Health equity will be in the spotlight as the Biden administration ramps up its Covid-19 response with multiple public White House briefings a week, including one scheduled Friday, to give updates on its progress.
Advocates say the solutions to societal inequities in health care are a tough challenge.
Communities of color, people with disabilities, and other marginalized groups have been disproportionately affected by the Covid-19 pandemic, both in contracting the virus, needing to go to the hospital, and dying. For example, Covid-19 death rates were twice as much for Black Americans as the rate for white Americans last summer, according to the Kaiser Family Foundation.
President Joe Biden is taking the first step into addressing this problem with a health equity task force that will provide specific recommendations on mitigating and preventing health inequities in underserved and minority communities. The group, which has a leader but whose other members have yet to be announced, will focus its recommendations on allocating Covid-19 resources fairly, equitably disbursing relief funds, collecting demographic data, and ensuring there is culturally aware communication to hard-hit communities.
“There’s the moral imperative. It’s simply the right thing to do to ensure that those who are hardest hit or at highest risk, have the opportunity to stay safe and healthy through this pandemic,” White House Covid-19 Equity Task Force head Marcella Nunez-Smith told reporters Wednesday in the administration’s first Covid response briefing.
Most Americans won’t have access to get vaccinated until the summer, said emergency doctor Uche Blackstock, so the Biden administration should use this time to work on culturally responsive messaging that targets certain communities and addresses their concerns. The White House could partner with community leaders, pastors, and other trusted members of communities of color to help educate people on the need for a vaccine and help them figure out how to get one.
Access to Vaccines
States need to build equity into their vaccination plans if they haven’t already, Nunez-Smith said. The administration will help them by ramping up available vaccine data that draws attention to areas that aren’t getting resources.
Among the other concrete actions the administration will take to improve access is waiving any out-of-pocket costs for Covid-19 vaccines and supporting more vaccination sites across states.
The Biden administration plans to ensure it’s “convenient and accessible to get to vaccination sites by increasing the clinical and community-based workforce for outreach, education, vaccination, and wrap-around service,” Nunez-Smith said. Vaccinations will also be administered at federally qualified health centers and mobile clinics.
Federal health centers are an important piece of the vaccine rollout puzzle, said Nancy Krieger, professor of social epidemiology at the Harvard T.H. Chan School of Public Health, because those clinics are “a trusted provider and they reach key populations.”
Transportation and time off will also play into the federal plan to get vaccines to hard-to-reach Americans. The administration is “working to make sure that transportation and paid time off are available so people can make it out to get their vaccine,” Nunez-Smith said.
Kreiger said that means the government will need to mandate that employers allow employees time off to get their vaccine. “It will be important to make sure vaccine is available for everyone. And oftentimes that will mean bringing the vaccine right to people,” Nunez-Smith said.
Data, Data, Data
Lack of data on race, age, and other demographics has been a problem for epidemiologists and public health officials since the beginning of the pandemic in the U.S.—first with those who were getting sick and dying, then on who was getting tested, and now who is getting vaccinated.
Just 17 states are reporting Covid-19 vaccination data by race and ethnicity, according to the Kaiser Family Foundation, and that data is often inconsistent and incomplete.
Without a good picture of where resources are and who has access, it’s difficult to say where new allocations are most needed, said Blackstock, founder and CEO of consulting firm Advancing Health Equity. States and local agencies need to be held accountable for submitting that data that includes those factors, she said.
How that happens is a challenge, she acknowledged, because it won’t help to hold up states’ funding over data flaws because health departments have been underfunded for years.
Biden’s plan to add to the public health workforce—nurses, doctors, and other public-sector professions who work in their community—will assist in equity efforts, said Amber Hewitt, director of health equity at Families USA.
Community health workers also are “trusted community messengers,” and adding to the workforce will help improve data collection, she said.
Blackstock said Biden’s equity task force should ensure there’s a way to track resources and interventions so it can measure if its efforts are accomplishing the stated goals, Blackstock said.
“We can use these crises to change our health and health-care systems at the most profound level. By centering health equity, we can build systems that address social and structural drivers of health at their roots,” Nunez-Smith said Thursday at a Families USA conference.