New York expanded COVID-19 vaccine eligibility this month to residents 65 and up. But getting an appointment has been an “extraordinarily complicated” process for some, marred by supply shortages, technology challenges and mobility barriers in reaching vaccination sites.

On Jan. 12, Gov. Andrew Cuomo announced that New Yorkers 65 and older were now eligible to receive the COVID-19 vaccine — but the news came with a warning.

“I urge patience as unfortunately there are far more eligible NYers than there is vaccine supply,” the governor said on Twitter, citing slow allocation from the federal government.

Indeed, a shortage of doses has continued to hinder New York’s efforts to vaccinate residents—the city was forced to reschedule some 23,000 vaccine appointments earlier this month due to lack of supply. It has especially thrown a wrench into reaching older New Yorkers, one of the groups most vulnerable to COVID-19, who account for nearly 15 percent of the city’s population. It’s not clear yet how many residents 65 and up have received the vaccine so far, as the city has yet to release a breakdown of vaccination data by demographics. Mayor Bill de Blasio has promised to release that data by the week’s end, and a spokesperson for the Mayor’s office said that information would be available by Sunday.

In addition to short supply, experts say there are several challenges older New Yorkers might face in getting vaccinated, including mobility barriers in getting to vaccination sites and the need for internet access and tech savviness to successfully book an appointment. Lisa David, president and CEO of Public Health Solutions, called that process “extraordinarily complicated” for seniors. She’s witnessed it both with the seniors her organization works with and also personally in trying to book a vaccine appointment for her 90-year-old father.

“What my family is going through to try and get him an appointment is extraordinarily frustrating,”  David says.

Technical difficulties

There are two ways to get information about vaccination: online and by phone.

Even before eligibility expanded from those over the age of 75 to people 65 and up, you could spend 30 minutes on hold after calling the city’s vaccine hotline, and wait times have gotten longer since, David says.

Another issue is the fact that there are three different websites — two run by the city and another by the state — where people who are eligible can view vaccination sites and get information on scheduling an appointment. These include a separate scheduling page to get a vaccine appointment at NYC Health + Hospitals facilities, and David has noticed differences in the locations listed on each website, adding to the confusion, she says. Some distribution sites allow users to book appointments online but others require a phone call.

Given the limited availability of vaccines, it can sometimes take hours, between scanning websites and making multiple calls, to successfully make an appointment.

“The investment in work and time is huge, and it’s confusing,” David says. She adds that even after getting an appointment, some seniors’ saw them rescheduled due to short vaccine supply.

A spokesman for the city’s Health Department says it is working to help residents sign up for appointments, calling the vaccination program “an unprecedented effort.”

“We want New Yorkers to be able to book a second appointment with as little effort as possible,” Michael Lanza of NYC Department of Health and Mental Hygiene wrote in a response to an inquiry to City Limits. “In the event that an eligible New Yorker is having trouble getting the vaccine or an appointment (for first or second dose) we will work with them to figure out the issue and help them to make an appointment. Currently, demand for the vaccine outweighs supply, so we ask everyone to be patient while we wait for more doses from the State and federal governments.”

At a briefing on Tuesday, Mayor de Blasio continued to advocate for the federal government  to allow the city to begin using its reserve of second doses while awaiting more supply, so the city could provide more seniors with their initial dose. Research has shown that taking just the first dose of the Pfizer vaccine offers 50 percent protection.

“Fifty percent protection for a senior citizen is so much better than no protection at all,” de Blasio said, saying it is “a matter of life and death.”

“The fear that senior citizens have been living in for the last year is overwhelming,” he said.

Location, location, location

Not only does the city’s short supply make it harder to get an appointment, it can slow progress on other crucial efforts that will be needed to reach more seniors, like outreach to communities who might feel greater skepticism about the vaccine. A recent poll revealed that 42 percent of New York City residents over the age of 18 who were surveyed expressed some degree of hesitancy about taking the vaccine, with greater hesitancy among Black/African American and Asian/Asian-American/Pacific Islander (AAPI) respondents, NBC New York reported. 

Rachel Oddman, a 69-year-old resident of East Harlem, has been learning how to use a tablet through PHS’ “Get Connected” initiative, which helps seniors living in NYCHA housing learn how to use technology. The program provides tablets, internet service, and technology training with the aim of helping participants access services online, like interactive classes or even vaccine information. 

Oddman tells City Limits that she’s still undecided about taking the vaccine. It would make a big difference, she says, if she could get it at her primary care doctor’s office, where she is used to going for check-ups or to get routine testing done. Although there are private clinics on New York’s list of vaccination locations, availability is not widespread enough yet to allow most eligible New Yorkers to get vaccinated through their usual doctor.

“I would feel more comfortable because I would be able to go back to them,” she says. Oddman adds that while she’s getting better at using the internet on her tablet to participate in interactive classes, so far, she doesn’t plan on changing how she accesses healthcare services. 

“I like to do things how I’ve been doing it, just going to the doctor, not online,” she says. Asked about what would have the biggest impact on whether she’d opt to get vaccinated, Oddman made it clear: the ability to get vaccinated at her primary care doctor’s office.

The location of vaccination sites are crucial, particularly for reaching seniors like Oddman who might have doubts about the vaccine, as well as for those with limited mobility that makes it harder for them to travel, or to wait on long lines outside. As with most public health goals, success requires meeting people where they are.

“You have to go beyond the healthcare system, because many people, frankly, don’t interact with the healthcare system on a regular basis,” says Bruce Y. Lee, a health policy and management expert at CUNY School of Public Health. He says that to avoid “significant disparities” in who gets the vaccine, the city must understand where people who are eligible for vaccination are located, then identify and create locations to best reach those people.

Experts pointed to the city’s COVID-19 Test + Tracing efforts to offer lessons for how officials should approach vaccine distribution. When testing first became available last spring, it was initially easier to access a test on the Upper East Side, because of the concentration of hospital systems there, David recalls. 

Once the city developed the Test + Trace team, they made concerted efforts to reach the low-income communities and people of color that had been hardest hit by the pandemic, opening pop-up testing sites in parks and other well-trafficked spots to reach New Yorkers closer to where they live, especially in neighborhoods with fewer healthcare resources. The city contracted PHS, for example, to do outreach and education around accessing services, including testing, in Queens. 

“What they’ve tried to do with testing has been moderately successful, which is to take this equity lens and make sure they’re setting up special access sites to be able to reach those populations,” says David. “That is absolutely not happening with vaccines yet.”

On the city’s COVID-19 vaccine location finder, there were just under 150 locations listed on Friday.

In response to an inquiry from City Limits, Lanza wrote that “the City is working with local health care providers and focused on building the same neighborhood network of sites that service people in their communities.”

The city has scheduled outreach conversations in communities in five languages aside from English, he added: Spanish, Mandarin, Korean, Arabic, and Russian. In the past week, it hosted  a Facebook live event in Spanish and a town hall for people with disabilities that used closed captioning and ASL. The city’s funded partners have also organized educational events in Haitian Creole, Bengali, Hindi, Arabic, Russian, Spanish, Urdu, Cantonese, and Korean, according to Lanza.

The city has opened vaccination sites for seniors at some NYCHA residences, and Mayor de Blasio announced an initiative earlier this month to provide older New Yorkers who need it with rides to vaccination appointments booked through the city, using Access-a-Ride, ambulette services, or taxi cabs via the Curb app. The city can offer approximately 10,000 such rides per week, the mayor said.

Still, challenges and questions remain. 

“We still don’t really have a comprehensive or cohesive plan to vaccinate homebound seniors. And quite frankly, there still is not an adequate plan for seniors in general here in New York City,” Council Member Mark Treyger, who serves on the Council’s Aging committee, said during a press conference over Zoom on Tuesday.

Treyger has proposed creating a “vaccine czar” position to centralize the mix of information and resources from private, city, and state health providers, and has called for the city to further partner with organizations that already provide home care to reach homebound residents.

De Blasio hinted at future efforts to address those mobility issues in his press briefing on Tuesday, though concrete plans have not yet been announced. 

“Homebound seniors who literally need an individualized approach … someone able to give the vaccine safely has to go to their home,” he said. “That’s obviously much more complex, takes a lot of labor, but we’re devoted to getting it done, particularly as we get more vaccine.”

Nicole Javorsky is a Report for America corps member.