MIAMI — When the state of Florida partnered with the federal government to open COVID-19 vaccine sites around the state in early March, the pilot program was supposed to help boost lagging vaccination in underserved communities.
Just over a month into the program — which used city parks, youth centers, community colleges and sometimes even roving vans to administer vaccines — state officials are claiming success, touting data that show people of color received the majority of the hundreds of thousands of FEMA shots.
But in Black communities, where vaccination rates are lowest statewide, the FEMA-supported vaccination effort fell flat, at least during its initial rollout, according to a Miami Herald analysis of vaccination data provided by the Federal Emergency Management Agency for the period between March 4 and March 23.
All but one of the 41 federally supported vaccination sites across Florida vaccinated a disproportionately low number of Black people compared with the demographics of the surrounding areas, the Herald analysis found. The only exception was a neighborhood center in Central Florida’s rural Haines City, where city officials quickly leveraged existing relationships with Black community leaders to raise awareness, without help from state or federal officials.
Overall, Black Floridians make up 17% of the population in the counties where the sites were located — but accounted for only 13% of vaccine recipients at those sites, the analysis found. (The percentage is calculated out of those recipients who disclosed their race and ethnicity, the vast majority of people.)
While both state and local leaders have blamed vaccine hesitancy in the Black community for low numbers, national polling shows that Black adults are now nearly as willing as whites and Hispanics to get vaccines.
Instead, Gov. Ron DeSantis’ tight restrictions on who could get vaccinated — eligibility criteria that favored age over other risk factors — and the state’s failure to coordinate with local officials to get the word out about the sites contributed to the failure, according to interviews with more than a dozen local elected leaders and public health experts.
“It’s a breakdown in the entire system,” said Michael Joseph, a commissioner from North Miami Beach, where FEMA and the state set up a site at a local community center for one week in March. Of the 3,113 people who showed up to the site, located in a majority-Black neighborhood in a predominantly Black city, only about 12% were Black.
“How can you have 12% in an area like this?” Joseph said. “It doesn’t make sense. I know the people who live here want to get vaccinated.”
Joseph and fellow North Miami Beach Commissioner McKenzie Fleurimond blamed a lack of outreach by state officials, for instance, failing to place ads on local Haitian-American radio stations such as Radio Mega and WLQY, as well as the television station Island TV.
Harold Sido, 18, got a vaccine at the Allen Park site in North Miami Beach in March. Sido only heard about it from his parents — his mother is a nurse — and was able to get a doctor’s note. A Haitian American freshman at Miami Dade College, Sido said he never saw the site advertised or talked about but he was grateful for the opportunity to get a shot. “I can finally hang out with my friends again,” he said.
The Herald interviewed a dozen elected officials from the greater Miami, Tampa, Orlando and Jacksonville areas, where FEMA worked with the Florida Division of Emergency Management to establish vaccination sites in March. All the officials told the Herald that the state did not make early, systematic efforts to advertise the sites. Often local leaders found out about the sites just a week before they opened, leaving them scrambling to develop outreach plans.
Gwen Myers, a Tampa commissioner, said she learned that FEMA-supported sites would open in her district from news reports. Angie Nixon, a state representative from Duval with two sites in her district, said no one from the state ever called her. Orange County Mayor Jerry Demings heard FEMA sites were coming to town from Valencia College, which agreed to serve as Orlando’s main vaccination hub, not the state.
“There is no question we were in the dark,” said Demings. “We could have fashioned a rollout that would have been much more effective than what we ultimately ended up with. We’ve been playing catch-up.”
A few sites that outperformed county demographics seemed to have two things in common: earlier notice from the state, and local elected officials who went beyond using social media and contacting church leaders to spread the word.
In addition to a lack of outreach by state officials, DeSantis’ age criteria disproportionately restricted Black people from the federal vaccination program, even though COVID-19 has hit Black people hardest and federal health officials had said their access should be prioritized. The age restrictions dramatically reduced the number of eligible Black people in participating counties, where only around 13% of the residents age 65 and older are Black.
Most people under that age would have needed a doctor’s note, which experts say is a hurdle that disproportionately affects Black communities, where fewer people carry health insurance or have access to a doctor.
“You can see the effects of the barriers, both by age and asking an individual to bring a doctor’s note, how it leads to inequitable distribution even if you’re bringing the doses in closer proximity to the communities,” said Rebecca Weintraub, an assistant professor in the Department of Global Health and Social Medicine at Harvard Medical School.
Some states like Vermont explicitly prioritized minority populations in their vaccine rollout, allowing people of color to receive the vaccine before white people of the same age. In Vermont, vaccination rates for Black people are keeping pace with the population.
“For people of color, especially Black people, what we’re seeing is that younger people are getting COVID, and they’re dying … at younger ages than what you see for the white population,” said Zinzi Bailey, a University of Miami professor who studies health care inequities and reviewed the Herald’s analysis. “So our criteria for vaccination do not match our criteria for the risk of COVID and death from COVID.”
“We keep on reproducing systems of inequity by some of these restrictions,” Bailey said. “By not prioritizing essential workers, by not prioritizing folks who are in certain conditions, then it’s really going to be benefiting white people as opposed to people of color.”
The state defended its efforts to raise awareness, saying it had sent out more than 126,000 texts and 400,000 emails to people who live near the FEMA-supported sites; knocked on the doors of nearly 300,000 homes; distributed fliers in English, Spanish and Creole; and sent mobile billboards into communities.
“Florida has been a leader in the vaccine rollout. The state has mobilized thousands of individuals to create, undoubtedly, the largest vaccination operation in the country,” said Jason Mahon, a DEM spokesman. “If any local official would like an outreach team to visit or revisit their community, we would certainly accept that feedback and visit as soon as possible.”
While the rate of Black vaccination at FEMA-supported sites appears somewhat higher than the overall statewide rate published by Florida’s Department of Health, the comparison has limited value as the state and FEMA define “Black” in different ways. (Black Hispanics are included in the state count but not FEMA’s.)
State emergency management director Jared Moskowitz said the FEMA-supported sites — which had vaccinated nearly 400,000 people as of early April — are working.
“My job is to get shots in arms,” Moskowitz said. “I view [the FEMA sites] as a success because they have vaccinated hundreds of thousands of people. How can that be a failure?”
He credited the state with pushing for the sites to be walk-up, rather than asking people to make appointments online, and also for setting up smaller temporary sites that rotate through predominantly minority communities, in addition to a main vaccination hub in each of the four metro areas.
Still, Moskowitz acknowledged the low numbers in the Black community.
“It’s not for the lack of trying. We sit here every day trying to do more,” he said. “This is not just a Florida problem. This is a problem in many other states.”
In a statement, FEMA said that getting the word out about the sites is the state’s responsibility.
‘FEMA camps’
In the early months of the state’s vaccine rollout, DeSantis made dozens of appearances to publicize his administration’s vaccination program, several times standing in front of Publix supermarkets with a “Seniors First” placard placed behind his lectern.
But the governor didn’t make a single appearance at the federal sites, which he disparagingly called “FEMA camps.” The sites were planned by the incoming Democratic administration even before President Joseph Biden was sworn in.
They were supposed to draw people who didn’t live near a Publix or inside a gated community, two locations often chosen by state officials for vaccination campaigns. Instead, many of Florida’s federally supported sites felt like ghost towns in the early weeks.
“‘Build it and they will come’ does not work,” said Miami Commissioner Jeffrey Watson, whose district hosted a FEMA-supported site at Charles Hadley Park in predominantly Black Liberty City.
While the site, an anchor of Miami’s Black community near one of South Florida’s oldest housing projects, was more successful than others in Miami-Dade, its 24% Black vaccination rate still fell far below the percentage of Black residents in the surrounding area.
“The state didn’t do anything. Just some generic signs,” Watson said. “You could go door to door. You could do some radio, you could do some TV.”
Records provided by the state show that emergency management officials did not start sending out canvassing teams in the neighborhoods around the sites until nearly two weeks after the federal program launched, even as local leaders asked for a robust political-style awareness campaign. (Moskowitz said the state didn’t want to start door-knocking until DeSantis lowered age requirements and more people became eligible.)
The governor’s office did not respond to requests for comment for this report.
As news stories proliferated in March about the program’s slow start, state officials were reluctant to produce metrics.
When the Herald pressed last month for a detailed racial/ethnic breakdown for people who had been vaccinated at the federally supported sites, DeSantis’ office refused. The state’s emergency management division has still not answered a public records request for those numbers.
The Herald was ultimately able to obtain the data from FEMA.
The results disappointed public health experts, who said they should have matched or exceeded demographics for Black residents in the surrounding areas.
“I think it’s a shame,” said Bailey, the UM professor. “Miami-Dade and Orange County are where we want to be pushing the most in terms of addressing issues of health equity, and they’re largely underperforming … and underperforming at a pretty big level.”
Still, some Black leaders applauded Florida’s efforts to bring vaccines to their communities.
“Without the state’s help in providing vaccinations and logistical support, the sites would not have been possible,” said Kionne McGhee, a Miami-Dade commissioner who served alongside Moskowitz, a fellow Democrat, in the Florida House of Representatives.
Otis Wallace, the mayor of Florida City, said he never asked the state for money or resources to help with outreach at a federally supported site in his city.
“We didn’t mind doing the legwork in our own community,” including outreach to pastors, advertising on social media and door knocking, Wallace said.
The Florida City site, located in a predominantly Black area, dramatically underperformed. Only 15% of people who got shots there were Black.
Reflecting statewide trends, the federally supported sites did a better job vaccinating Hispanics than Black people, especially in Miami-Dade, where Hispanics make up a majority of residents. However, the sites still fell short of vaccinating Hispanics at a level proportionate to the ethnic breakdown of the surrounding areas. Hispanics make up 40% of the population in the eight counties with FEMA-supported sites, but just 38% of vaccines went to Hispanics.
Nationwide, FEMA said the vaccination hubs, which have also been set up in New York, California, Illinois, Texas, North Carolina and more than 10 other states, are a success.
“Our data shows that 58% of all vaccine doses administered [nationwide] at the federal pilot [sites] went to communities of color,” FEMA said.
The national data was not broken down by race.
Florida’s federally supported sites are expected to remain open through May 26.
Statewide, FEMA-supported sites administered more than 245,000 doses between March 4 and March 23. Roughly 1.8 million shots were given out during that period across Florida overall.
Breaking down barriers
The vaccine rollout looked a little different in Haines City, a rural community of 26,000 in Polk County where local leaders took advantage of the city’s existing communications network with residents.
While the city’s small federally supported site gave out just more than 1,000 shots, one in three of them went to Black people, outperforming the area’s demographics. Black people make up about 20% of residents in the surrounding ZIP code and 15% of county residents overall.
From the beginning of the pandemic, Haines City had kept people informed using an email list of 2,300 community leaders that included pastors, neighborhood groups, service organizations, homeowners associations and student body leaders. It blasted news about its FEMA site over the list. Word of mouth took over.
“The citizens knew that we had been working on this,” said Deric Feacher, the Haines City manager. “They were ready.”
Haines City was the only federally supported site in Florida that vaccinated a disproportionately large number of Black residents when compared to both local and countywide demographics.
The site was located at a park in the heart of Haines City’s historically African American Oakland community. For days before the site opened, a prominent digital marquee at the neighborhood’s entrance advertised the opportunity to get a shot.
“People go there to play basketball, have a picnic,” said Feacher. “Seniors play checkers there. The Bethune magnet school is there. So parents saw the information daily. … You don’t just put it in the newspaper or a tweet.”
The city’s handling of the pandemic reflects its approach to local government, Feacher said. Four years ago, he converted an aging trailer in the city’s vehicle fleet to a mobile city hall that visits neighborhoods, answering questions about jobs, code enforcement and planning.
“We removed the barriers,” he said.
‘Couldn’t wait on the cavalry’
Successful vaccination campaigns require visibility and proactive outreach like the one in Haines City, public health experts and politicians agreed.
Too often, leaders think the job is done once they’ve talked to Black pastors, said Nixon, the Jacksonville-area state representative whom state officials never called about sites in her district.
“We have to take this outside the four walls of the church,” Nixon said. “The Black community is not as much tied to the church as it used to be.”
The federally supported site with the highest proportion of Black vaccine recipients statewide was Orlando’s Northwest Neighborhood Center, where 47% of people vaccinated were Black — but in an area where Black people are nearly 70% of the population and make up the majority of seniors.
Only eight other sites across the state performed even that well — outperforming county demographics while still falling short in the immediate surrounding area.
Experts consulted by the Herald called the results in Orlando “mixed.” The site’s moderate success appeared to be the result of local efforts more than state outreach.
Regina Hill, an Orlando commissioner, said she got roughly a week’s notice about the state’s plans to open a FEMA site at the neighborhood center, which is in her district. She knew there was no time to waste.
“We treated it like a [political] campaign,” Hill said. “That’s what it is: A COVID campaign.”
She organized a team of five people who knocked on doors at more than 8,000 homes around the site over three days. Two people working at phone banks arranged transportation for residents who needed it. Hill also organized a robo-call and text message campaign.
“There was no help in the beginning from the state. It was like pulling teeth at first to find someone to work with,” Hill said. “But this was a life-and-death situation. I had people crying to me trying to figure out how to bury their loved ones. My brother died. People were getting sick left and right. They were petrified. I knew I couldn’t wait on the cavalry.”
Eventually, she said, the state sent out its own canvassing teams.
Hill is planning to seek reimbursement from FEMA for the $2,700 her outreach campaign cost.
