‘What is the price of a life?’ The path ahead for health equity in Maryland and beyond

For two years, the term “vaccine hesitancy” permeated public health dialogue around the country. In Prince George’s County, where 62% of residents are Black and 20% are Latino/Latinx, the term was often linked to the community as the state determined its COVID-19 vaccine distribution plans, according to Stephen Thomas, Ph.D, director of the Maryland Center for Health Equity (M-CHE). 

“The response from people high up in government was, ‘African Americans and Latinos are hesitant. We can’t let vaccines go wasted.’ That glosses over the underlying inequalities.”

 

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For most Prince George’s County residents, the nearest mass vaccination site—Six Flags America in Bowie—was a 30 minute drive away. Prior to the site’s closure earlier this year, those who were able to make the drive were faced with a mile-long line and wait times of over an hour

Experts have defined vaccine hesitancy as “delay in acceptance or refusal of vaccination despite availability of vaccination services.” But without internet access, ownership of a car, and a few hours of paid leave and child care, receiving a vaccine proved to be a major challenge for many. Thomas says Prince George’s County residents who were skeptical of the state’s vaccination plan wondered why such a robust response was taking place, when people from their community have suffered from diabetes, heart disease, cancer, and other health issues for years prior.  

In September, Thomas and M-CHE Senior Associate Director Sandra Quinn, Ph.D published a 40-page report identifying barriers and potential solutions to the public health movement in Prince George’s County. After interviewing community members, informants, and conducting focus groups, the report found a number of cultural competency-related barriers around public health campaigns. 

According to Thomas, he spoke to African-American residents who felt the phrase “herd immunity” invoked negative connotations with the systemic treatment of enslaved people as chattel or property. The CDC now primarily refers to the phenomenon as community immunity. It is cultural nuances like these that Thomas urged public health officials to keep front-of-mind. 

“We learned hyper local responses to the pandemic get better health outcomes. You can’t just do a nationwide blanket message or communication. You have to be hyperlocal … part of that hyperlocal [response] is understanding what the history is in that particular zip code. So you need community-led, organized [efforts] in the community to advocate measures needed to close the health disparity gap.”

Community-led public health campaigns have proved to be successful. Hyperlocal efforts in the fall to provide education and transportation to vaccine appointments in a number of states helped reduce the gap in vaccination rates between Black and white Americans. 

In Prince George’s County, these public health campaigns are taking the form of barbershops and beauty salons, which partner local community advocates with health clinics to provide information about the vaccine. 

Thomas’ report outlines a number of policy recommendations to ensure community-based health infrastructure remains sustainable in Maryland communities: 

  1. Humanizing delivery and communication strategies around COVID-19 and the vaccine
  2. Establishing a holistic recovery process not only for COVID-19, but for other health conditions within the community, such as cancer, obesity, access to insurance, and other social determinants of health
  3. Ensuring community-based services receive proper staffing and funding. Thomas is advocating for a mandatory national investment of $4.5 billion per year in public health infrastructure 
  4. Generating opportunities for communities to be represented in the public health sphere, such as community health worker positions

For those concerned with whether robust funding or staffing may actually lead to better health outcomes, Thomas poses the following question: 

“What is the price of a life? … This is a pandemic, you want to look at what our failure to be prepared for the pandemic has cost us. [It’s] totally disrupted the global economy, totally disrupted how we work in our own country.”

Thomas also fears that failure to strengthen public health policies will cripple the nation’s ability to respond to future emergencies. 

“You strip public health of its powers to protect the common good—doing it in the name of COVID because of the politicization, five years down the road we find we may have crippled ourselves. When it comes to a foodborne outbreak at a restaurant, or the situation in Flint, Michigan with lead in the water, that’s all public health. We have to get back to the common good. We are our brother and sisters’ keeper.”