Funding Black and Latinx community institutions is the key to vaccine equity

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When our team at Duke Health launched a bilingual COVID-19 symptom monitoring program last March, we noticed over 90 percent of participants enrolling were white. We quickly started collaborating with nonprofit design studio on the question: how can we design COVID-19 interventions that challenge systemic racism and prioritize care for the most vulnerable among us? 

After dozens of interviews with community leaders and community members six key insights emerged that are noticeably absent from most conversations about fighting the pandemic. Number one: “When communities constantly feel ignored or see resources flowing in another direction, they’re primed to mistrust outsiders.” The Biden-Harris administration’s American Rescue Plan gives us an opportunity to rebuild this trust, but we must change course now in deciding where money goes.

We are among a team of 23 community organizers, non-profit leaders, public health practitioners, physicians, scientists, nurses, innovators and allies who have been collaborating closely to address the impact of COVID-19 in historically marginalized populations.

Black and Latinx communities have good reason to feel ignored. In the last year, we witnessed disproportionate illness and death within Black and Latinx communities, which compounds a long history of systemic racism in our healthcare system. Black and Latinx populations are about three times as likely as White individuals to be hospitalized with COVID-19 and about two times as likely as white individuals to die of COVID-19. Now, we witness barriers to access to COVID-19 vaccines within Black and Latinx communities. 

But there are stories emerging across the country that give us hope. In Durham, N.C., the first Latinx vaccination event brought together community based organizations, churches, a Latinx advocacy group, community organizers and a large health system to administer 150 doses in a Latinx-owned credit union. In Wake County, also in North Carolina, 16 churches came together to hold equity vaccine events staffed by the local health system. In Philadelphia, the Black Doctor’s COVID-19 Coalition surpassed 25,000 vaccinations with a strong network of community partners. At a national level, 55 percent of adults living in households making under $40,000 per year received help getting a vaccine. These underground networks and partnerships are opportunities to build community and bridge gaps in trust among Black and LatinX communities.

But the labor of the pastors, congregation members, community organizers and allies has largely been taken for granted. In the last five weeks we have partnered with community groups to run six COVID-19 vaccine equity events delivering thousands of doses to historically marginalized populations. The labor is real and significant. For our first 150-dose event, we asked everyone to log their hours and activities so we could rapidly iterate on the process. It took over 20 people 300 hours to make the event happen. The labor costs for that event, completely outside of the health system, amounted to $40 to $50 per vaccine dose. For the largest event of 500 doses, 3,000 phone calls were made to recruit and register older Latinx adults. Community members and local grassroots organizations have quietly stepped into the void, filling gaps created by decades-old deficits in public health funding. 

We have a unique opportunity to make resources flow directly to the community partners that empower vaccine equity efforts. The American Rescue Plan dedicates $7.5 billion to the Centers for Disease Control and Prevention for activities to plan, distribute and track COVID-19 vaccines and another $1.5 billion for a public relations campaign. The Centers for Medicare and Medicaid Services just announced an increase in Medicare payments which covers older adults with no mention of Medicaid payments, which covers marginalized populations. Some states, including Massachusetts, have recognized that reaching historically marginalized populations takes significantly more time and effort than other populations, because of the lack of funding and resources to bridge connections between public health, healthcare, and the community. Rather than have Medicaid pay less to provide services to marginalized populations, which is the norm, Massachusetts doubled the Medicaid reimbursement rate from $45 to $90 per vaccine dose. But we have yet to see policies explicitly pay community-based organizations for their work.

The Centers for Medicare and Medicaid Services and state Medicaid agencies must act now to define community health services related to vaccine equity that Medicaid can pay for — such as phone banking, canvassing and facilitating transportation — and state Medicaid agencies must pay community-based organizations for covered vaccine equity services. The National Academies of Medicine put forward similar recommendations in September 2019, mere months before COVID-19 hit our shores. These recommendations are even more prescient and pressing now as the long-term impact of COVID-19 infections and new variants await us. 

We must pursue policies that value everyday, preventative, non-medical support that improves people’s health outcomes. We need to make the investment to reach historically marginalized populations at community-based events and funds need to be evenly split between health systems and community-based organizations. These policies can ensure health systems include community-based organizations in health improvement efforts from the beginning and ensure adequate resources are directed to those institutions to build them up. This can create sustainable long term impact today on COVID-19 and tomorrow on chronic diseases, mental health and much more. 

If we don’t learn our lesson now, the COVID-19 vaccination rush will come and go. Our public health crises will persist and we’re bound to find ourselves back where we started, perpetuating the economic, social, education and personal inequity that characterized this past year.

Mark Sendak, MD, MPP is the population health and data science lead at the Duke Institute for Health Innovation at Duke Health. Mary L. Gray, PhD, a 2020 MacArthur Fellow, is a senior principal researcher at Microsoft Research and a faculty associate at Harvard University’s Berkman Klein Center for Internet and Society. They are both scientific advisors to Greenlight Ready and are among a team of 23 community organizers, non-profit leaders, public health practitioners, physicians, scientists, nurses, innovators and allies who have been collaborating closely to address the impact of COVID-19 in historically marginalized populations.

Tags COVID-19 vaccine Deployment of COVID-19 vaccines health disparities Health sciences Medicaid Medical research Vaccine

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