Structural Racism and COVID-19 A View from the Trenches
David Bishai, Health Officer of Harford County
February 15, 2021
In my county whites are three times more likely than blacks to have been vaccinated for COVID-19. As health officer it's my job to fix that. I must do so mindful of the generosity of the American taxpayers who paid for all the vaccines entrusted to our health department. Those taxpayers want justice, fairness, and an end to COVID-19. This is one of those situations where a common process that is not designed to offer advantages ends up succumbing to built-in disparities in terms of who knows what, who has what and past lived experiences that are not the same for everybody in today's America.
Vaccine clinic appointments are creatures of the internet. Some seniors can get online or get their kids to go online for them. For others there is the telephone. I have made the public health department's vaccine pre-registration system senior friendly by offering a phone bank to schedule calls by phone. The phone bank staff started off as health department regulars--people who signed up for jobs managing birth certificates, clinic administrators, restaurant inspectors. The phone work was grueling. Not everybody was nice. With fear and panic come frustration and anger. Staff were soon in tears. We hired temps and the calls stabilized, but even with a call-in system, I have 10,000 out of 17,000 seniors that have still not pre-registered in the public system.
It is worse in the private sector. Private pharmacies do not take COVID-19 appointments by phone. The online system to get an appointment in a private pharmacy can reward persistence and a network of friends and family who repeatedly click on dozens of CVS, RiteAid, and Walgreen's websites. Posses of aggressive boomers hunt in packs to snap up appointments at private pharmacies and mass vaccine sites and to share links around on WhatsApp and telephone trees the second there is an opening. The private pharmacists will (I assume) answer a patient's drug-related questions about the vaccine, but the pharmacy chains are not prioritizing public information about the safety and efficacy of the vaccine. People in pre-contemplation of the vaccine need to ask questions to decide if they trust it. They need people who look like them to talk about the vaccine. Our health department has been scheduling zoom calls for Q and A and hosting local cable programs with a brilliant African American physician to help get to people with questions.
In my health department our approach to try to achieve equity has been to go beyond the "Come and get it." approach. In mid-January we called for volunteers from the county to join "Harford Citizens Crush COVID" (HCCC). This group has 50 who come to weekly meetings and 450 members of a Facebook Group. HCCC has one division that has recruited clinic volunteers to vaccinate and staff the clinics. A second division is devoted to setting up listening sessions of people who have questions and trusted people to answer them. A third division is called Harford 💓's Seniors--their group is to spread the behavior of just phoning Aunt Bertha and saying "Hi, can I help you register for a COVID vaccine". Having volunteers or health department staff call seniors is untenable--the Office of Aging warned all seniors not to pick up the phone because there are would-be scammers offering fake vaccine appointments. I have already asked the medical staff at the local hospital to call all their patients. The HCCC volunteers are postering the towns and getting Boy Scout Troops to call all their Aunt Bertha's. There are two amazing Johns Hopkins students supporting the volunteers.
HCCC is not a diverse organization. Asking for volunteers in a county with 10% minorities gets a group that is less than 10% minorities. A non-diverse enterprise to get people to call Aunt Bertha and to get questions answered cannot reach everyone who needs to be included. We are at a crossroads. I have reached out to African American leaders to ask for their help and have given them the option of creating their own HCCC or joining the current one. COVID-19 could have offered a unifying moment where all of the people in a community realized their common interest in working together as one--this is the sort of structure that defeats structural racism. On the other hand if a parallel group owned and operated by minorities would get more done, then that is a powerful and pragmatic reason for it. The answer to this dilemma will come soon.
As a minority who wants the vaccine and whose mother wants it too, I spend hours each day, checking the vaccine availability. There is never anything available. I am registered everywhere and anywhere and yet, no vaccine. It may be easier to have 1 registration source rather than all the options as I’m holding space in all available distributors. My plan is to cancel all others once we get an appointment but how many people will do that?
ReplyDeleteI agree--a national "Uber" for vaccines would have been a wise choice. Hail a shot and then watch a screen for the progress of independent private entities getting closer to your address. This uber would not make shots get into arms any faster, but it would be less frustrating. Shot in arm rates are keeping pace with vials coming out of the factory.
ReplyDeleteAt least with the vaccines-uber that never got developed, the people who asked for a shot would not be in oblivion. I have 32,000 people who asked for a shot from Harford county. Every week I try to tell them their status with an email and spam filters block the message so they think that nobody is trying to update them. Office of Aging has a phone bank to call people to update them and the phone gets picked up only 37% of the time.
The leaders of operation warp speed are molecule people and put ALL their money into getting a molecule. We in public health spent last summer screaming at them. Get ready to deliver vaccines down the last mile. It would not have taken that much extra to worry about delivery. Ultimately this fall when we hit a wall of vaccine hesitancy, great molecules won't matter as much as the last mile.