As the nation waits this week to see who will be president and which party will control the United States Senate, New York’s Democratic governor has repeatedly blasted the Trump administration’s plan for distributing a COVID-19 vaccine once it is available.

Over the course of the week, Governor Andrew Cuomo’s criticisms fell into four categories.

The Enterprise submitted those concerns, listed below, to the White House and received a response from spokesman Michael Bars on Election Day to just the fourth concern — that information states must provide in administering the vaccine could be used instead to deport people.

“As we’ve already explained to Governor Cuomo, such information would only be used to support the unprecedented private-public partnership continuing to harness the full power of the federal government, private sector, military, and scientific community to combat the coronavirus and save lives,” Bars wrote in an email to The Enterprise.

He went on, “The reality is that having been absent from 17 consecutive governors-only briefings spanning the past 5 months, the Governor is substantially unprepared as states formulate their vaccine distribution plans. His politically-motivated attacks are counterproductive and reflect a profound lack of understanding for the complex public health challenges associated with administering a safe and effective vaccine to New York and communities across the country. He didn’t understand how to protect seniors in long-term care settings, nor does he understand vaccine distribution.”

Rich Azzopardi, senior advisor to Cuomo, had earlier responded, through an email to The Enterprise, on the same charge of 17 missed meetings when it was brought by Douglas L. Hoelscher, assistant to President Trump and director of Intergovernmental Affairs.

Cuomo, who chairs the National Governors Association, sent 36 questions from the governors to the White House for clarification on vaccine distribution plans. Bars sent a document with answers to those questions to The Enterprise, which is posted at altamontenterprise.com.

 “We learned early on that the White House calls were a total waste of time and nothing more than political propaganda, using elected officials as props to heap praise on the President and deny the virus’ existence,” Azzopardi said. “What the Governors of this nation actually require is a substantive operational discussion on policy and programming.”

These are the criticisms Cuomo has made about the Trump administration plan to distribute a COVID-19 vaccine:

— The proposed system isn’t robust enough to handle the volume of vaccinations and would jeopardize testing, which uses the same system.

The main distributors would be private pharmacies and private providers, Cuomo said, calling that “a very limited distribution mechanism.”

Describing it as the same network being used for COVID-19 testing, he said, “You’d have to sacrifice one or the other, either the number of COVID tests you’re taking or the number of vaccinations they could perform. Secondarily, you do not get the necessary scale to do the vaccinations on an expeditious basis.”

Cuomo estimated, “It could take one year to vaccinate the population using only a private sector network. This country can’t afford to take one year to do vaccinations. So, I think their fundamental plan, while simplistic, is deeply flawed.”

— Funding for states distributing the vaccine is inadequate.

“It’s classic for this administration to pay private companies to do it,” Cuomo said, stating, “It doesn’t allow state governments any resources to expedite the distribution or make sure that it’s done fairly or equitably. A state can’t facilitate distribution in poorer communities, in racially impacted communities, in communities that are suffering from health disparities.”

The Trump plan allows $140 million for all of the states, said Cuomo.

“I believe not providing state government with funds to supplement the private provider network is discriminatory and I believe it’s illegal,” Cuomo said.

— The plan is unfair to Black, brown, and poor communities.

Cuomo held a press briefing on Nov. 1 with the president of the NAACP and and the chief executive officer of the National Urban League all of whom alleged the Trump administration’s plan for distributing vaccines is racist because it ignores the same communities that had been overlooked for testing.

“Why was the COVID infection rate so much higher in communities of Black and brown people? Because they’re health-care deserts,” Cuomo said.

While chain drugstores are found in wealthy and middle-class communities, often they are not fund in poor neighborhoods.

— Information states must provide — particularly individual identification numbers — could be used to deport people.

Cuomo noted that the “data use agreement” says the information will be used by the Centers for Disease Control and Prevention and by the Department of Health and Human Services as well as “other federal partners.”

“My concern is that this information, without proper safeguards, could be used by non-health related agencies such as the U.S. Department of Homeland Security or Immigration and Customs Enforcement in furtherance of this administration’s anti-immigrant policies and its relentless pursuit of undocumented people,” Cuomo wrote in a letter to Trump.

He likened it to “the federal administration’s past attempts to extort the State of New York through the Trusted Traveler Program fiasco.”

In July, after federal officials had originally said New York State was alone in restricting access to motor-vehicle records, government lawyers said in court papers that other states also limited access but had not been subjected to a clampdown as New York had.

The matter is now being investigated by the inspector general of Homeland Security.
 

Federal response

Although Cuomo’s first three concerns were not directly answered by the White House, some information is contained in the answers the United States Department of Health and Human Services provided in answering the questions from the governors.

On the robustness of the proposed system, HHS told the governors that “most eligible healthcare providers have been allowed to administer any COVID-19 vaccine.”

HHS is partnering with Walgreens and CVS to vaccinate residents of nursing homes and is also partnering with retail chain pharmacies and networks of community pharmacists to increase access for the general populations.

To date, the document says, 12 partners have enrolled, comprising over 55 percent of the nation’s pharmacy network.

The document also says that, while the end goal is to offer vaccines to the entire United States population, priority groups will be identified. The top goal is to protect essential workers and “the most vulnerable elderly populations.” Secondary goals include “Maximizing public health protection while minimizing waste and inefficiency,” the document says.

Operation Warp Speed, it says “is working with manufacturers to ensure educational materials for providers and pharmacists, including information on proper handling, will be distributed to all jurisdictions and Federal entities.”

Asked by the governors about shortage of needed dry ice, HHS responded that, while capacity is sufficient broadly, rural areas may “experience difficulty attaining dry ice.”

On funding, HHS says, “To date, CDC has provided $200 million to states in support of Operation Warp Speed … and $140 million to states for enhanced flu activities.”

It also says, “The next tranche of COVID vaccine readiness funding of $140 million will be awarded by December 15th in order to expand this readiness work and fill initial gaps.”

HHS also asserts, “States should recognize that most of the major costs of a vaccine campaign are already being covered.”

Although HHS answers several questions from the governors about tribal nations dealing with the vaccines, it is silent on the concerns raised by Cuomo about Black, brown, and poor communities being underserved.

Answering a question from the governors about what educational material and in what languages will be developed, the document cites six government websites and says, “An example of translating complex scientific data and sharing it publicly is the simple mitigation message of the “3 Ws” (1) Wash your hands, (2) Wear a mask, and (3) Wait six feet apart.”

On Cuomo’s final concern, about individual identification numbers being misused, the HHS document says, “In order to accurately and effectively track the administration of the COVID-19 vaccine from several data sources including jurisdiction immunization information systems, it is necessary to collect personally identifiable data from vaccine recipients.”

This is needed, it says, to match a second dose, in case of an adverse reaction, or to assess the effectiveness of the vaccine among different demographic groups.

Albany County

On Sunday, in a conference call with reporters, New York’s governor and attorney general, Letitia James, along with Derrick Johnson, president of the National Association for the Advancement of Colored People, and Marc Morial, the former mayor of New Orleans and the current head of the National Urban League, called the Trump administration’s plan for distributing vaccines unfair because it ignored the same Black, brown, and poor communities that had been overlooked for COVID-19 testing.

James said that big chain pharmacies like CVS and Walgreens are located throughout wealthy communities. “The neighborhoods where more of our communities of color live do not have this type of access,” she said. “And that’s the core of the federal plan: a system where it will be easy for wealthy people to get vaccinated, and make it so much harder for those who are not.”

James called a plan that does not serve all of the people un-American.

Over six months ago, Albany County set up a program to test residents in underserved neighborhoods for COVID-19.

In mid-April, as the COVID-19 death toll for Albany County rose to 20 — it now stands at 142 — Daniel McCoy announced a program that would test people in “the most underserved communities in the county.”

“We have listened and we are going to deliver,” said McCoy, Albany County’s executive. The county continues to run the testing program, in partnership with the Whitney M. Young, Jr. Health Center, and pays for anyone who does not have insurance.

“There are huge disparities in the populations we serve and the neighborhoods we hope to take this to,” David Shippee, president and chief executive officer of the Center, which is based on Lark Drive in Arbor Hill, said in April.

“There is a high prevalence of chronic conditions there,” said Shippee. National data, he said, shows these conditions lead to a greater death rate among people of color.

Elizabeth Whalen, Albany County’s health commissioner, and McCoy had pushed for more community testing after initial testing had been narrowed to hospital patients and exposed health-care workers since federal test kits were limited.

On April 6, the state opened a drive-through testing facility in tents at the University of Albany’s uptown campus but the facility would only test “individuals that could drive,” said Whalen.

The tests are important, Whalen said in April, so her department could identify people who have COVID-19 and reach the people they have been in contact with so those contacts can be put under quarantine to prevent further spread of the coronavirus.

“Another core function of local public health is really to assess the health of the community,” said Whalen. Every three years, her department puts out a community health assessment to identify high-needs neighborhoods “where citizens have disparate health outcomes and underlying health conditions so we can target these neighborhoods.”

Whalen said working toward “test equity” had taken a great deal of discussion and planning and that the mobility of this plan — tents and a mobile unit from Whitney Young are used — make the sites easily accessible.

“Across the nation, we’re hearing about disparate outcomes of COVID-19 dependent on race,” said Whalen. “The data we have so far is not robust enough to see how this is playing out in Albany County.”

As of Nov. 1, the county had amassed significantly more data, which shows that, although a disproportionate number of Black patients have been hospitalized with COVID-19, a disproportionate number of Black residents have not died from the disease.

Albany County is 71.6 percent white and 11.4 percent Black.

The county’s dashboard shows that 62 percent of residents hospitalized with COVID-19 have been white and 24.5 percent have been Black. Among the Albany County residents who have died of the disease, 88 percent were white and 10.6 percent were Black.

Also in April, Micheline Ford, a critical-care doctor at Ellis Hospital in Schenectady, said that, in serving on the frontlines, “We’ve been seeing a disproportionate amount of African Americans that have been sick but also dying.”

Explaining why, Ford said, “It goes back to African Americans being high risk for diseases such as hypertension, diabetes, renal disease, and obesity as well as underlying heart disease, and a lot of these issues are sometimes not known in the African-American community. People are walking around not knowing they have high blood pressure or diabetes … .

“It’s often ignored … or there’s not access to health care. They have no transportation to health care or they have no insurance for healthcare … We are seeing a lot of patients coming in late.”

Ford called the pandemic “a wake-up call for the African-American community.”

On June 2, after Albany erupted in protests over the previous weekend, Whalen said at a press briefing, “I feel it is important for me today to discuss another public-health threat … That public-health threat is racism. Racism is real.”

Whalen called the killing of George Floyd — a white Minneapolis police officer knelt on Floyd’s neck for eight minutes as he said he could not breathe — “a despicable act that has angered the entire country.”

She went on, “But a large part of this anger is due to an underlying systemic problem that occurs across this country, and that is racism.”

Whalen said the county’s health department works with community members “to try to address inequities in health.” The department’s mission is, in part, to “reduce health disparities and promote health equity,” Whalen said.

“Equity,” she said, is different from “equality.”

“Equity means the absence of avoidable, remediable differences among groups of people whether those groups are defined socially, economically, demographically, or geographically,” said Whalen. “Equity is a process, and equality should be the outcome of that process. It is a difficult process.”

She said her department engages in that process every day. It hosts listening forums on maternal mortality. Staff go door-to-door in high-risk neighborhoods to address disparity in conditions like asthma, diabetes, and heart disease. The department educates the public and works on task forces designed “to help bridge the gap,” Whalen said.

Perhaps most importantly, Whalen said in June, is the need “to listen to the communities of color, to listen to the very real concerns that they have, and to work hand in hand with them to come up with better strategies to close these gaps, to help this anger, and to make sure that we are all working every day on solutions.”