From the start, the coronavirus pandemic has trained a particularly lethal target on communities of color.
More Black and brown Americans have contracted the virus and died as a result than white counterparts.
Now as the sluggish COVID-19 vaccine rollout engenders growing criticism, concerns are growing among communities of color that once again, their members will be relegated to the back of the line.
“I think the end game was left out of the pandemic vaccine program,” said the Rev. Frank Hairston-Allen, a church pastor and head of the Greater Harrisburg chapter of the National Association for the Advancement of Colored People.
“It’s glorious that they did this in 11 months, but now to the baseline on the southside of the tracks. When does it come here? When does it come to our cities? We don’t know. You could have vaccinated the whole other side of the river and we wouldn’t know about it. There’s no word coming through.”
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Gloria Merrick, executive director of the Latino Hispanic American Community Center in Harrisburg, says she is concerned that as with testing, her community will be last in line.
“We haven’t heard too much here, in terms of boots on the ground,” she said. “We haven’t seen anything that is speaking to the local community such as Allison Hill or Harrisburg. We haven’t heard anything yet. It hasn’t come this close to home.”
Indeed, the concerns are not without merit.
As state and federal officials endeavor to distribute the vaccine, they have yet to clearly articulate how vaccine deployment is going to play out in such a way that medically underserved communities are not left behind in the process, critics say.
Health officials also must work to overcome skepticism of vaccines among some members of minority groups. Experts said government officials should do more outreach efforts involving church groups, trusted community leaders and even celebrities. Health officials should be working now to convince minority groups to get the shots when they are available, critics said.
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‘Acknowledge the mistrust’
State Secretary of Health Dr. Rachel Levine last week said the commonwealth was a long way away from achieving any critical mass vaccination. Levine predicts it will be months before the vaccine is freely available to the general public.
At this point, vaccines have been given to doctors, nurses and other key personnel at hospitals, along with staff and residents in nursing homes. Levine has said the next phase of the rollout will involve those over the age of 75, first responders and other essential frontline workers.
Dr. Maya Ragavan, a pediatrician at UPMC Children’s Hospital and researcher on the equitable roll out of the vaccine, underscored the sensitivity of such a mass vaccination rollout.
“One thing that is so critically important for health care providers and researchers and other folks who are going to be delivering the vaccine is moving our framework away from, ‘We need to educate people about the safety and efficacy of the vaccine’ to ‘How do we build ourselves up as trustworthy?’,” she said.
“A lot of mistrust is well earned. It’s rooted in history, racism and trauma,” Ragavan said. “We have a responsibility as healthcare providers, researchers and as folks who are going to be ensuring communities get the lifesaving vaccine that we are trustworthy and that we acknowledge the mistrust and use that as a starting point to have a conversation about the safety of the vaccine and how important it is.”
The urgency cannot be overstated: Black and brown communities continue to suffer the highest death rates due to the pandemic.
According to the Centers for Disease Control, as of December 30, 2020, around 17 percent of COVID-19 deaths in the U.S. have been among non-Hispanic Black or African Americans. More than half of all in-hospital deaths due to COVID-19 during the first six months of 2020 were among Black and Hispanic patients.
Over the past four weeks, about 300,000 people in Pennsylvania have received one of the COVID-19 vaccines; most of those have been health care workers at hospitals. About 50,000 residents and staff from nursing homes have received the vaccines. The Pennsylvania Department of Health, which is closely following the guidance laid out by federal health officials, has rolled out a phased distribution plan and has vowed to ensure equitable access to COVID-19 vaccination.
‘Listen to the concerns’
Dr. Oralia Dominic, a chief medical officer and medical policy research analyst with Highmark, gave assurances that, while it may not be apparent to the general public, public health officials and medical stakeholders are rolling out a slew of initiatives designed to clear some of the hurdles that have historically marginalized underserved communities of color.
Education, outreach and collaboration with community partners are key to that strategy, she said.
“It’s imperative that education and outreach is done ahead of time, so that when the vaccine is available to the public and communities of color, they have no hesitation to receive the vaccine,” said Dominic, who is an advisor with the Department of Health’s Office of Health Equity. “For those who do not trust in the vaccine and opt to not receive the vaccine due to lack of health literacy, it could further impact those most vulnerable to COVID-19.”
Public health officials are sparing few resources at county and state levels, she said, but the sheer scope and urgency of the undertaking cannot be over-emphasized, she said.
“That type of coordination takes time,” Dominic said.
That strategy entails a complex system of initiatives that address factors such as health literacy to community involvement and investment.
Medical stakeholders like Highmark, for instance, have been working with community partners to overcome some of those deficits with initiatives like “CATE,” the mobile health unit program launched with the Department of Health that has been providing bilingual virus education, awareness and testing.
To date, the mobile unit has made stops to more than 30 municipalities in the state, 15 counties, and administered more than 1,200 coronavirus tests.
“When they speak we listen. The Department of Health listens,” Dominic said. “Voices are heard, needs are identified and we respond. Nothing is done in isolation. We do this in an all-hands-on-deck approach.”
Levine said Tuesday state officials have had regular conversations with community leaders about engaging members of minority groups. She said the state will do more public outreach about the importance of the vaccine but is also waiting on the arrival of federal funding.
“We have a vaccine communications plan that we will roll out after we get the funding from the federal government to actualize that,” Levine said. She added, “We need a federal plan, a federal communications message that is coming out about the safety and the effectiveness.”
To be sure a visible, sustained community partnership is going to be critical in ensuring all communities are cared for in the mitigation of the pandemic.
Ragavan said that for the rollout to communities of color to be successful it needs to be intentionally focused on those communities.
That can range from town halls done in cooperation with trusted partners such as churches and community organizations to high-profile community figures. And those opportunities are limitless, ranging from faith leaders to sports icons.
“That will be very important,” Ragavan said. “I absolutely think we need to think out of the box as to how the vaccine is delivered and how to make it easier for folks to get. The wisdom of community partners is that they know so much…in many respects they know the best way to distribute the vaccine in a way that’s responsive and aligned with community priorities.”
In recent months, Dr. Jennifer Kraschnewski, professor of medicine, public health sciences and pediatrics at Penn State College of Medicine, has been focused on building and reinforcing community partnerships. She has recruited the help of a popular Lebanon restaurateur, a bakery, a local radio station, church leaders, even a well-known local taekwondo champion.
All, she said, are providing direct connections to their communities.
“If the community is not interested in the vaccine, it is not going to listen,” Kraschnewski said. “We need to understand and listen to the concerns of the community. We need to be there with trusted community partners who the community looks to for answers. We need to supply those so they are well equipped to answer concerns.”
And it’s not just surmounting COVID-19, she added. Underserved communities are being ravaged by job losses, food insecurity and other ancillary effects of the pandemic.
“It’s an incredibly huge problem,” Kraschnewski said.
Churches play a role
Dr. Sharee Livingston, an OB-GYN with UPMC Lititz, knows first hand the power of community connections.
Livingston, who is Black and received the vaccine a few weeks ago, has been doing outreach to churches, particularly Black churches, with the hope of raising education and awareness about the vaccine among those communities.
She said it’s a tall order given the Black historical narratives around such figures as Henrietta Lacks, whose cells were used without her knowledge or consent to develop cell culturing, and the unethical research on Black men with syphilis at the Tuskegee Institute who were left untreated for experimentation purposes.
“I understand why people of color are skeptical,” Livingston said.
Livingston said that while historical disparities and social determinants to health play a critical role in the perspective communities of color have towards the vaccine, community connections could go a long way to bridging some of those gaps.
Black churches, she said, can play a critical role.
“The Black church serves as a reliable source of spiritual guidance, general information, and comfort in the Black community,” Livingston said. “Working with Black churches helps to get the word out that the vaccine is safe and reliable and puts us on a pathway to overcome this horrible pandemic.
Livingston credits her participation recently in a local church Zoom session for the decision from a 93-year-old Black woman to get the vaccine.
“She was willing to get the vaccine after hearing me speak, and that is what matters most,” she said.
‘You need a big game’
With full distribution of the vaccine months away, public and private health officials urge everyone to continue wearing masks, washing their hands and social distancing.
While those are necessary practices to limit the spread of the virus, some minority community advocates say they are ready to hear more about how government officials plan to give out the vaccine equitably.
Merrick, leader of the Latino Hispanic American Community Center, remains concerned that her community isn’t getting enough attention.
“I know what is happening from a big picture but as far as anything that speaks to what is going to happen in our local communities here, I’ve not heard anything yet,” Merrick said. “It’s not unlike COVID testing. We didn’t hear anything until later on when testing became more accessible. We were on the back end of that too. I don’t know if we will see a pattern here. We need to start asking those questions. I don’t know what that pecking order will look like.”
Hairston-Allen, who has presided over more funerals in the past few months than at any time in the last 10 years, says that what is needed – and lacking – is a visible and aggressive campaign to reach members of his community.
“Government is going to have to step in,” he said. “You need a big game not a small game. You can’t wait on Walgreens or CVS. You have to call on the fire department, the armory, the police, school gyms. You have to open them up. You have to herd people through. Do it in a big way for the Black community to receive fairness.”
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