Commissioner Bharel: What it means to be an equity city

Mar. 7—Throughout the pandemic, data has been driving Massachusetts's Public Health response and now it's driving the vaccination effort.

"It's been a very long year. It's been a very hard year. There's been a lot of suffering and death," said Public Health Commissioner Monica Bharel in an interview with The Eagle-Tribune. "Throughout that work we have seen some of us are more impacted by COVID-19 than others. We know from our data that unfortunately, Black and brown communities have a higher burden from COVID-19 both for cases, hospitalizations and deaths."

That's why the state has implemented a program targeting 20 cities and towns — including Lawrence, Haverhill and Methuen — that have been hardest hit by COVID-19 as "equity cities" two weeks ago. Those prioritized cities and towns of over 30,000 people will receive help distributing the vaccine to those disproportionately affected by the virus.

Recent data from the Kaiser Family Foundation shows Massachusetts is leading the country as one of the larger states vaccinating more Black residents as a percentage of the vaccinated population. Black people accounted for 6% of the vaccinated population while they represent 8% of the total COVID-19 cases and 7% of the state's population.

However, the same data set shows there is a greater disparity in Hispanic people accessing the vaccine. Only 5% of the vaccinated population in the state is Hispanic. Despite Hispanic people making up 12% of the state's population and 28% of COVID-19 positive cases in the past year, according to the Kaiser Family Foundation.

In priority cities there are more pharmacies and local health clinics working to distribute the vaccine to break down barriers, Bharel said.

Currently, with a shortage of the vaccine, the state is working on a public awareness campaign to ensure citizens have "the best most-accurate information so they can make good decisions" to get the vaccine, Bharel said.

Part of that public awareness campaign means giving each of the priority equity cities their own community liaison who helps get out local messaging about the vaccine. In Lawrence, the liaison has helped with bilingual messaging, hosting town halls and is working on a social media campaign to get information out to residents, Bharel said.

Eventually, as vaccines become more widely available there will be more allocated to these specific cities and towns, Bharel said.

The Eagle-Tribune asked Bharel to explain the program and where the commonwealth is in its vaccine distribution process. Bharel's answers have been edited for length and clarity.

How were the priority cities identified?

Bharel: The list was generated by starting with the list of communities with the highest case rates and also the ones who had the social and economic impact. We used the CDC Social Vulnerability Index that takes into consideration multiple economic and social barriers to accessing health.

So we took those then we excluded cases in long-term care and correctional facilities because they had been vaccinated in phase one. Then we ranked the list by case rate, looking at this burden of cases and cross-matched that to the highest populations of color. Then we cross-matched that to the highest percentage of people of color. And we made sure to include the top 15 cities that had the highest burden of disease and that lead us to this list of 20.

What is the role of a community liaison?

Bharel: The role of the liaison is to really connect the community to resources and provide assistance as they need it.

It's very important for us when we go and work with these 20 hardest-hit priority communities we are not going to tell the community what to do. We are there to raise the voice and accentuate the voice of the members of the community so that they can be heard.

Why is targeted messaging in these communities important?

Bharel: When we get information from people who we have trust in and people who are known to us it is easier to digest.

Being hyper-local with this community liaison effort is really part of our intention so the messaging is hyper-local from individuals that people know are from their community health center or community organization they trust. Or a faith-based organization that can help people trust.

Why is this a public awareness campaign without additional doses given at this time?

Bharel: Right now we have more capacity in Massachusetts to give vaccines than we have supply from our federal partners. So that's frustrating for all of us because there are people eligible to get the vaccine who cannot get it because we do not have the supplies. Everybody in Massachusetts who wants to be vaccinated will be vaccinated. It will take time. It will take patience. It will take all of us doing this work. But it is our collective goal.

We want to be prepared for what's coming. Building trust and confidence takes time. So as people become eligible we want people to feel safe and understand the scientific facts about the value of this vaccine. The second goal is for all of the people currently eligible can have the barriers decreased to getting the vaccine.

When supplies allow, will these priority cities be allocated more vaccines?

Bharel: Our absolute goal is, as the vaccine becomes more available and the federal vaccine allocation increases, that we will be making more vaccines available throughout these communities.

How will state and local officials know these measures are working and their residents are being vaccinated at the same rate as residents across the state?

Bharel: We are looking at making information available at a community level. Communities have asked for things like zip-code data. Because I understand in a community you could have certain areas more impacted than others, so we are working with local communities on that. We will be providing them with more detailed data to help their hyper-local approach.

Public health experts across the country have said the Johnson and Johnson vaccine could help increase equity by going to underserved areas because it is only one shot and easier to store. Will Massachusetts use it in a targeted way to help promote equity?

Bharel: Unfortunately, we got a one-week supply of the Johnson and Johnson, and we don't have a consistent supply. We will get a new shipment at the end of March. So we will be able to plan it when we have more clarity on regular dosing related to Johnson and Johnson.

With three vaccines currently approved, do you recommend one more than another?

Bharel: All three vaccines are effective against COVID-19 and all three vaccines have gone through rigorous clinical analysis. I'm pleased we will have these three options in Massachusetts. Whatever vaccine becomes available to someone I would urge them to get it when their turn comes up.

Vaccines are available, does this mean life is going back to normal?

Bharel: We unfortunately still in the pandemic. Wear your masks. Social distance. Don't gather in large groups.

I know it's been a really long time, but there is a light at the end of the tunnel and these vaccines are the light at the end of the tunnel. Our job is to make sure every resident has access to one and we are working hard to make sure that happens.

President Joe Biden announced this past week that the United States will have vaccines for every adult American by the end of May. If the federal government delivers the vaccines that quickly, is Massachusetts prepared to distribute them that quickly as well?

Bharel: Absolutely. We hold no vaccine back. We have many ways to distribute them. Our goal is to vaccinate as many people as quickly, efficiently, effectively and equitably as we can.