NEW YORK — If you were really scared of something — a fear founded on rumor and history, that you could get sick and possibly die, lose your ability to have children, alter your DNA or be left at the mercy of pernicious government surveillance — would you do it anyway, for the prospect of a membership to the Public Theater? Or a free glazed doughnut at Krispy Kreme?
These are not hypotheticals but in fact examples of the kind of bait that New York City began publicizing last month to increase COVID vaccination rates. With no evidence of whether such a strategy might be effective — and the belief presumably that it is worth trying anything — states and municipalities across the country have been working to incentivize immunization. In Kentucky you can get a free lottery ticket; Alabama has offered the opportunity to drive a truck around the Talladega speedway.
An unwillingness to get the COVID vaccine, complicated as both a matter of politics and psychology, has become increasingly concerning to public health officials as the Delta variant, more contagious than the standard coronavirus, has begun to spread. In New York, 44% of new COVID cases seen by the city’s health department are attributable to the Delta variant, a doubling over the course of a week.
Although 52% of New Yorkers are completely vaccinated, that statistic is highly misleading. In most parts of Central Brooklyn — in places like Brownsville, Canarsie and Bedford-Stuyvesant — only a third of residents have been fully immunized. This is a distinct contrast with affluent parts of the city, where the figure is more than twice as high; in the Financial District, for example, the ranks of the immunized stand at 98%.
The reasons for refusing the vaccine differ by community and demographic, dooming any unified approach. In Staten Island, for example, where some of the highest COVID rates in the city have surfaced again lately, the data has shown that young people are the ones exempting themselves.
Among Caribbean immigrants, the city’s health commissioner, Dave Chokshi, told me, skepticism about the vaccine has fomented around concerns that it will endanger fertility. This stemmed from a report that circulated on social media suggesting that it caused a woman’s body to fight off a spike protein involved in the making of the placenta. It wasn’t true.(
But the work of convincing Guyanese women in Crown Heights that the vaccine is not a threat to pregnancy is different from the work of convincing 17-year-olds in Tottenville that it is worth getting off the couch and going to CVS. One has involved enlisting pediatricians and others to talk to teenagers, bound to their invincibility, about the effects of long COVID. The other has required the more complex business of countering the intractable fallacies of the internet.
It is not clear what succeeds. The city’s approach to correcting vaccine disparities can seem long on aphorisms (“convenience, community, conversation,” in the parlance of the health department) and short on cultural awareness, blind to the broad range of anxieties born of the long-term dismissal of poor urban communities.
Making vaccines more available is useful to the extent that there are lots of people who are holding out because they still can’t make their way to them. Tens of thousands of vaccine doses have been distributed through the city’s mobile sites — and this is obviously a good thing. But ease of access cannot override deeply held doubt.
Two weeks ago, the city announced it would start offering vaccines at home to anyone who wanted them. When I asked Dionne Grayman, president and co-founder of We Run Brownsville, a women’s health organization, about this, she was dubious.
“There is a feeling of ‘I didn’t want you in my house before any of this,’” she told me. “It can feel intrusive; it can feel to people like ‘The state is in my house.’” The risk, of course, is alienating people to the degree that they only become more apprehensive, more confirmed in their suspicions that they are not understood.
“The incentives are insulting,” said Grayman, who has taught high school English and now trains educators. “There are no Shake Shacks in Brownsville. Who are you talking to? This is dignity snatching; it is not dignity affirming. There’s dignity in listening to people.”
In an effort to move the process along, doctors and public health officials have worked to engage community leaders — the phrase “trusted community messenger” is one you hear repeatedly in this context — to deliver the word on the importance of vaccination.
When Grayman sat down with them, she told me, she had a vision different from the one espoused. She wanted a place for people in her community to have long conversations about what might be holding them back — “a real one-on-one, with no coded language,” she said — the chance to be heard, perhaps during repeated visits, in the way that pamphlets and television ads and Zoom town halls (assuming you have broadband to begin with) cannot possibly provide.
“There is all this language — ‘vaccine hesitancy.’ People aren’t ‘hesitant.’ They don’t trust a system that has never worked for them before,” Grayman said.
From the perspective of public health, the job is to counter fear, but this disregards the extent to which certain fears are legitimate and demands a set of solutions beyond just trying to persuade people that they have nothing to worry about. For instance, many people have had negative reactions to a second vaccine dose, reactions that can put you out with chills, fever and fatigue for a day or more.
Erasma Beras-Monticciolo, who grew up in Brownsville and now serves as the executive director of Power of Two, an organization in the neighborhood that works with new mothers, found that among clients who were not getting vaccinated, many worried about who would take care of their children if they got sick.
This was a logistical issue that in Beras-Monticciolo’s view was not inherently hard to fix. In certain situations, she pointed out, the city’s Administration of Children’s Services will provide child care for mothers in the hospital giving birth. If there were coordination between city agencies, ACS could provide temporary care for mothers who needed it as a result of vaccination.
Power of Two was doing this on its own.