Watch the AMA's daily COVID-19 update, with insights from AMA leaders and experts about the pandemic.
In today’s COVID-19 Update, Aletha Maybank, MD, MPH, AMA’s chief health equity officer, shares an update on equity issues and the pandemic, including the Biden administration's announcement of members of the health equity task force, charged with issuing recommendations to prioritize health equity in the federal government’s COVID-19 response and recovery.
Dr. Maybank also discusses inequities in vaccine distribution and the importance of collecting race and ethnicity data to guide health care decisions in the months to come.
Learn more at the AMA COVID-19 resource center.
- Aletha Maybank, MD, MPH, chief health equity officer, AMA
Unger: Hello, this is the American Medical Association's COVID-19 Update. Today we're talking with Dr. Aletha Maybank, AMA's chief health equity officer in New York who'll give us an update on equity issues and the pandemic. I'm Todd Unger, AMA's chief experience officer in Chicago.
Dr. Maybank, lots of big news since we spoke to you last, starting with a new president, a new administration that has a renewed focus on equity. Can you tell us what we've seen so far from the Biden administration and share your hopes for what's to come?
Dr. Maybank: Yes. Thanks Todd and good to be on with you. I know we haven't talked in this venue since the new year, but really glad to be on the show today. So yes, a lot has happened. I mean, I think the administration has been very clear that equity is absolutely a priority and even listing and saying racial equity as a priority as well and that this is going to go through and across all of government and all of the federal government. And that's, from us who've been doing this work for years, it's like music to our ears to hear that there is potentially a really strong commitment to ensuring that the policies and the programs that are put forward by the federal government are all going to have an equity lens moving forward. Or they're going to build to that space of having an equity lens.
And so we saw on February 10th, there was an announcement of the members who were going to be in the COVID-19 Health Equity task force, which is led by Dr. Marcella Nunez-Smith who is wonderful and a wonderful colleague. And it was one of the first executive orders that he put forward.
The purpose of the task force, and hopefully it's obvious to many, is to really provide recommendations on the inequities that we know are existing even before, but really as a context, but what's happening right now during the pandemic and all the things that we need to do to make sure that there's an equitable roll-out. What I have really valued, honestly, about looking at this task force, I think the administration did a wonderful job at picking the folks for this task force.
When you look at it, it is truly clear that they centered voices and voices who are representing communities of those most marginalized. And that's a key step to doing equity work. We have to do that. And so you'll see, there's the president of Meharry, a historically black medical college, representatives of disability rights. There is a high school senior on the task force, folks who are representing people who are incarcerated and Domestic Workers Alliance.
And all these folks are really reputable in those spaces. So I'm really looking forward to seeing what the recommendations will be moving forward and the guidance. And then clearly we here at the AMA and the Center for Health Equity are always available to support in any way. And we'll continue to do the work that we're doing to advocate for greater equity for not only the health care system, our physician community, but patients and people at large.
Unger: Well, they have their work cut out for them because we've seen such a broad range of disparities throughout this pandemic. And one that we're seeing again, repeating this pattern, is around vaccines. So can you talk a little bit about what you're seeing around inequities in the vaccine rollout, which has been rocky and a lot of room for improvement here?
Dr. Maybank: Absolutely. It's an ongoing, it's the problem presents itself, right? And we're always trying to struggle with what the solution is. Our data tells us there's a problem, and again, what's the solution? And I feel this is where the equity experts are really important and to really, really value what they're saying.
I think about Dr. Camara Jones and she's just excellent at frameworks for, "How do we really achieve equity during these times?" And it's not just a moral compass, but it's a practical opportunity for us. And that first, we have to value all individuals and populations equally. And folks will say, "Yes, I do that," but the reality is that we don't because our data tells us that we're not doing that. And if we're not centering voices in the way that I just mentioned that the health equity task force is, then we're not taking those pragmatic steps that help us do that. In order to really value all voices and people equally, they have to be at the table. We have to listen and understand what their experiences are. That's one thing.
The second thing is recognizing and rectifying all the historical injustices. And so we had a great piece come out by our CEO yesterday about the history of AMA and then we have to recognize that and rectify that. But it's the same thing in the context of how people experience injustice. All the conversations around mistrust and building trust, one, fully aren't really usually framed right.
The reality is that, people feel that way because of those historical injustices. And it impacts how we are able to do the work that we want to do in terms of achieving equity and making sure everyone has access to vaccines. So we have to pay attention to that. And as institutions we have to question, "How do we become more trustworthy? How do we look at our systems of racism and exclusion and discrimination that don't allow people to trust us?" That's the second thing.
Then the third thing is about providing resources to those according to need and treating people equitably. It's not just equally, where you're providing people to same, we have to value people equally but we need to treat people equitably based on the history. And so if people have been disinvested, they haven't received resources, then they need more. And we're not doing that, we're not really providing resources according to need. We're trying to. I'm not saying the country's not making efforts, but it's not making deep enough efforts to really reach Black and Brown people.
Unger: Can I ask you just to talk a little bit more ... you made that differentiation between treating people equally and treating people equitably in regard now to specifically around the vaccine. What does it look like? What's that change look like?
Dr. Maybank: And just a correction, valuing people. So this is the valuing people equally. So you and I are equal, I come to the table and I say, Todd is equal to Aletha, right? But for some reason, maybe ... and this is the reality, I don't have as much wealth as you do, or I don't have a home. That means we have to be treated differently based on that. The value is there as people, but we need to treat people differently. So I need more, I need a house. I need money that way we get to the point of being more equal, per se.
So, that's what we're not seeing. As an example and I'll bring up how the strategies are happening. So there's lots of focus on building, creating these mass vaccination sites ... and I started volunteering in New York City at one on this past Saturday and I got my first, Moderna at that.
And the mass sites are great. They're great for speed. They're great for getting a lot of people vaccinated all at the same time. But think about if you live in an area, even in New York City, I'd have to say. If you don't have transportation and those vaccination sites are one per borough, what do you do? How did you get there?
My mother, as another example, just to bring up story because I think it's helpful, lives in New Jersey and her vaccination site was at a community college. And the assumption is completely that she has a car because it's a drive through. It's in a long, big area that you drive through and you get to the space. But if you don't have a car, what do you do? How do you get the vaccines? How do you even know, let alone if you have a car, how do you know somebody is healthy enough to even leave their space in order to get it.
Another gap that we're seeing that starting to elevate in the news are gaps around pharmacies and where they're located. And I saw a great map of a particular large-scale pharmacy and some data in Chicago that showed where their pharmacies are located. And it's all around the perimeter of the west side of Chicago, not in the heart of west side of Chicago. So that presented itself as a barrier.
That means we have to have more intention. We have to look at the data like that and we have to have more intention and strategies to go deeper and to say, "How are we going to really connect and get vaccines within the communities that really need the most that we know are actually excluded?" That's the word we have to use is that these communities are excluded.
Unger: It's frustrating because, it's not like we didn't know about these problems before COVID, they've been exacerbated by them and we've seen the statistics around mortality going into this. And now we're just repeating those same issues in the vaccination rollout. I wonder why are these issues not anticipated because of the planning that it takes to really do what you're talking about?
Dr. Maybank: It's a great question and I think that's the question of why does racism still exists? At the end of the day we have to have the will, the urgency of now to say that ... and that's all of us. And leadership, that's not used to talking about equity and justice, have to show up in a different way. And really, again, value people equally.
The reality is, you only understand for the most part what it is you see and what it is that you experience. And as leaders of institutions, if you only have a small window or a window of what you see, it's really hard to fully understand what communities who have been made most vulnerable are experiencing. And in order to get that context better, again, I go back to the critical nature of centering voices.
We don't see the world as it is, often, but we see it as we experience it. And so not having those voices at the table, we're missing out on potential solutions and opportunities to make sure that we are delivering care. And for this particular situation, delivering vaccines in a more equitable way. And I feel if folks are not doing that, centering those voices, ideas and experiences at minimum, and we're not collecting data at minimum, it's all lip service. Really. A commitment to equity, you have to make that commitment to equity to say, "We're going to do those three things that I mentioned at the top of the show."
Unger: So given where we are right now, and the urgency of the situation and the statistics that we have before us, what needs to be done?
Dr. Maybank: Hopefully, with the new administration what's going to be helpful is that we're going to have some level of coordination. I think that is going to be tremendous. Coming from the public health perspective, that has been really difficult. It's really hard to achieve equity when you don't have some level of targeted approaches and strategies that are going to be somewhat universal in some ways, but also targeted universalism in the neighborhoods that we know are hit the hardest. So with this national coordination, I think we're going to achieve that a lot more easily.
I also think, again, as I mentioned at the top of the show having the health equity task force and having some recommendations from there. And I'm sure they're providing guidance out along to the federal level on what to do and the critical nature of that. The conversations that have been happening that I've seen lately, and these are really have come a lot from communities of color. I think there've been a lot of ground-up responses that have been amazing from positions of color and providers of color and other leaders of color.
I think about Dr. Ala Stanford who's in Philadelphia who organized a COVID Black Collaborative. And since the beginning of COVID, they got a van together and they went around and started to do testing. And now they're doing vaccination rollout. But it's those opportunities that I think we need to identify and those strategies that are happening organically, per se, across the country.
Then we need to fund those strategies and figure out how to scale that. Because those are coming from, from my perspective, directly from the communities, directly from the people who are experiencing it. And so they're putting forward ideas, putting together and bringing together people from different walks of lives and professions to achieve the goals we're looking to achieve. That oftentimes it's really hard to do when you're at this other level of government, very distant and not proximate to what the problem is. And so I think we need to really call to those who are approximate, look at what they're doing, fund what they're doing, and be able to replicate that.
Unger: A lot of times when we talk something that sticks out in my mind, as you say, we have to meet people where they are. And in this case, we literally need to be people where they are with urgency.
Dr. Maybank: Absolutely. Yes.
Unger: You mentioned something in the discussion too, around data. I recall from early discussions with you back at the beginning of this, where we just didn't have data about who is getting COVID, now we know. The disparities were evident early in this process and have really come to pass. There're issues around vaccination too. Is that a place that you were focused in terms of getting the data for that?
Dr. Maybank: Yeah, the same way. You're right, Todd. Early on there was a lot of focus on just data around cases and hospitalizations and deaths. And now, it's not surprising, as you mentioned the same systems and structures were basically in place as they were about a year ago. And so we're challenged again to have data missing, and a lot of data missing as it relates to vaccinations. Almost half, like 47% of missing data across the country.
And in talking with other folks at Kaiser Family Foundation, who's doing some great work around trying to collect this data around vaccines, there are so many barriers as it relates to collecting data. There are structural barriers, there are policy barriers, there are institutional barriers.
Then there are barriers about what people know and what they don't know and understand about the importance of collecting race and ethnicity data. The importance of how collecting race and ethnicity data is actually an equity strategy. And you're really not fully committed to equity as a strategy if you're not collecting that data.
We have started to, at the American Medical Association we're going to make efforts to work in partnership with people on this, but to really draw some attention to the importance of collecting data. There's a lot we can't change at this moment in terms of some of the systems and structures. We can advocate for it and we'll use our advocacy arm to do that.
However, we can provide some education to health care workers and providers and physicians of just the importance of it. Some folks don't feel comfortable asking those questions. And so there are some guides and some tools out there that we're going to soon provide to the community and the physician community on how to get more comfortable in, how they should ask the questions around race and ethnicity. Just to help encourage health care workers, not only just physicians, but also in the pharmacies and all the different places that they're going to be collecting data.
Then we also know that patients are uncomfortable with providing that data for many legitimate reasons as I mentioned before, in terms of the lack of trustworthiness of institutions. Based on all the kinds of isms and the power systems that have excluded people, discriminated people and oppressed people, that people have fear in sharing those datas.
Immigration data, that's fearful for some people to show up and share. So I think our role is knowing that there's a power dynamic with us as health care institutions and provider, is that it's our role to help with that comfort for our patients around the importance of collecting race and ethnicity data.
Unger: A lot of those issues just need to be anticipated and worked into that particular structure. One of the things that we're seeing right now is, it's certainly about an issue around supply. And hopefully we're going to see supplies increase, and as that happens, do you see a role for employers to play in vaccine distribution and ensuring equity in that process?
Dr. Maybank: Absolutely. I also ... And I'm going to get to employers too. But I also want to mention, I know this is something that we're really advocating for at AMA, which makes sense, is that the physician practices need to have, and they are employers too I guess, but they also need to have access to the vaccines. There's a huge gap in physician practices getting access to vaccines across the country. And that's important from an equity perspective.
And it's just important in general because we know that physician and the health care provider is one of the most trusted entities in a person's life. Even in light of all the historical injustice, the physician is a trusted entity. So they need the vaccines in order to give them and to be able to talk to their patients. But that's where a patient is more likely to go to.
It may be harder to get to the mass vaccination site or the pharmacy that's not in their neighborhood, but they oftentimes have a relationship with their physician or a health care provider. So I just wanted to really elevate that because it is an equity strategy to make sure that the physician practices have the vaccine.
In terms of employers at large, I think you're absolutely right. The initial supply was very short, but employers have this opportunity to educate, I think, is going to be really critical. But also to be able to provide the space to also potentially give vaccines if they have access to them as well.
Myself and Dr. Esther Choo along with Chelsea Clinton published a paper in USA Today about two weeks ago about all the things that employers can do in order to create a space of which really is supportive of getting the vaccines. And it's everything from education and setting up this onsite vaccination, like I mentioned, but also encouraging paid time off for when folks do get the vaccine.
I had my first shot of Moderna on Saturday and I was tired the next two days. I was surprised by that, I didn't think that that was going to happen, I've heard with the second. But I was tired and some folks are completely fatigued, fever, all of those things can happen and they have children at home. So they need space and time to be able to go get the vaccine. So that's really important.
And then there's going to be the conversation that comes up as it relates to mandates or not. And they're going to all have to be considered. Right now I think most employers are absolutely, more so, encouraging folks to get the vaccine than they are mandating, but there will be concerns that really go across the board as it relates to the human resources and policy risks, privacy discrimination, just other employee relations issues. So there's going to have to be a lot of coordination between employers and a lot of communication to make sure that everyone is comfortable with what the situation is in the employment space.
Unger: And I think there are a lot of ways that employers can play an active role in advancing equity through vaccination on many fronts as well.
Dr. Maybank: Absolutely.
Unger: Well, Dr. Maybank, it is always fascinating to hear your perspective. And thank you for the leadership that you and your team are showing on this important topic. That's it for today's COVID-19 Update. We'll be back with another segment shortly. In the meantime for resources on COVID-19 visit ama-assn.org/COVID-19. Thank you for watching and please take care.
Disclaimer: The viewpoints expressed in this video are those of the participants and/or do not necessarily reflect the views and policies of the AMA.