It’s been exceptionally hard to get public health concerns about distribution heard over the din of people who work in hospitals assuring everyone that the issue is supply. That’s because that is what they see, especially when housing super cold storage for the two available vaccines. But, that is just the first step..for anything that happens outside of the hospital. For public health, all the work is the invisible parts after the storage.
The truth is, the short term limitation is supply. The long term problem is where the rubber meets the road, and that, my friends, is a public health infrastructure issue.
Vaccine distribution long game is going to be infrastructure. This linked article from Harvard talks about the issue from someone who actually understands this, because she works in the community connections piece itself.
“The biggest problem right now is the state’s lack of engagement with the communities that have been experiencing disproportionately high rates of COVID-19—for the most part, low-income communities of color and immigrants. We really need to think about how best to strengthen communication about vaccines among these groups. We need to equip community leaders with education about the vaccine, as well as information on how to register for vaccines, so they can share it with their networks. By community leaders, I mean churches, elder-serving organizations, and grassroots groups like the Black Boston COVID-19 Coalition. We will not be able to overcome the legacy of mistrust of our government and medical institutions overnight, but engaging these community leaders is an essential first step that I wish had been part of the state’s strategy from the start.”
This is their concern in Massachusetts. Let me tell you, if you don’t know, that Massachusetts is well set up, because of their public health funding, resources of top universities with loads of experts, and connections between hospitals and universities in medicine, research and public health. There are very few states that have the funding they do. It’s not all blue states, I keep hearing people try to push this. People throw out CA as if it’s some bastion of public health. It’s not. It suffers from extreme issues and difficulties given its size and variety of climes, it’s immigration issues and both multiple urban densities as well as wide swaths of rural.
The states with great infrastructure and funding (Better than most anyway) are Minnesota, Michigan, Massachusetts, Washington, and on down from there. These also have the top schools in public health in our country.
So what does this mean? It means that, regardless of supply issues, the main problem will be what other states, those that do not have the investment in connecting communities to state resources and experts, are going to do. It cannot be created out of thin air by National Guard or loads of money. It requires engagement from communities with state and local health – that is what creates trust and gets minority communities involved in accepting vaccines.
This is fundamentally an infrastructure issue, and it will especially affect states with poor connections to local low-income and minority communities, where state health departments don’t have lots of grant funding to create those public health programs throughout their states to connect with groups in need. They don’t get those big grants because they don’t have a ton of expertise at the state health departments to manage these big grants. So states like Indiana, Mississippi, Alabama, just continue to land at the bottom in rankings of metrics of public health and wellbeing.
We have to start admitting this, and stop allowing those who live and breathe hospital or research to dominate the discussion of what this will look like. Frankly, they have no idea what it takes to do anything in these communities. It takes work, and lots of coordination most states don’t have time or connections to make, in order to build trust, to get Black and Latino people to want to come out to a vaccination clinic that may require them to find transportation and take time off work (these clinics that only go 9-4 in largely white suburbs nowhere near a bus line are killing me, this is not equal access).
The people who need these vaccines are not getting them right now. The small portion going into arms of non white people is not acceptable. The vaccine hesitancy is real, but so is the major obstacle to getting the vaccine into arms, and that is a state coordinated program in minority communities. It requires creating, staffing, organizing and orchestrating making mobile clinics happen. It requires partnering with whatever available community transportation is there to go out and drive people to a clinic. It requires residents to use connections with local barbershops and religious groups to advocate for their neighbors to go ahead and get the vaccine. It requires it to happen from the inside and be coordinated from the outside, and those relationships just are not nearly as readily available as people think.
Community health is hard. There is a reason people like me do this work for very little pay, though, and that is because when you finally create something that gets to people, it makes a huge difference. And you get to see it and be a part of something bigger than yourself, and sometimes you get to meet the people it helps. Every program matters. But every program takes monumental efforts to create. It’s why so few of us remain in state and local public health. It’s so so hard and it’s underfunded.
So please, for the love, community health work experience really should be your main resource for information about what this will look like. Talk to the community agencies, talk to your local public health friends, talk to the program managers at the state health department. Ask the people who do the hard work on the ground.
If only the media would do that perspective some justice by actually interviewing real public health workers about public health.
This is going to take some time and there are going to be many many bumps in the road, especially if we want to get to 85% vaccination coverage. It’s in the interests of everyone to get all communities covered, but it’s not solely fixed by federal intervention. That will help, but it won’t solve it. We need connections in communities. If you are connected, reach out to people at your local health department to work together to create vaccine clinics in places where minority communities can access them. If you are a religious leader, reach out. If you are a well-connected leader in your community, reach out. We need all the community help we can get. So also volunteer. Myself and a friend are going out to volunteer this weekend to give vaccines and I couldn’t be happier to be able to do something.
But even if you aren’t a healthcare professional, they need helpers. They need people to check folks in and manage traffic. Maybe there are possibilities of helping Connect the clinics to those who are shut in. Maybe you could be a translator. Did you know Indiana has a huge Burmese population? Also, always in need of Arabic translators. There are things you can do to serve your own communities, but you have to start by digging to find your local health department. See what you can do!
Please get engaged. This effort will be so much more successful if everyone tries to participate, to get community acceptance up, to help in whatever way you can. We can’t do this from a federal level. It’s got to be grass roots if we want it to reach everyone.
Take care of each other. This doesn’t have to be passive, you can help in your own communities. And please, make it sustainable. Don’t just do one shift, make it weekly if you are able. Let’s make sure we can make this work, even if our system isn’t really set up well for this.