Alameda County is in a good position overall when it comes to the vaccination effort. While some people are still being hospitalized with severe cases of COVID-19, the last death due to the virus in the county was recorded on May 8, and vaccine supply continues to outpace demand, meaning there are more shots available now than ever before.
However, the American Civil Liberties Union of Northern California says it’s found a flaw in an algorithm the state uses to determine where to send vaccine doses, and how many to send.
California tried to ensure greater equity by focusing on zip codes that suffered worse during the pandemic, including doubling the vaccine allotment to these areas, reserving appointments in the state’s MyTurn system, and creating a network of vaccine distributors to reach populations deemed a priority. But the strategy may not have been as equitable as some would have hoped.
Jacob Snow, a technology and civil liberties attorney with American Civil Liberties Union of Northern California, analyzed the state’s system and found that it left out numerous small, hard hit neighborhoods located outside of priority zip codes.
Zip codes are geographic areas assigned a specific five-digit number for the purposes of sorting and delivering mail, but government agencies also collect detailed demographic data on the people who live in each zip code, and COVID-19 case rates have been tracked across each zip code during the pandemic. There are 26 zip codes covering Oakland, some of which overlap with other cities.
The state used zip code level data to ensure that doses made it to hard hit areas and addressed some of the inequalities in vaccine access and need. These inequalities are readily apparent when looking at different populations in Oakland’s zip codes.
For example, while 75% of Alameda County residents have received at least one vaccine dose, only about 59% of Oakland residents who live in the 94606 zip code that covers areas just east of Lake Merritt have.
About 43% of residents of 94621, which encompasses deep East Oakland below Bancroft Avenue and includes the Coliseum area and the airport, have been vaccinated with at least one dose.
And the 94603 zip code, which reaches from 90th Avenue to the San Leandro border, has the lowest percentage of people vaccinated in the city, with only 41% having gotten a first dose.
The Oakland zip code with the highest vaccination rate is 94611, which includes Piedmont, parts of the Oakland Hills, and part of Contra Costa County. There, 77% percent of people have had at least one dose and 52% are fully vaccinated.
The three East Oakland zip codes are majority Black and Latino with a median household income between $42,000 and $56,000, while 94611 is 64% white and household incomes average about $129,000. By prioritizing the three East Oakland zip codes for doses, clinics, and access codes, the state prevented even wider vaccination gaps from emerging.
But according to the ACLU of Northern California, the zip code focus left behind residents of some smaller neighborhoods that aren’t located in these priority boundaries, but where the virus has still inflicted disproportionate harm. These smaller neighborhoods can be identified by looking at the census tract level. Census tracts are typically much smaller geographic areas than zip codes.
Snow recently mapped out the tracts excluded from the state’s zip code algorithm.
“From our perspective, it shows the focus on equity falls short,” Snow told The Oaklandside.
He started by looking at the state’s Healthy Places Index, a tool that uses several data points and risk factors like median income, education, and healthcare access to predict life expectancy for people living in California’s more than 8,000 census tracts. He found that some of the lowest-ranking census tracts in the Healthy Places Index are located outside of the zip codes where COVID-19 vaccines have been prioritized for distribution.
In East Oakland, the 94601 area code that overlaps with Fruitvale is prioritized under the state’s distribution system, but this zip code excludes neighboring tracts with low HPI scores. One of these neighborhoods is Allendale, including areas around Brookdale Avenue between 35th Avenue and High Street, below 580 freeway. This census tract is located in Oakland’s 94619 zip code, and because it includes upper-income areas like Redwood Heights and Skyline Boulevard, it wasn’t prioritized in the state’s vaccine rollout.
On 38th Avenue in Allendale, there’s a corner store with prominent liquor ads and limited produce. Across the street is a newly opened gourmet donut shop and Black Lives Matter murals. Designated bike lanes connect the neighborhood to Fruitvale BART. The Coalition of Concerned Medical Professionals, an all-volunteer organization that helps working people overcome political and economic barriers to healthcare, has their offices in this neighborhood.
Olivia Rodriguez, CCMP’s operations manager, said their location gives them a front row seat to the already existing inequities that the pandemic made worse for people living inOakland’s low-income neighborhoods. “It goes beyond the vaccine,” she said.
Rodriguez remembers an ice cream vendor in his 30s who got COVID-19. The man called 911 for help as his symptoms worsened, but the operator dissuaded him from going to the hospital because he was younger. “Two days later, he’s on a ventilator,” she said, adding the man eventually physically recovered.
Rodriguez said the failures—from the lack of testing to how shutdown orders had a bigger economic impact on essential service workers—are evident in the response at the national, state, and county level: not enough people are out meeting people where they live. The nuanced differences in each neighborhood, in terms of resources and problems, hasn’t adequately been built into the public health response.
“If you walk block to block, it’s pretty much the same,” Rodriguez said about the invisible border where the 94601 priority zip code ends and Allendale begins.
Snow said looking through the holes in vaccine allotment is just one way to show how algorithms used in public health have real world consequences, even if they begin with pure intentions.
“It underscores the importance of having people who know the lived experiences in these areas,” Snow said. “Just because some parts are part of an algorithm that doesn’t mean everything has to be part of an algorithm.”
But now that the state has reached a vaccine surplus and doses are readily available to most people who want them, Snow said switching the allotment system to census tracts “doesn’t make any sense.”
Alameda County’s vaccine distribution efforts will continue for the foreseeable future and the county is currently reviewing proposals for an entity to run its community vaccine operations, which will be geared to reach the final 25% of the population that hasn’t gotten a shot yet.
Meanwhile, healthcare workers are still trying to fill the gaps of those not vaccinated. In addition to shortcomings in the state’s distribution methods, another reason some communities have lower rates of vaccination is hesitancy, often resulting from distrust of the medical system, or a lack of access to facts about the vaccine’s advantages. That’s why health leaders serving communities of color continue to emphasize the message that’s supported by science: the vaccines are safe and effective. But that message is not always clear, especially in communities of color who may not feel heard when visiting a white doctor.
Dr. Brenda Oiyemhonlan, an emergency medical doctor at Kaiser Permanente’s Walnut Creek Medical Center who is Black, said Black patients often give a sigh of relief when they see her walk in the exam room.
“Having us there is important,” Oiyemhonlan said during Allen Temple Baptist Church’s “Faith and Facts” virtual session last week. “We’re actively working to diversify the face of medicine.”
Oiyemhonlan and Dr. Sherilynn Cooke, an internist with Kaiser Permanente, focused their hour-long virtual session on common questions and concerns people may have about the vaccines, including the speed at which they were developed and how, exactly, the mRNA vaccines work.
Cooke addressed some Black people’s general distrust of the vaccine, pointing out that all four Black medical schools in the United States—Meharry, Howard, Morehouse and CDU—were all involved with studying the vaccine’s effects on Black people.
Rev. Dr. Jacqueline A. Thompson, senior pastor at Allen Temple, says she, too, had concerns with the vaccine at first but eventually got her shots because she didn’t want to expose her 92-year-old mother to something she might not be able to fight off. And she wants people to get the right information so they can make an educated decision about their vaccination status.
“I have heard all the questions, all the conspiracy theories, all the conjectures,” Thompson said.
“This is a safe vaccine,” said Cooke.
