Joint Statement on Ensuring Racial Equity in the Development and Distribution of a COVID-19 Vaccine
The COVID-19 pandemic has become the defining health and racial equity crisis of our time, with Black, Latinx, Native and other communities of color suffering from its effects at nearly three times the rate of white people in the U.S. The pandemic response has been profoundly hindered by a lack of coordination of communications, strategies and systems among local, state and federal agencies; a historic underinvestment in public health infrastructure; and inability to protect those most susceptible to COVID-19 – including frontline health and essential workers, caregivers, the elderly, individuals in multi-generational housing, and communities of color.
With the physical health of every person and the economic health of our country at risk, the leaders of the national vaccination effort cannot afford to make the same mistakes with the development and distribution of a COVID-19 vaccine. Doing so would further increase racial health and economic inequities and significantly hinder the country-wide effort to eradicate or even adequately control the long- and short-term spread of the virus. While government and drug development organizations have allocated significant and urgent resources into vaccine development and distribution planning, many of the strategies proposed in the United States lack a clear focus on (or in some cases, any consideration of) racial health equity and clear coordination among federal, state, tribal and other local levels.
Leaders of this effort cannot expect the same systems, or the same approaches, that have historically mistreated and underserved Black, Latinx, Native and other communities of color to benefit them now. Without addressing the racially-based mistreatment of these communities and acknowledging vaccine hesitancy – most notably, a deep and justified distrust of government and scientific and medical systems – the national COVID-19 vaccination effort in the U.S. is destined to fail, further exacerbating racial health inequities.
Despite our uncoordinated and ineffective national response since the onset of the COVID-19 pandemic that has disproportionately impacted communities of color, the leaders of the U.S. vaccination effort can thoughtfully and authentically engage communities to address vaccine hesitancy and increase vaccine acceptance and access. The country has an incredible opportunity to learn from our collective past and change course. Federal, state, tribal and other local officials and community leaders have learned a tremendous amount about effective strategies to combat this pandemic, including contact tracing, PPE distribution, and community-centered testing strategies. Now is the time to apply these lessons-learned, nationally.
The guiding principles below are the result of productive conversations with leaders from all parts of the vaccination effort – including government institutions, national and local health associations, universities, caregiving leaders, philanthropic organizations and drug developers. They are designed to ensure Black, Latinx, Native and other communities of color and those most susceptible to COVID-19 have access and opportunity to receive safe and effective COVID-19 vaccines when they become available.
The U.S. vaccine development and distribution strategy must:
1. Authentically engage Black, Latinx, Native and communities of color and tribal governments. The COVID-19 vaccine raises concerns stemming from a long history of harm and current mistreatment of communities of color by government and medical/health care organizations. Engagement does not mean conducting one focus group or adding one person of color to a task force. The vaccination strategy must act in accordance with the input from various communities – like the comprehensive plan in development by the Indian Health Service. The success of the entire U.S. vaccination effort hinges on our ability to do this well.
2. Expand clinical trial and vaccine literacy in communities of color. Every culture has different reasons for vaccine or clinical trial hesitancy. Investing resources in tailoring and delivering messages, based on learning from each community and not just “communities of color” as one block, in both clinical trials and vaccination delivery, is key. Black, Latinx, Native and other communities of color are routinely underrepresented in clinical trials and recruitment of these communities will continue to be a challenge. Increase resources in places where people of color discuss and get health information, like schools, barber shops, hair salons, faith-based organizations, Tribal Colleges and Universities (TCUs), and Historically Black Colleges and Universities (HBCUs).
3. Offer full and complete transparency about the safety and efficacy of the vaccine. Clinical trial data and information about vaccination rates, risks and side effects must be easily accessible and understandable at a fifth-grade reading level, translated into multiple languages, and communicated through various mediums. Apply learnings from flu and other past vaccination efforts to COVID-19 vaccine education.
4. Include Black, Latinx, Indigenous and other communities of color in both clinical trials and appropriate phases of distribution. Black, Latinx, Native and other communities of color have long been underrepresented in clinical trials, posing risks to safety and efficacy results. Allocate additional resources to communities of color and groups that express high levels of distrust with the government and the scientific medical community as a result of consistently poor outcomes or systematic mistreatment.
5. Ensure vaccine development protocols meet safety and efficacy standards. Given widespread concerns about the rapidity of COVID-19 vaccine development, vaccine safety and efficacy profiles must comply with Food and Drug Administration standards for approval. If an Emergency Use Authorization is granted instead, the FDA must clearly articulate where those standards diverge and disclose the monitoring safety plan until the product is approved for a license.
6. Strengthen our local/community-based public health infrastructure. While public health officials will be tasked with local oversight of the massive vaccine distribution, funding and spending of these departments has been decreasing since 2010. Funds must be allocated to state and local public health systems.
7. Expand, train and sustain a U.S. community-based workforce to aid in distribution of the vaccine. Community health workers, Promotores de Salud, and health advocates are the most trusted and knowledgeable about their local communities. This workforce, which has been largely underfunded in the U.S., should be paid a living wage, valued for their lived experience and knowledge, and given a leading role in designing the vaccine distribution strategies that will work for their communities.
8. Combine vaccination distribution with other essential resources, including mental health. Similar to contract tracing efforts, unmet essential resource needs could be a barrier to receiving the vaccine (and to communities accessing the population health benefits of vaccine distribution more broadly). Vaccine distribution is an opportunity to re-engage people and build trust and continuity with primary care or a medical home that can address the full range of health needs, including essential resources like food, heat, housing, or mental health services.
9. Expand primary care capacity and access points. Compared to white Americans, African-Americans and immigrants are less likely to use primary care as their main source of care. Native populations also have limited access to hospitals and clinics. Increasing cultural-competency for primary care practices and expanding vaccine access points – such as connecting communities with existing COVID-19 testing sites – and increasing funding so that nursing homes can fully administer the vaccine.
10. Ensure vaccinations will be free to all. COVID-19 demonstrated how some uninsured people avoided testing and treatment because of the potential costs. Payer and pharmaceutical companies should forgo profits from COVID-19 vaccines. Healthcare administration costs for administering the vaccine should not be passed on to individuals.
We believe enacting these principles will mitigate some of the inevitable health inequities bound to arise with the vaccination efforts. Rather than wondering in 2021 what we could have done differently, let’s begin with what we know will make a positive impact now.
Thank you to the nearly 20 partners that helped create and shape this statement. In the weeks ahead, we will be creating and sharing more detailed operational strategies built upon the foundation of these principles. Please sign on to support these principles, share your feedback, and join our collective effort to build a coordinated, equity-centered COVID-19 vaccine strategy.
The ABIM Foundation
Big Brothers Big Sisters of Eastern Massachusetts
Camden Coalition of Healthcare Providers
Care Share Health Alliance
Center for Community Health Alignment
Center for Health Care Strategies
Center for Health and Social Care Integration
Center for Primary Care, Harvard Medical School
Community Health Acceleration Partnership (CHAP)
Community Health Worker Association of Rhode Island
El Sol Neighborhood Educational Center
Florida Community Health Worker Coalition
Health Care Improvement Foundation
Health Care Without Harm
Health Resources in Action
Last Mile Health
MetroWest Health Foundation
National Association of Community Health Workers
National Center for Complex Health and Social Needs
National Network of Public Health Institutes
Native Ways Federation
Partners in Health
Penn Center for Community Health Workers
Peninsula Conflict Resolution Center (PCRC)
Texas Health Institute
UHealth Care Lab, University of Miami Health System
Richard J Bookman, PhD
Durryle Brooks, PhD, MA
Stacia Clinton, BA, RDN,
Lydia Giles, BS, Quality Improvement Specialist
K. Allen Greiner, MD, MPH
Matthew Howie, MD
Jane Kelly, MD
Sara Lehrer, HIM Medical Scribe
Alicia Lynch, PhD
Felipe Gougeon, RN, MPH
Lauren R. Powell, MPA, PhD
Adrianne Proeller, Community Outreach Specialist
Karen Sepulveda, BSPH
Sarah Lawrence, Director, CCHW, MSW, PhD
Alexandre White, MD
Lisa Kidd, Certified Senior Community Health Worker
Russell Phillips, MD
Gordon Schiff, MD