Doses by ZIP Code: Chicago’s Vaccine Rollout Still Marked by Racial Inequities

A health care worker from the community health organization, Enlace Chicago, vaccinates a Little Village resident. Enlace Chicago is one of the many anchor organizations associated with Mayor Lori Lightfoot’s Protect Chicago Plus program. Photo courtesy of Enlace Chicago/credit: Enlace Chicago IG@enlace.Chicago   

Jackie Neiman, 71, called, texted and anxiously watched her computer in the hopes of securing her first COVID-19 vaccine. She’d been at it every day since Jan. 25, the day Cook County expanded to Phase 1B of the vaccination plan, which includes essential workers and residents over 65 years old. Neiman’s physician recommended she download an app, LiveWell, through her health insurance, but she learned that it only worked on an iPad or tablet — neither of which she owns. She needed to go through whatever loophole the Cook County Department of Public Health had to offer her.  

“I think this is a crime against taxpayers,” Neiman said of Chicago’s vaccine rollout. “It’s a crime.” Still, Neiman considers herself one of the lucky ones, given the health care resources in her community.  

In the first month of vaccine eligibility, even the lucky ones must wait by a phone blaring on-hold muzak or refresh “no appointments” pages on pharmacy websites. But in more vulnerable Chicago neighborhoods, people are counting on their earned days off from work, monthly phone data, spotty WiFi, or a Pace bus to a city bus to a train to a health care center. With the Herculean effort required to book an appointment, and mass vaccine sites such as the United Center promising doses at the expense of long hours in line, vaccine eligibility is far from a godsend.  

While many public health experts chalk these difficulties up to vaccine shortages across the country — and certainly winter storms only shrunk availability — community health organizers recognize a more vicious narrative at play. South and West Side Chicago neighborhoods and suburbs need more health care institutions and community wellness plans.  

Nora Garcia, director of programs at the suburban Cook County-based, nonprofit Healthy Communities Foundation (HCF), said that the southern part of HCF’s funding region, south of I-55, lacks health care institutions and providers. “Individuals who normally travel have to have a means of travel in the first place to get to these institutions,” Garcia said. “Transportation is a barrier.” Other barriers include internet access and language.  

In the hopes of resolving Chicago’s historic health inequities, Mayor Lori Lightfoot and the Chicago Department of Public Health announced Protect Chicago Plus on Jan. 25, their solution to health inequities that challenge communities of color. The plan covers 15 neighborhoods that have a high vulnerability index for COVID-19 complications, based on metrics from the 2018 U.S. Census American Community Survey, and gives all residents from these neighborhoods eligibility for vaccination. 

The CCVI metrics consider neighborhoods’ individual poverty, unemployment, per capita income, level of insurance, living with disabilities, populations under 17 years old, crowded housing, no primary care provider and single-parent households. As part of Protect Chicago Plus, Arturo Velasquez Institute hosted the first vaccination event in Little Village, which the Chicago COVID-19 Community Vulnerability Index (CCVI) determined to be among the top five most vulnerable neighborhoods in Chicago (Little Village is part of South Lawndale).  

The Velasquez Institute, nestled in Little Village along one of Chicago’s industrial corridors, provided space for 23 organizations that collaborated at policy tables for months, conducting outreach in their neighborhoods, signing residents up for the vaccine and answering questions. The Institute coordinated with Enlace Chicago, a community-based organization in Little Village, to book appointments for Little Village residents.  

Over the course of two and a half days, the grassroots organization registered around 2,000 people, according to Katya Nuques, the executive director of Enlace Chicago. The population of Little Village, however, totals almost 75,000. 

“It’s coordinated, but I’m not saying it hasn’t been chaotic,” Nuques said. “You have your policy table and hyperlocal coordination, but nothing has been easy about COVID. It’s still been significantly difficult to put together the vaccination effort.” 

Residents who live in the 15 neighborhoods under the Protect Chicago Plus program have a far greater risk of contracting COVID-19 based on health factors such as age (in pink) and a lack of a primary care physicians (in red). Their occupations as essential workers (in orange) only further expose them to COVID-19. 

By her estimation, Nuques said the process took around a half-hour per individual signup. And that’s because organizers must register through the City of Chicago’s website — and the site asks a lot of questions. Some required fields, such as email address, can’t be filled in because many Little Village residents simply don’t have an email address, Nuques said. In those situations, organizers have to create an email address for community members. 

“The number of vaccines that are available for Little Village community members during this Protect Chicago Plus two-month vaccination event is very limited,” Nuques said. “We have to strategize a way to do outreach and to let people know vaccines are available without raising expectations that everybody’s going to be able to get the vaccine.” 

A member of Enlace Chicago’s emergency response team, which includes its Street Outreach Workers, Safe Passage, and Promotorxs de Salud, receives her first dose of the COVID- 19 vaccine. Photo courtesy of Enlace Chicago/credit: Enlace Chicago IG@enlace.Chicago 

Esperanza Health Centers Chicago, another anchor organization working with Protect Chicago Plus, played a major role in administering the vaccine to at-risk residents in Little Village, Gage Park, Brighton Park, Archer Heights and Chicago Lawn. Dan Fulwiler, president and CEO of Esperanza Health Centers, said in an email that, in addition to getting the vaccine to its patients, Esperanza is working to get “thousands of people in the community” vaccinated who don’t normally see a doctor. 

“All of that has to be done over a matter of six months or less,” Fulwiler said. “For Esperanza, that means tripling the number of visits that we do on a daily basis. It strains all of our systems, but scheduling and billing are probably the hardest hit. Our call center is working like crazy to keep up with the demand.” 

To date, Esperanza has delivered 36,974 vaccine doses—20,026 to established patients and 16,948 new patients.  

In the medical community, hedging expectations and working overtime sum up this difficult year. Some of this has to do with health care institutions being few and far between in neighborhoods with low social determinants of health. Research from a 2018 study conducted by the Healthy Communities Foundation found that certain ZIP codes in the HCF funding region experienced inequitable health outcomes, despite neighboring ZIP codes enjoying some of the best health outcomes. From this, HCF was better able to understand health inequities by race and place. 

The Centers for Disease Control and Prevention define social determinants of health in terms of health care access and quality, education access and quality, social and community context, economic stability, and social and infrastructural environment. Garcia said the results of the social determinants research was a “preview of exactly where we would see the hardest hits of COVID in the region.”  

When the pandemic struck the United States, Garcia said Healthy Communities Foundation doubled down on providing general operating support, made a few grants available for emergency assistance, and advocated for the ZIP codes they needed to serve most. 

West Englewood’s mortality rate from COVID-19 marks the highest toll in the city. The neighborhood lost 243 residents to the pandemic between January and December 2020.   

While advocates recognize the health resource desert in Black and brown communities, the local health care community didn’t always keep score of these specific disparities. Many health care providers administering the vaccine early on weren’t collecting important data on race and ethnicity, information that more accurately pinpoints areas in need. 

Dr. Allison Arwady, commissioner for the Chicago Department of Public Health, signed a health order Jan. 25 that requires health care partners participating in Protect Chicago Plus to report race and ethnicity data about vaccinations to the Chicago Department of Public Health, according to a press release from the Office of the Mayor.  

While data collection may improve future racial inequities in health care, datasets themselves don’t reflect the full scope of the problem. Patrick Brosnan, the executive director of Brighton Park Neighborhood Council, said that undocumented immigrants comprise around 40% of the Brighton Park community, and that these workers fall outside of the city’s sick leave guarantees for COVID-19 symptoms. Many essential and undocumented workers have employers who force them to come back to work, regardless of symptoms. Brosnan said the city doesn’t investigate these labor practices, nor does it do anything to regulate them. 

According to the CCVI, Brighton Park’s essential workers make up 18.7% of the community population, which is comparably higher to even the most vulnerable Protect Chicago Plus neighborhood, West Englewood (12.1%). But Brighton Park isn’t part of the Protect Chicago Plus neighborhoods, despite its overlapping instability factors, such as economic instability, a lack of education and health access, and gang violence, according to Brosnan.  

“Protect Chicago Plus is mostly a press release. It leaves out 11 of the hardest hit communities, including Brighton Park,” Brosnan said. “And inexplicably, it doesn’t try to rationalize why Brighton Park, or Hermosa, or some of these other neighborhoods that have been really hard hit, why these neighborhoods weren’t included.” 

Not only is the general neglect of many communities of color costly, but so too is the lack of health literacy and trust in public health programs. With a long and ugly legacy of medical racism, some people in Black and brown communities aren’t exactly racing to the vaccine lines with open arms. The 1932-1972 Tuskegee Study, among the most infamous incidents of medical racism, experimented on the long-term toll of untreated syphilis on unsuspecting Black men, whom researchers deceived with the promise that they were providing treatment.   

Despite these past atrocities, leaders in the Black community pushed for health and wellness opportunities, sometimes in less orthodox settings. Pastor Michael Neal, the senior pastor at Glorious Light Church in Bronzeville, understands the uneasiness around the vaccine in his community. He helped churchgoers and local residents take agency over their physical well-beings — which includes demystifying information surrounding the available COVID-19 vaccines. 

“We know that African Americans are disparate when it comes to health equity and outcome,” Neal said. “We want it to be our goal to reach out and promote health, not only to extend life and physical well-being, but also to send a message to the broader community about making healthy choices and being healthy.”  

One way that Neal promoted well-being is through forums on safe inoculation, which create spaces to share information and empower people to make informed decisions. Recently vaccinated residents can give the “play-by-play” on how they’re feeling in terms of side effects and emotions.  

Neal hopes more people in his community can get the vaccine. He recalled a recent bike trip to the United Center after he learned he was eligible for a vaccination. Curious to learn on behalf of his community, he asked how he could schedule an appointment with the United Center if he didn’t have a computer at home. The United Center worker shrugged his shoulders and gave him a number to call. He wasn’t able to make an appointment via the provided number because the system was allegedly down. 

“When I think about this from the perspective of a non-resourced person, it didn’t make me feel good,” Neal said.  

Neal observed that, when the vaccine rollouts began, communities of color watched white residents flood vulnerable neighborhoods like Englewood, Roseland and South Shore to get vaccinated. Vaccine-eligible Cook County residents could go anywhere to get the vaccine, after all. But Neal said that white residents taking advantage of a historically racist system added to distrust felt in communities of color. 

“These areas have long-suffered from segregation, so you wouldn’t normally see white people there,” Neal said. He thinks if more community centers received doses, as opposed to vaccines being peppered throughout the city, there would be less distrust and more equitable allocation. 

Meanwhile, after months of trying to break through eight different vaccine gatekeepers to schedule an appointment — including ZocDoc Walgreens, Oak Street Health, Cook County, Osco, Meijer, Advocate and North Shore — Neiman still wasn’t making any headway. It was only after the United Center opened that she could book an appointment through ZocDoc. A mass vaccination site like the United Center, to Neiman, meant standing in a long line packed with people. Because of her preexisting health problems, this was not ideal..  

It was only after Ald. Harry Osterman opened Weiss Hospital to vaccine-eligible non-patients that Neiman canceled her United Center appointment to schedule at a facility that better aligned with her comfort levels. After two months of nonstop scheduling attempts, she received her first dose March 23. 

“After I scheduled with Weiss, I just sat in my chair shaking. This has been hanging over me for so long,” Neiman said.