic CrescentCare set up a station on the neutral ground outside the club, which was offering a free watermelon lemon-drop shot to anyone who’d gotten vaccinated. So many people lined up that they began administering shots half an hour early, with a nurse drawing up doses from a cooler in her car. By 9, they’d given out 80 Johnson & Johnson shots, said Katherine Conner, CrescentCare’s vaccine manager. 

“And we were only supposed to start like 10 minutes ago.”

“I really believe that this is the next phase,” said Dr. Jason Halperin, the HIV and infectious disease lead at CrescentCare. He’s not alone. City health officials, who supported and helped organize the Shots for Shots event, say that this kind of targeted outreach, especially to young people, is going to be critical for stemming inequities in vaccinations.

A month after vaccine eligibility expanded to include the majority of Louisianans, Black residents of New Orleans are still receiving a disproportionately low share of doses. New state data suggests that the disparity has shrunk over the last two weeks. But public health officials and clinicians all say that significant, complicated barriers stand in the way, especially in reaching young people.

Across the country, but particularly in Southern states, vaccination rates of Black Americans have lagged. That’s especially grave, because Black people have died of the illness at disproportionately high rates. In New Orleans — which is about 60 percent black — 73 percent of people who have died from the disease have been Black. The same story largely holds for Latinos nationwide.

Since vaccinations began in December, 42 percent of first doses have gone to Black residents, and 46 percent have gone to white residents. The city is only 34 percent white.

But that aggregate number hides some week-by-week variations. In the weeks following March 9, when vaccine eligibility was expanded to include people with a large list of preexisting conditions, just 35 percent of first doses went to Black New Orleanians.

That number has improved to 42 percent since late March. In interviews with The Lens, city health officials have attributed some of those trends to issues with information and access, especially after changes in eligibility. 

“White residents are most likely to have different ways to access vaccines,” said Dr. Jennifer Avegno, the city health director. “They’re most likely to have a car, and have a job that allows them to take off work.”

And she says that the nature of hesitancy and access has changed as the majority of elderly people have been vaccinated.

Data Center

But a recent Data Center report argues that in some ways, inequities were built into the vaccine priority groups. 

“Vaccine eligibility criteria set by the state did not strongly enough prioritize those most impacted by COVID in New Orleans,” based on a retrospective analysis of Orleans Parish coroner data, the report says.

Allison Plyer, the Data Center’s chief demographer, and a coauthor on the report, says that the findings are intended to be forward-thinking but that they demonstrate a way in which public health officials can set clearer equity goals.

The Data Center found that the earliest phases of vaccine eligibility — which prioritized nursing home residents and people over 70 — likely provided many more high-risk white New Orleanians with the vaccine than high-risk Black New Orleanians.

That’s partly because younger Black people were at a similar risk of dying as older white people, and because elderly white people are more likely to be in nursing homes. It also found that the professions which were in the middle tiers of vaccine priority, including teachers, EMTs, and dentists, were whiter than the city’s population.

“Meanwhile, other essential workers who are majority-minority were not prioritized until the last priority group,” the report reads. It specifically points out that butchers and other meat processing workers are “47 percent Black and 11 percent Hispanic,” and suffered a large number of outbreaks.

In response to the findings, Christina Stephens, a spokesperson for Gov. John Bel Edwards, wrote over email that “the Governor has prioritized health equity from very early on in the pandemic, as one of the first states to publish race data for those people who had died and … creating a Health Equity Task Force.”

“It’s important to look at the context of when vaccination started – the picture wasn’t so rosy for Louisiana,” she continued. “Our statewide percent positive was above 10 percent, our COVID hospitalizations were weeks from peaking a third time and variants were spreading through the United States. There was immense focus from the federal government on getting older people vaccinated as quickly as we could, while managing vaccinations for health care workers with a supply that was limited at the time.”

Plyer agreed that from a logistical standpoint, simply changing the priority groups probably wouldn’t have been much better.

“If they said, ‘OK, everybody 55 and up is eligible,’ that numerically sounds like it was heading for a more equitable outcome, but we know what would have happened. All the folks with means and internet access would have been the first to get it.”

Stephens also wrote that the state’s vaccine priorities had been based largely on the guidance of the federal Advisory Council on Immunization Practices. While that’s true in broad strokes, ACIP recommended in January that food, agriculture, and grocery store workers become eligible at the same time as first responders.

How much is hesitancy playing into this?

“The question is, why?” said Thomas LaVeist, the dean of Tulane University’s School of Public Health and Tropical Medicine. “Is this an access problem, or is this a vaccine hesitancy problem? If it’s hesitancy, then we’re dealing with issues of trust.”

As of last month, national vaccine hesitancy rates among Black and white people were essentially even. But recent survey data from the Louisiana Public Health Institute gives more clues about local attitudes.

Half of Louisiana residents say that they are willing to get the vaccine, and another 35 percent say that they’re unsure. The survey isn’t large enough to give parish-by-parish results, but Louisiana Department of Health Region 1, which includes New Orleans, has the highest levels of willingness in the state.

“We’re seeing more hesitancy in the African-American community than white residents,” said Dr. Beth Nauman, LPHI’s managing director, who analyzed the survey data. ‘But there’s more nuance to the differences than just race.”

White men are more likely to say they will take vaccine than any other group, and Black women are most likely to say they will never take it. That’s somewhat surprising, given that nationally, Republican men, who skew heavily white, express the most hesitancy.

But hesitancy is high in all women between the ages of 18 and 44, and 30 percent of those women say that they will never take the vaccine. All people between the ages of 18 and 29 expressed higher levels of hesitancy than their older counterparts.

Nauman stressed that “hesitancy is a spectrum,” and that people are both open to changing their mind, and are basing their opinions on different information. “Concerns about side effects and efficacy are important concerns for their decisions, so we should be meeting their desire for more information.”

Avegno said that’s begun to inform the city’s outreach. 

“When it was only 70 and above, we didn’t have to spend a lot of time talking about pregnancy and fertility issues–that was not a problem.”

Still, she said, “these myths have been around for a while. It’s going to take more than one or two town halls to get this into the community.”

And the survey found that people who express hesitancy still list healthcare professionals and the Louisiana Department of Health as their most trusted source of information. That suggests that LDH’s Bringing Back Louisiana campaign, which is partnering with community groups for outreach into undervaccinated census tracts, is likely to be effective in reaching hesitant people. (LPHI is a partner in the campaign.)

Structural inequities

But every observer agrees that access is likely playing a role.

“There’s a lot of conversations of vaccine hesitancy or deliberation, and I’m sure that’s there as well,” Halperin said at the Dragon’s Den event. “But I think there’s a population living in New Orleans that is so busy with other priorities. And they’re often young and otherwise healthy, so bringing the vaccine to them is what’s so essential.”

He said that nine staff members from the Dragon’s Den had been vaccinated within the first half hour, and “all of them said the same thing: They are working all the time, they couldn’t make it to the Convention Center or to our clinic. But they came out here and got the vaccine.”

The Data Center report also argues that “a person who indicates they ‘probably or definitely won’t’ get the vaccine does not necessarily indicate they are hesitant.”

“There’s research nationally where people are expressing hesitancy because they think it costs money. They express it because they can’t get there, they can’t take time off of work,” Plyer said.

Because hesitancy is so much higher in young Louisianans, such events could be crucial to outreach and uptake. And, according to the Data Center report, “targeting vaccine hesitancy among younger adults may improve equitable uptake overall.” According to Plyer, demographic data implies that there’s a group of young Black parents in the city, and “those folks will probably have the largest barriers,” from tight schedules to economic pressure.

But both Halperin and Avegno say that recent manufacturing problems with Johnson & Johnson vaccines, leading to smaller shipments over the coming weeks, create a hurdle to expanding that kind of outreach.

“Dr. Halperin and I had this brainstorming dream list: we should go to this bar, and that bar,” Avegno said. “Just as we were getting the tool we needed to get the hardest-to-reach folks, it was ripped away from us. We’ll do an event with Pfizer or Moderna in the community, but it’s so much more difficult for everybody.”