A year into the COVID-19 pandemic and months into the vaccine rollout, inequity in vaccine access is still a major issue in nearly all states. For example, according to an analysis from Kaiser Family Foundation, 20 percent of vaccinations have gone to Latinx people in Texas, while they account for 42 percent of cases, and they make up 47 percent of COVID-related deaths, while they are only 40 percent of the total population in the state. Racial and ethnic minorities in underserved communities, particularly Black and Latinx people, are experiencing something of a déjà vu as they struggle to get vaccine information and appointments, similar to when their access to testing was limited.
One organization that has shown leadership in this area has been the Equality Health Foundation, based in Phoenix. Months of effort in working for testing and vaccination equity has allowed for learnings along numerous dimensions around how to create greater equity for populations disproportionately impacted by the virus.
Recently, Healthcare Innovation Editor-in-Chief Mark Hagland spoke with Tomás León, interim CEO of the Equality Health Foundation, regarding that organization’s activities in the past several months, and his perspectives on the issues and opportunities facing those working for testing and vaccination equity in the current pandemic situation. Below are excerpts from that interview.
Let’s begin by my asking about the history of your organization. How and when was it founded?
The Equality Health Foundation was founded two years ago with funding from Equality Health, our founding corporation. We wanted to address the social determinants of health in underserved communities. We know that there are a number of barriers getting in the way of the health of communities. And it’s not the work of a single organization. You have to do it with others. Our vision for health is equal health for all, and we’re focused on building partnerships. The vision is a society of health communities, in which every person can achieve optimum health. And to do that, we need to address the 80 percent or more of the factors that make up our health, tied to the social determinants of health.
So, tell me about the landscape around the social determinants of health, and the pandemic, in the state of Arizona.
We’ve got a number of disparity issues, in terms of income, housing, food insecurity, housing issues, especially factors affecting the Hispanic, African-American, and Native communities here in Arizona. And when the pandemic hit, we already knew that it would have a disproportionate impact on communities of color. That’s why we decided we would step in the gap to serve the community and help the community through this health crisis. We noticed there was a lack of testing in these diverse, underserved communities. And so we pulled together a public-private partnership to address access to COVID-19 testing, and issues around quality of life in these communities.
That drove the building of our coalition and the design of our testing model. We developed good testing practices, and for those who tested positive, we developed a medical follow up with our medical partners, to help them stay safe, and keep their families safe. And then we would connect people with community resources, so we’re doing food ox distribution, and connect them with rental assistance and utilities assistance, etc., taking a comprehensive approach.
When did the COVID initiative begin?
We started in May 2020, when the pandemic hit, and we started hearing about the disparities for the Hispanic and African-American communities, so we reached out to Pilgrim’s Rest Baptist Church, to reach the Black community, and other churches. We launched our first testing event there, and have been doing testing just about every weekend since, mostly on the South Side and West Side of Phoenix. We started using state and county data to identify highly exposed areas with higher positivity rates than other zip codes. So we started to identify partners, public and private, besides the church.
Do you have other partners?
Yes, there’s a huge list, but just to name a few, the Arizona department of health Services, Maricopa County, the City of Phoenix; those are the state and local organizations we started to work with. And then our lab partner, Sonora Quest Laboratories, who have been in the trenches with us since May; they do all the specimen collection and lab processing, doing the nasal-swab testing.
And then we had other healthcare partners; some are FQHCs, some are community clinics, like Adelante Healthcare, Valle del Sol, Mountain Park Healthcare, and so on, so that their medical professionals can work with those tested positive. And that’s important, because many underserved communities lack relationships with doctors. So when they test positive, they’re being connected to NPs or physicians. Providing them information and guidance, and ask, do you have a doctor? And if not, you can get ongoing support from the clinic. So it’s all about establishing that medical home for communities we’re reaching and serving that have been disenfranchised and disconnected from the healthcare system.
How many individuals have you tested?
We’ve tested and supported over 35,000 individuals since May. And we’ve tested in 40 different locations—zip codes in South and West Phoenix. And we have a list of over 40 partners that we work with. For example, we’re distributing food boxes and our events through a partnership with Grand Canyon University and CityServe. CityServe is a farmers-to-family program. They partnered with Grand Canyon to distribute food boxes to communities, and we were asked to partner with them, so that we can distribute them at testing events. We’ve distributed—this last Saturday, 165 food boxes. And we’ve given out 660 food boxes since we started that partnership four weeks ago. That one’s pretty new. We added, just in the last month, that partnership to our program.
And then the newest element is that our partners at the City of Phoenix reached out to us because they were working with Walgreens and had a supply of the J&J single-dose vaccine that was set to expire. So this last Saturday, we added COVID-19 vaccine vaccination on the west side of Phoenix. People got testing, a vaccine dose, and a food box.
How many people were vaccinated on that day?
We vaccinated 365 people. We got contacted on a Thursday morning, had a planning meeting on Thursday, started promoting it on Friday evening, our bilingual call center got flooded with calls, and we had to create a wait list; we’re working with Walgreens on that.
We’re primarily working with Maricopa County and a network of public-private partners and community stakeholders. When we launched our effort with testing, we co-founded a rapid COVID-19 coalition that brought together all of these public-private partners. Now we’re moving into this next phase of the vaccine, so we’ve established this One Community Initiative, and we’re mobilizing Hispanic and Black community leaders, to focus on fair and equitable distribution of the vaccine in these underserved communities that have been hit the hardest by the pandemic. This event last Saturday launched that initiative. And we’re planning to activate the rest of that initiative starting in May, to be involved in vaccine distribution.
What have the biggest learnings been so far, for you and your colleagues, around all of this?
There have been three. Number one, it’s important to have the most accurate and available data to help pinpoint our efforts and identify where the disparities are. And that was a challenge with the COVID testing and the vaccine rollout. And when data was available, it showed huge disparities. For example, in Arizona, only 6 percent of those who received the vaccine were Hispanic, though they make up 30 percent of the cases and nearly 30 percent of the deaths in Arizona, so clearly the Hispanic and African-American communities were being underserved in this. So we want to be part of the distribution of the vaccine. The percentage of Arizona that’s Hispanic is 35 percent. So clearly, Hispanics are experiencing a great disparity, including now, a lack of access to the vaccine. So data’s important to direct efforts and pinpoint gaps and identify efforts.
And the second is that it takes multi-level partnerships, both with state and local municipalities and local public and private partners. No one organization can do it all, but you need a coordinating body, whether an alliance or coalition, focused on where we need to go to reach communities hit the hardest; so that was another lesson we learned, and are applying with the vaccine effort.
And the third lesson learned is that you have to take these efforts into the heart of the community. A lot of states are setting up these large pod sites that are far from the communities impacted the most. So you have to develop an accessible delivery system—you have to go into the churches, American Legions, parks, onto college campuses. You have to set up a system of sites connected to the community. That was a big lesson, too, to connect to businesses and other entities in the community.
How do you expect things to develop in the next year or so?
Right now, the immediate focus is fair and equitable access to the vaccine. Before September, we hope to achieve that national and state goal of getting 75-80 percent of the community vaccinated. Long-term, there are two things: one, this coalition-building that we’ve done is a preparedness and responsiveness coalition that can be activated anytime there’s a public health crisis. Today, we’re responding to the COVID-19 pandemic. We’ve established connections and protocols and communication channels that can be activated in future situations. And the next focus, the focus of our mission and foundation, is to begin to address these social determinants of health in the community that put people at risk. When people don’t have access to healthcare, to food, and have multiple chronic conditions that put them at risk for the virus, and lack access to the Internet and to computers, when appointments can only be made online—that left a lot of individuals out in the dark, because they didn’t have access to computers or the Internet or to bilingual call centers. There are a lot of root-cause issues to focus on. We strengthen the health community and minimize the risk factors for people living in those communities who will hopefully stand a better chance of being less at risk as the result of a new public health crisis. This pandemic has revealed those inequalities and the disparities caused by these root cause issues.
What kind of budget are you working with right now?
I’m working a shoestring budget. We’re making lemonade out of rocks right now. The funding we got came from the state and the county and from the cities, who received some of the CARES Act funding, and contracted with us to implement some of these testing and vaccination efforts. We were able to utilize those resources on a cost basis.
Are you hoping to get corporate funding?
We did get some corporate funding from some of the health plans that have stepped up and made some contributions to support these efforts; and we did get some funding from location corporations. Most of it came out of CARES Act funding; and we’ve submitted proposals to the AZ Department of Health Services and the County to help fund multiple access points in communities. We’ve put in a big proposal around that. It will also cover a public awareness and community access campaign, to start addressing vaccine hesitancy issues in the Hispanic and African-American communities.
Is there anything you’d like to add?
We’re all trying to reach community-wide immunity, to jumpstart our economy. But to do that, we need to focus on continued COVID testing, and continue with practicing the prevention measures we’ve implemented in the state of Arizona. We need to continue educating people, and getting people ready to step in line and get them ready to receive the vaccine.
And we’ve seen the importance of promotoras. [As Wikipedia explains it, “A promotora is a lay Hispanic/Latino community member who receives specialized training to provide basic health education in the community without being a professional health care worker.”] One of the grants we received in partnership with ASU from the NIH [National Institutes of Health], was to enhance our community testing model with community health workers. They’re playing multiple roles in this pandemic that they have not used before. They’re using saliva-based test kits among the public. They assist with door-to-door and public events. These are bilingual community health workers. And they help uncover some of the needs—food insecurity, rental assistance, and other needs, and they help connect people to those resources. And we help people to find a vaccine location, registering for vaccination, and ensuring transportation to get people to those events. These are organizations that get piecemeal funding from donors and corporations. They’ve demonstrated that they’re a key element in the healthcare delivery system. So we have to figure out a way to evolve that role forward and make it sustainable. So that’s a key part of our approach, and key to our reaching people and engaging them, in the vaccination process.
