COVID-19 Sparked a Health Equity Movement – and Vaccines are Just the Beginning
Alexandra Quinn, CEO, Health Leads
Tene Hamilton Franklin, VP of Health Equity and Stakeholder Engagement, Health Leads
Denise Smith, Executive Director, National Association of Community Health Workers
Claire Qureshi, Senior Director at the Community Health Acceleration Partnership
Carly Bad Heart Bull, Executive Director, Native Ways Federation
Dr. Alexandre White, Departments of Sociology and History of Medicine at Johns Hopkins University
It’s 2026. Imagine that we could look back five years and be proud of how we unified our strategies and objectives across the U.S. to enable an equity-centered COVID-19 vaccination process that protected hundreds of millions of people. That we could celebrate a new trust in American health systems, institutions and providers among Native, Black, Latino/a, Asian, Pacific Islanders (API), and other communities of color. That our rebuild from the COVID pandemic finally addressed racial health inequity in all neighborhoods and at every level – individual, institutional and systemic. Imagine that our vaccination process ignited a health equity movement that is rooted and invested in community-level leadership.
It may feel far away, given present day COVID headlines, and growing health inequities exacerbated by a dysfunctional national vaccination rollout. Federal and state stimulus which failed to provide equitable access to and support for organizations and individuals of color also neglected to respond to the additional barriers created by low health literacy, uninsurance and underinsurance, transportation and language disparities.
Despite a recent increase in demand for the flu vaccine, the U.S. has a history of low adult immunizations in comparison to other countries, due to a variety of historic inequities in our health systems including medical apartheid, experimentation and racism from health providers and researchers that have disproportionately burdened communities of color for hundreds of years.
Yet, even with these egregious missteps that take the lives of precious friends and family members every day, we can right this ship. Equitable distribution of the COVID-19 vaccine is our opportunity to acknowledge and correct the failings of the 2020 pandemic response while also beginning a healing process from generations of disparity in health status and outcomes. We can choose to work as a collective toward a unified goal, instead of reinforcing dangerous siloes and hinging the health of so many on efforts of individuals and local groups fighting upstream against systems designed to create barriers.
Vaccine approval, distribution and uptake could still be a bright spot in our COVID response – the moment that community members and organizations can work in authentic partnership with local, state, tribal and national public health and medical institutions to deliver a life-saving essential health resource broadly and equitably. Our vaccine response can also be the opportunity to put us on a path to create more equitable, lasting systems of health.
Multiple Initiatives and Groups Focused on Equity-Centered Vaccines
Many people, institutions, and organizations are working towards the goal of an equitable, safe, and widely-taken vaccine. The authors of this post have been in over 50 vaccine-focused meetings, convenings and webinars and sit in on many vaccine-focused working groups and campaigns – from the hyper local to the nationally led. Every single person in each of these meetings, groups, and webinars wants to make vaccine distribution and uptake a bright spot. They want Black and Latino/a communities, rural communities, vaccine-hesitant or denier communities, and others to trust and get the vaccine. They are working around the clock to make this happen.
At the same time, each of us is building on broken, deeply siloed and under-resourced primary care, public health, and community health systems. But we are at a turning point. With a new administration focused on equitable vaccine distribution, we must now align our vaccine strategies across the country to ensure that the most central players in the effort – including the National Academy of Science, Engineering and Medicine, Center for Disease Control and Prevention and the CDC Foundation, and Johns Hopkins Center for Health Security – work in concert with private funders, governors, tribal leaders, regional healthcare institutions, community health workers, local public health, and many more invested people and systems.
As Dr. Rueben C. Warren and colleagues write, building trustworthiness and trust with BIPOC communities must be a central goal in this effort. In deciding to access and take the vaccine, community members are making a decision not only about their health, but also about history and trust. Our collective well-being is dependent on this set of decisions. Many institutions have conducted research and are planning campaigns and locally-rooted outreach strategies to try to address these issues. Successful public health campaigns, like those around AIDS and tobacco, are helpful reference points. Yet, with the scale and scope of this crisis, when we are deeply divided, with distrust and disinformation at an all-time high, previous playbooks may not work.
Beyond a Playbook: A Health Equity Movement
We need more than better messaging and better playbooks. We need a movement. We need to challenge the systems of practice that lead to mistrust and disappointment in health care more broadly. Social movements are a powerful frame for healing as a country for eradicating health inequities. We can learn from history where communities who mobilized held institutions and systems accountable for their impacts, policy and practice. From Civil Rights to the National Domestic Workers movement, social movements offer key lessons, including collectively working towards a shared vision, and a clear, even if expansive, set of goals, actions, and policy changes that have both social and economic impacts. Building on health social movements like eradicating Polio to collectively drive equitable uptake of COVID vaccination can also serve as a springboard to an ongoing movement towards racial health equity across the U.S.
Enacting an equitable COVID-19 vaccination campaign is not solely about ensuring access to the vaccine for all. Too often, top down public health interventions leave those most requiring of health support feeling alienated from decision making processes. For Black, Latino/a and Native communities that have too often been the subjects of medical experimentation, unwanted or coerced medical treatment, or have had their voices ignored in decision-making processes around public and community health, an equitable COVID-19 vaccination campaign could begin to reckon with the damage wrought both by these histories and the pandemic response until now. An equitable COVID-19 vaccine movement could not only help solve the most acute public health issue of our current moment, but should reframe the nature of community-centered health care.
This starts with reframing who is leading this first leg of equitable vaccinations and the information and resources they can access. While social movements often have a few identifiable and highly visible leaders, successful movements are “leader-full.” Those that are most impacted lead and make decisions, not just “consult” or share their “lived experience” at an appointed focus group. Equitable access to knowledge, tools and training is critical for frontline movement leaders. Democratizing data and enabling open access to information will be critical. For the vaccination effort to be not only successful but equitable, we need to ignite and equip leaders at every level, not just at the CDC or gubernatorial level, but at the neighborhood level.
To enable a health equity movement, we need to turn to and invest in those already leading in their communities.
Join Us: Building this Movement Together
With 20+ leaders and organizations, we outlined principles for equitable vaccine distribution in October. Many of these principles can serve to guide not only vaccination distribution, but health equity efforts writ large. Many of these principles are shared by local, state and national leaders and are included in the Biden administration’s initial pandemic response plans. Next, we will work to bridge local communities, learn from each other and combine talent and resources to better support communities.
The pandemic has forced the most dedicated and passionate community and health equity champions from across this country – from individuals to organizations – to step up in unimaginable but heroic ways. You have all fought tirelessly against inequitably designed systems to serve your communities. The trust and faith we so desperately need to repair lies with you. It’s past time to come together to leverage our collective strength. Join us and let us know how you can be part of the movement.
You can also reach out to HealthEquityMovement@healthleadsusa.org with any questions, suggestions, connections, resources or excitement about our growing community!
Thank you to leaders of CONVINCE USA, CUNY Graduate School of Public Health and Health Policy, who also contributed to this article.