It shouldn't have been so hard, Noel thought. Her age and job made her among the first group eligible under Florida's vaccine roll-out. But the odds were against her from the start. Information was limited, and mostly in English, which, even after 40 years in Miami, was still something of a barrier for the Haitian immigrant.
Work did not leave her much time for vaccine hunting, either. And every time she phoned Jackson Health — the only place she knew of giving out vaccines — she was told there were no appointments available at all, much less on the weekend.
"I called so many times," Noel said.
Even though she knew her diabetes put her at higher risk for severe COVID-19 infection and she was also terrified of giving the virus to the elderly woman she cared for, Noel had practically given up by the third week of March.
At the time, only about 13% of adults who lived in Noel's majority-Black ZIP Code had been vaccinated, according to an el Nuevo Herald/Miami Herald analysis that used population estimates from the U.S. Census and vaccination data provided by Miami-Dade County. That differed starkly from wealthier, whiter enclaves like Key Biscayne and Fisher Island, where nearly all adults had already received at least one shot.
Unlike many of her neighbors, Noel caught a break: Her daughter happened to see an Instagram post about the city of North Miami hosting a vaccine pop-up at a community center. The location, just a few blocks from Noel's home, and the timing, a Saturday, were ideal. Noel finally got her shot.
"I praise the Lord for that," Noel said outside the mobile vaccination site on March 21. "I praise the Lord for North Miami. They're doing a wonderful job."
The North Miami pop-up was part of wider efforts by state, county and local officials to address lagging vaccination rates in underserved communities since March.
Now almost half of adults in Miami-Dade have received at least one dose of the vaccine. But the disparities between Black and white communities, and rich and poor, have remained largely unchanged.
Despite a month of door knocking, mobile vaccine campaigns, the addition of federally supported vaccination sites in minority neighborhoods, and loosened state eligibility restrictions, vaccination rates in majority-Black areas were still nearly 40% lower than the county as a whole as of April 17, the Herald analysis found.
Politicians have been quick to blame the disparity on vaccine "hesitancy." But residents of undervaccinated communities interviewed by the Herald described a far more complex range of emotional reasoning and logistical hurdles.
There was never just one thing that kept someone from getting vaccinated but rather a compounding and often fluid set of circumstances: lack of information from trusted sources, a complicated appointment sign-up system that privileged white-collar workers with more flexible schedules and paid time-off, difficult-to-reach vaccination sites that required access to a car, and doctor's note requirements that disproportionately hurt underinsured Black and brown communities that have less access to doctors.
The hassle of getting a vaccine can be the determining factor for a patient who is feeling any amount of fear or uncertainty, said Muriel Jean-Jacques, a clinician and assistant professor of medicine at Northwestern University who studies vaccine inequities.
"You're able to get [patients] from an 'I don't think so' or 'I'm not sure' to a 'yes,' but then they can't just go get a vaccine down the hall. Instead, they have to go home and try to deal with an online system — and that 'yes' quickly turns back to a 'no,'" Jean-Jacques said.
Disparities in Miami-Dade's vaccination rates largely result from poverty and the resulting structural barriers, she and other experts interviewed by the Herald agreed.
Vaccination rates were lower in communities where people lack access to vehicles and health insurance, the Herald analysis found. Overall, vaccination rates were 30% lower in ZIP Codes where more than a quarter of residents live in poverty.
Despite public health experts saying it is crucial to publish and share such data, neither the state nor Miami-Dade County regularly send ZIP Code data to city officials.
Jackson Health, one of the biggest providers of vaccines to Black Miami-Dade residents, says that vaccine demand is slowing and that it will no longer give out shots. If demand does not pick up, the vaccination disparity could become permanent, with potential long-term negative effects on the health of Black communities, experts warned.
"We need to be so intentional and so deliberate in trying to prevent disparities from the get-go when we have the opportunity and to remedy them as quickly as possible once we're aware of them," Jean-Jacques said.
'Not rocket science'
The scale of the disparities shown in the Herald analysis was not only predictable but also preventable, said Georges Benjamin, executive director of the American Public Health Association.
"Equity doesn't happen automatically. It happens by intent," Benjamin said. "So if you're trying to achieve equity, you have to devise a plan that will achieve equity. And if you don't do that, you will get what you got: an unequal distribution. That's not rocket science. That's math."
In order to avoid replicating existing inequities, Florida should have made it easier for Black residents to get shots from trusted sources from the first day vaccines were available and started its roll-out by sending more doses to Black communities than to wealthier, white ones, according to Benjamin and interviews with five other public health experts.
Instead, Gov. Ron DeSantis' December roll-out privileged age over other risk factors and ignored an abundance of public health research that shows color-blind policies lead to racial and economic disparities in health outcomes.
In March, under fire for how many pop-up sites were being opened in wealthy, white, gated communities, the state began working with the federal government to bring sites to predominantly Black areas. But the Herald found the sites did little to combat disparities. Few people from surrounding communities showed up, in part because there was little advertising beyond social media. The same lack of outreach affected sites that the state opened in partnership with Miami-Dade municipalities.
Noel, for instance, said that without help from her daughter she never would have seen the Instagram post that allowed her to get a vaccine.
"I don't use any social media," she said. "I'm an old lady. I don't want to be bothered with that stuff."
The vaccination rate where Noel lives is still only half of the county rate overall, and far below wealthy areas like Coral Gables, Miami's Brickell financial district and Aventura.
"Are you serious? That's horrible," said North Miami Councilman Alix Desulme, who lives in the same ZIP Code as Noel and has also been vaccinated, when a Herald reporter told him of the disparities.
Desulme said the cash-strapped city could not spend much of its own money on outreach.
"This is not working. We need to know how bad the problem is so we can try to allocate our resources and get people vaccinated," he said. "I'm going to try and get on the phone with the governor. This is crazy."
In addition to North Miami, areas of Sweetwater, Liberty City, Miami Gardens, Opa-locka, North Miami Beach, Homestead and Florida City, which are predominantly Black or have large numbers of poor Hispanic residents, have the lowest vaccination rates in the county. Together, the ten ZIP Codes with the lowest vaccination rate have only 30% of adults vaccinated. The top ten have 88% of adults vaccinated.
"This is incredibly valuable data," said Erica Avila, a Homestead councilwoman.
Like every local official interviewed for this story, Avila did not know the ZIP Code data existed, even though the numbers are collected by the Florida Department of Health and sent weekly to Miami-Dade County's Office of Emergency Management, which provided them to the Herald.
Avila said she now plans to target door-knocking campaigns to the ZIP Codes in Homestead with the lowest vaccination rates.
DeSantis' office did not respond to a request for comment for this story. Neither did the Florida Department of Health or the Florida Division of Emergency Management.
Withholding data
After being contacted by the Herald, Miami-Dade County emergency management officials now plan to share the ZIP Code data with the county's 34 municipalities, according to Rachel Johnson, a spokeswoman for Miami-Dade Mayor Daniella Levine-Cava.
"I'm sure sharing the data with these cities will help focus their efforts," Johnson.
The state of Florida, which provides the data to the county, has not committed to that kind of transparency.
The Herald was unable to perform a state-wide analysis of vaccination rates by ZIP Code — something public health experts say is crucial to understanding which communities are being failed by the state's vaccine roll-out — because the Florida Department of Health has not released comprehensive data to the public, despite requests from multiple news outlets.
After Orange County officials released ZIP code vaccination rates to journalists in mid-April, the state cut off the county's access to its data, news station WFTV reported.
Facing the threat of a lawsuit from the Herald and a consortium of other news outlets, DOH provided limited vaccination data by ZIP Code from inconsistent dates between February and April for six other counties: Alachua, Lake, Leon, Nassau, Sarasota and Orange. (DOH also provided maps showing vaccination rates by ZIP Code for five additional counties, but not the underlying data, making it impossible to analyze.)
Get the data
An analysis of those records by county shows trends similar to Miami-Dade: Areas where more Black people live tended to have lower vaccination rates than the county overall.
In most of the counties where data were provided, areas with a higher proportion of Hispanic residents also tended to have lower vaccination rates. That's different from Miami-Dade, where Hispanics make up a majority of the population and majority-Hispanic communities have been vaccinated at the same rate as the county overall.
But across every county, areas with higher rates of poverty and other structural barriers like lack of access to vehicles or insurance also had lower vaccination rates.
Poverty is more common in Black and Hispanic communities, creating disproportionate barriers for vaccine access, said Monique Brown, an assistant professor at the University of South Carolina's Arnold School of Public Health.
"Working might be one of the barriers, transportation issues," Brown said. "The digital divide: If appointments have to be made digitally, that's a barrier."
Wealthier, tech-savvy residents don't face those kinds of challenges.
"I had the time and the skills to track this down," said one 70-year-old Black woman who works from home in North Miami Beach and asked not to be named. "And I fought."
The woman said she spent weeks hitting the "refresh" button on appointment websites and making phone calls before finally getting her first shot in early February at a site in Lauderhill — a city that is almost 80% Black.
Aside from the site's healthcare workers, she said, she was the only Black person there.
Miami Herald staff writer Douglas Hanks contributed to this report.
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