Public health officials in Boston kicked off last fall’s back-to-school season with a free COVID-19 vaccination clinic aimed at combating the large racial disparities in vaccinations among young children. Local news reported that hundreds of Bostonians turned out to the event, creating a line “further than the eye could see” through the city’s Franklin Park. Attendees could participate in games, get school supplies, and walk away with a $75 gift card.
Similar efforts were implemented across the city, with health officials working with schools and youth centers to provide targeted vaccine access to the population’s most vulnerable. Mass vaccination sites were set up in November, and at least one of the five clinics remains open every day and in the evenings for those unable to go during the 9 a.m. to 5 p.m. workday.
With the aggressive vaccination effort, Suffolk County, where Boston is located, boasts one of the lowest COVID case rates in the country, and the racial gap in vaccinations has significantly narrowed. In April, the city’s public health commission will host a conference with local leaders and health care professionals to find ways to apply the successful strategies learned during the coronavirus pandemic to other health disparities.
“And we’re not just thinking about vaccination,” said Dr. Bisola Ojikutu, executive director of Boston’s public health commission, “but also thinking about ongoing access to testing, access to influenza vaccination, and really providing comprehensive services.”
The COVID-19 pandemic highlighted the persistent racial disparities in public health, with Black Americans being hospitalized and dying of the virus at significantly higher rates than white Americans during most of the spread. But over time, those disparities have narrowed — and even reversed. Now, across the country, communities are discussing ways to apply lessons learned during the COVID pandemic to other health disparities, from the flu to cardiovascular disease.
In San Francisco, Dr. Kim Rhoads founded Umoja Health in the summer of 2020 to address COVID-19 testing and vaccination in communities disconnected from traditional health systems. Now, the coalition is “expanding our scope to address the burden of cancer [and] other chronic diseases,” according its website. From thoughtful public health messaging to community-led vaccination drives, Rhoads said, the targeted strategies used during the pandemic can be applied to address other health concerns that have persisted for decades.
“The same people with disparities in COVID are the same people with disparities in cardiovascular disease and cancer,” she said. “We added diabetes screenings, and we have the ability to do cardio screenings.”
Back in Boston, public health officials employed a number of strategies to reach the most vulnerable. They have worked with local media and built digital ad campaigns to push out accurate public health information in English, Spanish, and Haitian Creole. All of their messages are translated into multiple languages, sometimes up to 11 different languages, Ojikutu said.
The city also recently invested in a wastewater surveillance system, which can detect infectious disease through the city’s water system. While the system wasn’t in place during the height of the COVID-19 pandemic, health officials are preparing for the future, Ojikutu said.
“Instead of pulling back, we have continued to move forward,” she said. “This is about continuous effort.”
Building relationships between health departments, researchers, and well-known Black local leaders was another major driver in increased testing and vaccine uptake, experts say. Having people work at vaccine sites who looked like the Black communities they serve was crucial.
And most essential to narrowing the racial disparities in vaccinations — and in turn who’s most susceptible to the worst outcomes — was the city public health commissions’s empowerment of community lead efforts, Ojikutu said. It was about shifting power.
“The power doesn’t always sit at the public health department or at City Hall or in state government. It really goes to the community,” Ojikutu said. “That has been instrumental.”
Georgia’s battle with Mpox
Soon after mpox, the viral infection formerly known as monkeypox, spiked in the United States last summer, the racial disparities were glaring. In Georgia, more than 80% of cases were in Black men, many of them gay or bisexual.
Initially, much of the state’s response to mpox was left to local health officials who have fractured relationships with Black residents, which created an early barrier to effective, equitable treatment for the mpox virus.
“We don’t have the strongest, healthiest relationships with communities because of systems of oppression and because of systematic racism, and lack of funding,” said Joshua O’Neal, the director of sexual health programs at the Fulton County Board of Health.
From the first free vaccine pop-up events in August, it was clear access wasn’t equitable. Black people had only received around 45% of all vaccine doses, despite making up the vast majority of new mpox cases.
Dorian Freeman, the clinical infectious disease program director at the Gwinnett, Newton, and Rockdale County Health Departments, recalls that 64% of patients at the first few vaccine pop-ups were white, and only 27% were Black.
“It was atrocious,” said Larry Walker, the executive director of Thrive SS, an Atlanta-based organization that connects HIV positive people to care, about the vaccine rollout’s numbers. “When we saw that the people impacted were Black gay men living with HIV, more specifically, we felt like this is our community, we have to respond.”
Ultimately, local and state health leaders reached out to community partners with whom relations had strengthened during the COVID response.
Thrive SS reached out to O’Neal to strategize getting information out to their communities. Thrive provided the Fulton Board of Health with a list of over 400 people waiting to get the mpox vaccine, and that list grew to over 1,000 people, Walker said. The Fulton Board of Health got A Vision 4 Hope, a community-based STD testing service based in College Park, a contract with the state so that the service could provide its own vaccine clinics, O’Neal said.
In Gwinnett, Freeman said the health department’s partnership with Positive Impact Health Centers, an organization that serves those who are HIV positive, not only allowed it to get mpox testing and vaccines to those most affected by the virus, but also get people HIV care. With that partnership, Positive Impact was able to provide vaccines at its Duluth location in Gwinnett County.
“Sometimes we found that individuals would disclose their diagnosis that they were HIV positive, so we were able to evaluate whether or not they were in care,” she said. “We would ensure that they got linked to care, which would happen that same day.”
After some shifting of who was being reached first, local health departments began to see more people of color in the lines for the vaccine, overcoming vaccine hesitancy and being able to have more access to appointments.
As Black, queer folks celebrated culture at last year’s Atlanta Black Pride, organizers saw the weekend as another opportunity to get vaccinations in the arms of those most affected by the spike in mpox infections.
Party promoters and event organizers connected with local health organizations to share information and encourage vaccination among attendees. The result? More than 4,000 doses were administered in one weekend, a significant public health win — and a lesson in how critical community engagement is to addressing racial disparities in diseases across the country.
While vaccine disparities still persist, Atlanta’s success in getting more Black people vaccinated was a success, said Justin Smith, director of the Campaign to End AIDS at the Positive Impact Health Centers, and “it’s a testament to those early partnerships that were made.”
“I think the challenge of the next phase of the mpox response is really trying to make sure it’s integrated into all of our other types of existing sexual health services,” Smith said. “One of the ideas that folks are really trying to push was ‘could the mpox vaccine be available in pharmacies? When you go and get your COVID booster, or your flu shot, you know, you can also get your mpox vaccine.’”
The future of health equity
As these localities slowed COVID-19 and mpox’s impacts on their communities, it became clear that the approaches that were working could be applied to a wider range of health disparities. Free access to testing, vaccination, and trustworthy information allowed Black communities to feel safe in taking ownership of their own health, experts say.
But as the number of coronavirus infections decreases, so have the initiatives around government funded tests, vaccines, and public health messaging. A lot of the efforts started during the pandemic’s peak are no longer in place across the country, including emergency orders and health insurance coverage, said Sabrina Assoumou, a Boston infectious disease physician.
“What I worry about is we’re going to lose ground if people don’t have access to health care,” she said. “I worry that the gap will widen again.”
The way forward, experts say, is to use the community relationships built during the pandemic and apply them to other health outcomes.
“Are they truly lessons learned if we don’t take them and use them to implement interventions across all disease disparities?” said Rhoads, the professor.
This story was published with the support of the Solutions Journalism Network through the Health Equity Initiative.