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What keeps the White House COVID-19 task force chair up at night?

Checking in with Dr. Marcella Nunez-Smith on COVID-19 and equity

Dr. Marcella Nunez-Smith, now chair of the White House’s COVID-19 Health Equity Task Force, appears via video at a December 2020 news conference with President-elect Joe Biden and incoming Vice President Kamala Harris.
Dr. Marcella Nunez-Smith, now chair of the White House’s COVID-19 Health Equity Task Force, appears via video at a December 2020 news conference with President-elect Joe Biden and incoming Vice President Kamala Harris. (Chip Somodevilla/Getty Images file photo)

Corrected 9:54 p.m. | Mary C. Curtis, host of the Equal Time podcast, usually ends her show by sharing what’s keeping her up at night. This past week, she posed the same question to Dr. Marcella Nunez-Smith, chair of the White House’s COVID-19 Health Equity Task Force and associate dean for health equity research at the Yale School of Medicine.

Here’s a transcript of that conversation, edited for clarity and brevity, on the latest on COVID-19 and equity:

Mary C. Curtis: So at the beginning of this pandemic, Black folks and Latinos were overwhelmingly being impacted for so many reasons. They were disproportionately frontline workers. They were living in communities that had systemic health issues, with tougher access to health care, and also living in multigenerational households. Has that changed since the vaccine?

Dr. Marcella Nunez-Smith: Yeah, it can feel like so long ago. And it really it hasn’t been, we’re talking about just the past year and a half. And your summary was just spot on — all the many reasons why we saw communities of color, in particular, just get hit so incredibly hard by the pandemic. And hit hard in terms of the health consequences — age adjusted rates of who was in the hospital and death are just sky high. And, of course, we think about the economic impact in our communities, we think about the educational impact. So not an issue of biology, but really an issue of the social realities, and the legacy of discriminatory practices and policies over generations. So that’s such an important context for us to set.

And then, where are we now? Not one, not two, but three vaccines in the United States are effective at protecting us from the worst of COVID-19. Hundreds of millions of doses given safely, for free and easy to access. So it’s so important to revisit this question — is everybody benefiting from the promise of vaccination?

We see now, just in these recent weeks, multiple national polls, one from the CDC, one from Kaiser Family Foundation, one from Pew … that show that these gaps in who’s getting vaccinated by race and ethnicity have narrowed, have closed — and in some cases, we’ve even seen a reversal. So for example, people who identify as Hispanic or Latinx, some of these surveys put the rates up with 76 percent having connected with at least one shot. And that’s higher than the averages we see, around 71 to 74 percent or so, for whites. For Blacks, similarly, it’s up there, above 70 percent. And when we look at those over 65, those gaps have been closed for months already, in terms of race and ethnicity. So older adults are getting vaccinated at high rates.

Curtis: Many minorities were mistrustful, some of the medical community and may have been vaccine-resistant as well. Now, has that changed? And why?

Nunez-Smith: As we have this conversation about about vaccine readiness and understanding, one of the first things I would say is, this is an individual-by-individual decision-making process and conversation. And so every moment any of us spends engaging with someone who isn’t yet vaccine ready is worth it. And we have to come with a spirit of both respect, but also curiosity and not presume to know what questions a person has.

But you’re absolutely right, that if you think about the ways in which the government, many health care institutions and others have conducted ourselves, we haven’t always proven ourselves trustworthy. So it’s only rational that people will have some degree of skepticism. And again, it’s it’s not just the history. It’s not just about the U.S. public health service study of untreated syphilis in the Negro male at Tuskegee. It’s also about people’s contemporary experiences, trying to go get health care and feeling discriminated against and treated differently — not having access to high quality health care.

Curtis: The delta variant really tore through the nation. And now the death toll is more than 700,000, or 1 in 500 Americans. So even though that variant seems to be slowing down, when you look at the overall numbers that do show a downward trend on COVID rates, I want to ask: What keeps you up at night?

Nunez-Smith: Ah, only one thing? I am here in New Haven, Conn., and we’re a small city of about 150,000 people. I remember when we hit 150,000, one of my close colleagues, someone who went on to himself have COVID, reached out, and he said, ‘That’s as though all of New Haven has been lost.’ And we were stunned by the magnitude of grief and loss then. And so it is almost incomprehensible — 700,000. And particularly these most recent, so many of them preventable. We have the vaccines. And not every person certainly, but so many people who we’ve lost could have been vaccinated, could have been protected from the worst of COVID-19.

So getting to 100 percent of those who are eligible to be vaccinated … keeps me up at night.

This report was corrected to accurately reflect the percentage of Americans who have died from COVID-19.

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