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Federal vaccination data show mixed record on equity

Exclusive data suggest the Biden administration's community vaccination centers, designed to promote equity, hit the mark in some cities — but fell far short in others.

WASHINGTON — Nearly 3 out of every 4 shots administered at the federal government's Covid vaccination center in Cleveland went into the arms of white people, according to site-by-site data provided exclusively to NBC News by the Federal Emergency Management Agency.

Non-Hispanic whites are 33.8 percent of the city's population. At the same time, Black people were given just 10.8 percent of the shots, even though are nearly half of Cleveland's residents. And in figures that comport with broader national vaccination trends, Asian Americans got shots at a higher rate — and Hispanic people at a lower rate — than their shares of the population.

The full dataset, covering 39 federal Community Vaccination Centers in 27 states, suggests that President Joe Biden met his promise to "fight this virus with equity" in some parts of the country but not in others. Where the administration fell short, it was not for lack of effort: Both political appointees and career officials at federal agencies say equity was the watchword of the program.

"During the mission, our intentional, evidenced-based and consistent decision-making advanced equity," FEMA Administrator Deanne Criswell said in a statement to NBC News. "We moved fast to deliver vaccines to underserved communities in collaboration with our federal, state, local, territorial and tribal nation partners. Our country is in a better place now because of it, especially as we continue to support our partners in their localized efforts to increase vaccination levels."

Overall, federally managed vaccination centers delivered 5.6 million shots from mid-February to July 5, when the program ended, according to FEMA's records. The agency was able to track demographic data only for the recipients of 81.4 percent of the doses, leaving a major hole in the picture of the efficacy of the equity push. In addition, FEMA officials said, the agency was not able to determine how many of the doses were one-time Johnson & Johnson shots and how many were first or second doses of the Pfizer and Moderna vaccines.

Of the 4.6 million doses delivered to people whose race or ethnicity was reported, 41.9 percent were given to non-Hispanic whites, 25.5 percent were administered to Hispanic people, and 14.7 percent went to Black people. Asian Americans accounted for 13.9 percent, 3.6 percent went to people who identified as multiracial or checked "other" on their forms, and half a percent went to Native Americans, Native Alaskans and Pacific Islanders.

The Census Bureau reported last month that non-Hispanic whites make up 57.8 percent of the U.S. population. Hispanic people account for 18.7 percent, and Black people constitute 12.1 percent of the population, according to the 2020 census.

The federal vaccination centers were set up to supplement state-run operations by making shots more readily available to the most socially vulnerable populations. The risk of severe illness or death from Covid-19 is greater in certain communities of color — including Black and Hispanic populations — because of disparities in the health care system, according to the Centers for Disease Control and Prevention.

While the share of vaccine doses administered to people of color at federal centers across the country exceeded their share of the population, the skew had little effect on the overall vaccination demographics, because the federal centers accounted for such a small proportion of all the shots that were delivered. The program was designed specifically to reach minority communities, in part by putting centers in areas where they were most likely to reach people of color, focusing on advertising campaigns on communities of color and tailoring programs in different states to reach a diverse array of communities.

"What are we willing to do to make sure that the most vulnerable populations and underserved populations are served first?" a FEMA official said of the questions at the center of the federal vaccination center push. "What are we willing to do to make sure that we're taking care of those communities?"

Beatriz Amberman, chair of the Virginia Coalition of Latino Organizations, praised the Biden administration for consulting with local leaders like her when FEMA opened its vaccination program in the state.

She recommended several steps the state government had not taken, including allowing patients to get shots without pre-registering for appointments and without providing more than their own names and contact information for people who could reach them in case of adverse reactions to a vaccine. FEMA's targeted engagement with the Latino community helped alter the state's approach, Amberman said in an interview.

"It was after FEMA came to the area and modeled that system," she said. "That helped ease the concerns of the state. After FEMA left, the state was convinced by the results that was the way to go."

Virginia's federal vaccination program, centered at Norfolk's Military Center Mall, administered 87,333 shots beginning the last day of March. The demographic data for the site are more precise than for most of the centers, identifying patients' races and ethnicities for 92.7 percent of the shots.

Fifty-four percent of the doses went to people of color, according to FEMA's data, including 31.1 percent to African Americans, 10.1 percent to Hispanic people and 8.4 percent to Asian Americans. Norfolk's population is 43.4 percent non-Hispanic white, and 45.1 percent of the shots went to whites.

At the first federal vaccination center, opened in Oakland, California, on Feb. 16, FEMA reported providing 59.2 percent of doses to people of color, compared to a metro area population that is 71.7 percent nonwhite. Whites accounted for 40.1 percent of the vaccinations.

Like many of its counterparts, the Oakland program used a "hub and spokes" model, with a central site at the Oakland Coliseum and smaller clinics around the region to reach out into communities, said AmeriCorps workers who helped manage the effort. That included engaging with churches and nonprofit organizations to find people to vaccinate, a process that largely failed to achieve equity for the Black and Hispanic communities in Oakland.

Officials on the ground in Oakland were surprised to hear that Asian Americans accounted for nearly 30 percent of vaccinations in the city's federal vaccination program — about double their share of the population — while Black people, at 6 percent, and Hispanic people, at 19.7 percent, were far below their respective shares of 23.8 percent and 27 percent of city residents.

"We went into communities that didn't have access and couldn't get their population to the big hub," said Parth Singh, one of the AmeriCorps workers. "We didn't have visibility into any of the big data that was being accumulated."

FEMA chose its sites first by descending order of state population, starting with California, Texas, Florida and New York, and worked with state officials to identify precise locations. To find spots where equity could be prioritized, the agency used the CDC's social vulnerability index, a measure that ranks susceptibility to health disadvantages county by county.

When then-New York Gov. Andrew Cuomo protested the decision to put a site in rural white Chautauqua County, a sparsely populated expanse in Western New York, FEMA adjusted its process to take into account the social vulnerability of clusters of census blocks. New York ended up with six vaccination centers, including upstate locations in Yonkers, Albany, Buffalo and Rochester. At the time, Cuomo was planning to seek re-election, and all four of the sites were more hospitable to his brand of Democratic politics than heavily Republican Chautauqua County.

In Albany, 73.4 percent of shots for which patients' demographic data were available went to non-Hispanic whites. In Buffalo, the figure was 63 percent, and in Rochester it was 61.7 percent.

However, a handful of mega-sites stood out for their comparatively high numbers and shares of nonwhites who were vaccinated. In Los Angeles, where 322,570 doses were distributed, 27.8 percent went into the arms of white people — a bit lower than the citywide percentage of 28.5 percent. That site, at California State University's campus in the city, gave more shots than any other pilot vaccination center.

At the New Jersey Institute of Technology's Wellness and Events Center in Newark, just 16.8 percent of nearly 286,000 shots were administered to whites. The city's population is 11 percent non-Hispanic white.

The FEMA official said community engagement was an outgrowth of trying to figure out how to reach the most vulnerable populations — and those least likely to have easy access to shots.

"Our whole-of-government and whole-of-community approach both achieved results and served as a generator of best practices at every level," Criswell said. "At FEMA, we're leveraging this experience to ensure we continue to equitably deliver our programs and assistance."

She also acknowledged that the agency can do more to reach underserved communities.

"Systemic issues require systemic change," Criswell said. "FEMA is committed to strengthening how we serve survivors who face unique barriers before, during and after disasters."

CORRECTION (Sept. 6, 2021, 5:25 p.m. ET): A previous version of this article misstated when the Census Bureau reported its 2020 demographic data on the U.S. population. It was Aug. 12, not earlier this month.