The problem with New York’s vaccine task force

Gov. Andrew Cuomo announced a new panel of scientists to evaluate the safety of any future coronavirus vaccines approved by the federal government. Yet, determining whether President Donald Trump’s administration sacrificed safety and efficacy to approve a vaccine in the upcoming weeks would be one thing, but making sure a vaccine gets to the people who need it the most is another.

“It has a number of levels,” Cuomo said of a potential vaccine. “There are social justice concerns. There are racial justice concerns. There’s going to have to be an extraordinary public education campaign, because with a lot of people you’re just not going to talk through the anxiety about the vaccine.”

The governor previously named state officials and health care industry leaders to a task force that would oversee the state’s efforts on vaccine distribution. It included experts on hospitals, nursing, organized labor, pediatrics and even the state budget. Yet, the panel did not include any epidemiologists or anyone with expertise in community outreach to the people most affected by the coronavirus pandemic.

Black and Latino people have died at much higher rates than white New Yorkers. Underlying health conditions and higher rates of employment as essential workers have been reported as potential reasons for the disparity, but new evidence suggested people of color waited longer to seek treatment due to distrust in the health care system because of prior discrimination. “It would be critically important to include representatives from diverse communities in the (task force) whose collaboration and trust would be critical to get people to be willing to line up to get the vaccine,” said Wafaa El-Sadr, a professor of epidemiology at the Columbia University Mailman School of Public Health.

The governor said people familiar with such concerns could be added to the distribution task force at a later date, though he added that the task force was not likely to meet until after the federal government approved a vaccine. A passive approach means wasted time in reaching out to vulnerable communities to make sure they will take part in a future vaccination program, according to El-Sadr, who has worked in more than 21 countries on issues related to maternity health, AIDS and tuberculosis. “The work to get ready for a vaccine should start now or should have already started,” she said.

Gareth Rhodes, a member of the Cuomo’s coronavirus task force, said the first goal of the newly appointed distribution task force was to meet a mid-October federal deadline for submitting plans to the Centers for Disease Control and Prevention outlining the “logistics, data and funding” of vaccine delivery. Efforts to specifically address potential racial disparities will occur later either by adding people to the task force or by establishing a third panel once federal vaccine preparations were more clear, he said. “A core part of these plans – and role of the individuals who will be named to lead this part of the vaccine program – will be to ensure a special focus on reaching underserved, hard to reach, vulnerable, less accessible and vaccine-hesitant populations,” Rhodes added.

The 14-member task force included state Health Department Commissioner Howard Zucker, state Budget Director Robert Mujica, SUNY Chancellor Jim Malatras, Northwell Health President and CEO Michael Dowling, and the leaders of groups representing hospitals, county health officials, pharmacists and doctors. George Gresham, president of 1199SEIU, represents largely Black or Latino unionized workers, but appears to be the only person with more than a tangential link to such communities on a task force mostly made up of white state officials and health care industry leaders.

Cuomo did not directly respond to the lack of racial representation on the task force when asked by City & State on Sept. 24, but he suggested the task force would still be able to address underlying concerns in minority neighborhoods because of the sheer size of outbreak in hard-hit neighborhoods in Queens and Brooklyn. Worrying about issues other than those directly tied to the spread of the coronavirus was just “playing politics,” he added.

The governor created this task force in response to ongoing concerns that Trump would push the Food and Drug Administration to hastily approve a vaccine in the upcoming weeks for political reasons. “Looking at the list of members, it seems to me that it is ... a group that is not examining the clinical trial data but rather determining how we can optimize the benefits from a vaccine,” El-Sadr said. In other words, the task force may be much more effective at addressing logistical issues than evaluating the safety or effectiveness of a vaccine.

There are currently 11 vaccine candidates now in Phase 3 trials, the final stage in the approval process, according to a tracker run by The New York Times. This suggests that distribution of a future vaccine could begin in early 2021, assuming everything goes to plan in Operation Warp Speed, the federal government’s multibillion-dollar effort to develop a vaccine and distribute it to hundreds of millions of people.

Some of those potential vaccines would require refrigeration and multiple shots to work, which suggests that there would be lots of practical issues to solve. “The COVID situation is significantly different and more complex than anything that we have had to deal with in the past,” Kris Ehresmann, an infectious disease director at the Minnesota Department of Health, told The Atlantic. Given the nationwide scope, much of the responsibility for approving and distributing a vaccine would fall under the purview of federal government agencies like the FDA and the CDC.

Individual states do have a role to play in distributing vaccines, at least based on the nation’s experience with H1N1 flu a decade ago. “Vaccine administration sites, including private providers, clinics, government-run points of dispensing, and others will need to make requests to the state for the vaccine, and states will prioritize and approve those requests against their daily allotment,” the National Governors Association wrote in August. Cuomo, who is the chair of the organization, arguably expanded that purview through his two new task forces.

But El-Sadr said a lack of experts familiar with issues affecting people of color during the pandemic suggested that the governor was missing an opportunity to make a difference if and when a safe and effective vaccine is developed. “It takes hard work to identify trusted community spokespeople and champions, to provide them with the information so that they can share with their own constituencies,” she said. “Failing to do this will set us back and jeopardize our ability to succeed in confronting COVID-19.”

Editor’s Note: After the publication of this story, Gareth Rhodes, deputy superintendent and special counsel at the state Department of Financial Services, provided a comment to City & State, which is now included in this updated story.