Vaccines and Communities of Color: Johns Hopkins’ Dr. Monica Schoch-Spana on Quest for Equitable Distribution and Lasting Solutions

Dr Mona Schock - Spana

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Marianne O’Hare : Welcome to Conversations on Health Care with Mark Masselli
and Margaret Flinter, a show where we speak to the top
thought leaders in health innovation, health policy, care
delivery, and the great minds who are shaping the hea lth ca re
of the future.

This week , Mark and Margaret speak with Dr. Monica Schoch -
Spana , Co - Chair of the Working Group on Equity in COVID - 19
Vaccination. CommuniVax is a n ational consortium of experts
and advocates involved in the vaccine process. She is also a
medical anthropologist and Senior Scholar at Johns Hopkins
Center for Health Security at the Bloomberg School of Public
Health. She talks about their new report , Equity in Vaccination:
A Plan To Work w ith Communities of Color t oward COVID - 19
Recovery and Beyond .

Lori Robertson also checks in . Managing Editor of
F act C heck.org looks at misstatements spoken about health
policy in the public domain, separating the fake from the facts ,
and we end with a bright idea that's improving health and well -
being in eve ryday lives.

If you have comments, please e - mail us at [email protected] ,
or find us on Facebook or Twitter ; we love hearing from you .
Now , stay tuned for our interview with Dr. Monica Schoch -
Spana here on Convers ations on Health Care.

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Mark Masselli: We are speaking today with Dr. Monica Schoch - Spana , Co Chair
of the Working Group on Equity in COVID - 19 Vaccinations . ,
CommuniVax , a n ational consortium of experts and advocates
involved in the vaccine process , t hey just released a detailed
report advising state and local governments on how to support
vaccination campaign that works for people of color.

Margaret Flinter: Dr. Schoch - Spana is a medical anthropologist and Senior
Scholar at the Johns Hopkins Center for Health Security at the
Bloomberg School of Public Health. Her team has been
examining many challenges from the COVID - 19 pandemic,
from v accine readiness to mental health. She is an advisor to
Homeland Security. Monica, we welcome you to Conversations
o n Health Care .

Dr. Monica Schoch - Spana : Thank You .

Mark Masselli: Well , you know, the CommuniVax is such an important
initiative. Community leaders, public health experts, health

Dr Mona Schock - Spana

care providers, a vaccinologist , the team was brought together
in last Novemb er to sort of create guidelines to ensure that
communities of color gain equal access to COVID - 19 vaccines. I
wonder if you could just tell our listeners more about the
Communivax initiative , who the partners are and how this
report came together .

Dr. Moni ca Schoch - Spana : The Communivax coalition has three major components. The
first is a coordinating hub that includes social and cultural ,
political , operational and social justice perspectives on COVID -
19 vaccination. But the coordination is of five local r esearch
teams that are embedded in their own local communities and
working with public health implementers and applying what
we call an ethnographic perspective on COVID - 19 vaccination ,
delivery communication and uptake. That means community
centric , and a lso , from the perspective of an insider . We are
benefiting greatly nationally from surveys at the n ational level.
The rollout of the vaccination campaign really can benefit from
the more granular understandings that people have about
what vaccination means to them and what’s keeping them
from being vaccinated. So, we have teams in Maryland,
Alabama, Idaho and California . Along rural and urban
con tinuum , c urrent presence in Latino communities and also
Black communities.

Margaret Flinter: Well Monica, your te am at Hopkins has been working on how
to best prepare the public at large for vaccine readiness and
we know there has been hesitancy across the broader
population and perhaps in particular in communities of color.
Your report has five key actions that you’ ve identified that will
promote greater awareness of the vaccine safety, its efficacy,
how well it works. So, share with our listeners the five I’s that
you identify in this report , and as a medical anthropologist I
think you understand so well wh y e ffecti ve communication i s
at the very core of these objectives. So, maybe share a little bit
about that with us.

Dr. Monica Schoch - Spana : We’ve put forth the Five I Framework for s tate and local
officials to think about how they can advance equity within
COVID - 1 9 vaccinati on campaigns in their backyards. And the
first is iteration , which means ongoing improvement and
consistency and steadfastness , and what we mean by iteration
is that in the vaccination campaign there is the urgent work of
vaccina ting as many peo ple as possible. On the other hand,
there is another critical work stream which is the trust building
that must transpire between government, public, health and
communities of color , a nd there needs to be ongoing
exchanges between public health and their c onstituents of

Dr Mona Schock - Spana

color. So that’s iteration.

The s econd is involvement. Often times there is a sense if only
we deliver the scientifically accurate information in culturally
sensitive and personally meaningful ways then people will just
come around to be vac cinated. What we are saying with the
involvement principle is that public health needs to consider
members of these hard hit communities as co - c reators of
vaccination delivery and communication systems. They are not
passive by standards and there is a grea t deal of community
related data and community knowledge that needs to be
tapped for this vaccination campaign to succeed. Information
is about getting the information that can inform decision
making by people of color , and again , it’s not just p ackaging
t he science so that it’s more accessible. At the same time, we
need to sit and listen to what the perspectives and inputs are
of communities of color , where vaccination plays a role , in
their experiences of the COVID - 19 response , and what it
means going for ward in terms of economic and social and
health and well - being.

I think, where our Communivax group departs a little bit from
other work on vaccine confidence and access are on the two
additional I’s . Th e first is investment , and lastly , integration.
What we would like for the implementers of the vaccination
systems is to think about the vaccination campaign not simply
as a public health intervention , a one - time one - off public
health intervention. It is indeed an economic enterprise that
can be mobilized t o advance a community development and
economic revitalization goals within hard hit communities of
c olor.

And then with integration, our point here is that vaccination
may be kicking off an d accelerating a process of recovery , but
we have not in the United States , engaged in , particularly at
the community level , cross - sector integrated planning for a
comprehensive and holistic form of recovery from the
pandemic. There is certainly a focus on vaccination and there is
also a focus on jump - starting the economy , but we also need
to think about mental health, our emergency management
systems, our health care delivery systems , h ow are we going to
improve all of those so we don’t have disproportionate impacts
in the future.

Mark Masselli: Dr. Schoch - Spana, I love s o much of what you said , and the five
I’s initiative that you have , and really trying to build trust ,
having the BIPOC communities part , c o - c reator of this effort ,
and then looking forward . And I really want to talk about

Dr Mona Schock - Spana

looking forward because I know you see this unique
opportunity to create a lasting improvement in the public
health infrastructure. Talk to us a little bit about the aspect of
the plan that goes beyond getting one or two shots in the arm ,
and those are important shots , b ut how do we levera ge this
moment to make something more meaningful, impactful and
long lasting in the system?

Dr. Monica Schoch - Spana: Yes . Let me spotlight t w o concrete objectives. The first is the
strengthening of the public health infrastructure , such that
public health practitioners can create genuine relationships
through which they engage their community partners. We all
know about the under - resourcing of the public health
infrastructure in the United States , but there is a story
embedded in there and that is the under - resourcing in
particular of the organizational capacities for communication,
community engagement , and we have not equipped our health
departments strategically or in terms of resources or personnel
such that they can do the longstanding work of strengthe ning
trust, building it where there is none . And so we need
personnel operating budgets and investment of an executive’s
own time in t he community engagement work that is essential
to public health practice in the United States.

So there is strengthening o f the public health infrastructure for
community engagement . At the same time, we also need to
create and finance a coherent public health sector in the
United States. We have community health workers who have
deep roots , particularly in BIPOC communities , and who play
an essential role on an everyday basis to help surface and meet
the health and wellness needs of BIPOC communities. But we
do it in a very ad hoc, unsystematic way , and our financing
systems in the United States do not invest in the communit y
health sector. We may have a public health infrastructure
that’s underfunded; we may have a fragmented mostly for
profit health care sector , but even more in need of cohesion
and coherence is the community health sector , and we don’t
have the financing m echanisms to do that just yet.

Margaret Flinter: Well, Monica , you raise such great points , and one of the areas
that is now really bubbling up in the news everyday. First was
can we get the vaccine , and then is can we distribute the
vaccine , and now it is who are we distributing the vaccine to .
Right ? And we started with our over - 75 year old population ,
but lot of attention now to are we getting this to the hardest
hit communities , a re we getting it to diverse communities and
communities of color . One of t he -- I don’t know if it’s criticism
or commentary I am hearing , is that maybe the way the VAMS,

Dr Mona Schock - Spana

The Vaccine Administration Management System that was
developed , maybe it’s not where it needed to be around being
able to track racial and demographic data. I am wond er ing if
you can just sort of educate us where are we at this point at
being able to report that out in a meaningful level . Are we
relying entirely on self - report of patients , which may include a
choice not to? Are we looking at c ens u s trac t data , or
predictive analytics or anything to give us as robust a sense as
possible about whether we are hitting the mark and getting
vaccine distributed in an equitable way?

Dr. Monica Schoch - Spana: Y ou know, data is absolutely key to achieving equity objectives .
We know as a nation that we have not done a good job of
tracking in a very system atic way the impacts on racial and
ethnic minorities in the United States. So there is the impact of
the pandemic to begin with. There are issues also of
distribution system s that are in place and does their location
map , f or instance, on GIS Maps of areas of need. We also need
to do a better job of tracking , as you said , the uptake across
different de mographics. So it includes racial and ethnic
minority groups , but because t hese groups are not
homogenous, we also need to pay attention to age and gender
and also intersectionality with education. I think data is
important because it puts a fine point on a reality that there is
inequity in the Uni ted States that can be reversed , but we need
to have a monitoring system that allows us to baseline where
we are, where we can make adjustments along the way , and
shift so that we are improving.

I think , also , it takes a lot of political courage in the United
States to tackle issues like systemic racism . And the more
objective data we have to say look, we can show you quite
factually that there are disproportionate effects, we need to
create policies that remedy those. So data, it puts a boundary
around an otherwise socially contentious a nd politically touchy
subject and provides leaders the courage they need to tackle
something like systemic racism.

Mark Masselli: We are speaking today with Dr. Monica Schoc h - Spana , Co Chair
of the Working Group on Equity in COVID - 19 Vaccinations .
CommuniV ax , a n ational consortium of experts and advocates
involved in the vaccine process , j ust released a report titled
“Equity in Vaccination: A Plan t o Work w ith Communities of
Color t oward COVID - 19 Recovery and Beyond” . Dr Schoch -
Spana , I want to go back to y our note earlier that we are
under - resourcing our health departments and our public
health systems. I think that’s such an important observation.
As you start to think about this grassroots local level activity

Dr Mona Schock - Spana

that goes on , what are the resources that wil l be needed , and
how do you see sort of the partnership , maybe re - imagining
the public and private partnership , that could yield some
meaningful results? This pandemic laid bare the really terrible
condition that our country has at this local public health level.
Talk to us about some of the creative imaginative partnerships
that might exist out there.

Dr. Monica Schoch - Spana: Well, to speak to your first question , which is sort of the
limited capabilities within public health departments , I should
note tha t I conducted two national surveys among local health
departments in the United States to try and understand better
what resources and practices they were using to engage
community partners a n d the larger public health emergency
management system. And thos e health departments that
excelled at what we call intense public engagement , that is ,
they weren’t just handing out brochures . Okay? They were
convening joint planning sessions, they had town halls . There
was more transparency about what the strategic dir ections
were of the health department. Those health departments that
had intense community engagement had a strategic plan. So it
was prioritized at a strategic level and embraced as a top
priority.

They also had dedicated personnel whose jobs were to serv e
as community navigators and ombudsmen to div erse sectors of
their community. They also had operating budgets so that they
could convene meetings, listening sessions, and also public
town halls. So, sadly that portfolio is not robust among the
3000 or so health departments across the United States. They
also had granting mechanisms to partner with community -
based organizations. But I don’t want to overemphasize the
work that needs to go on in the public health infrastructure to
the detriment of understandi ng where we can do more
innovative things.

I had a spokesperson from a Latino h ealth NGO say, “ Many
grants are going to get us many change. ” And so, really we do
need to create more innovative financing mechanisms to get
resources to community - based and fa ith - based organizations
that had deep roots , particularly in underserved communities
of color , and create a sustainable community health
infrastructure. Many of these also have relationships with a
variety of community health workers. So we need to really
beef up not just the public health infrastructure but the
community health sector.

Margaret Flinter: Well that is so important , and I am so glad you highlighted

Dr Mona Schock - Spana

that . And I think a s one of our guests several weeks ago said,
one thing about this pandemic , t here isn’t anybody in the
United States at this point that doesn’t understand what a
public health person is, what a public health special is, because
we have seen how important it is. But I wonder if we could ask
you to comment on another area of your wor k .

Dr. Monica Schoch - Spana: Sure.

Margaret Flinter: We have the vaccine now , but no vaccine against mental
health distress , and we ha ve seen mental health distress writ
large throughout this pandemic. There ha s always been
disparities in access to mental health , generally not enough to
go around for everybody anyway , b ut particularly, for our
communities that have been hardest hit . And I know this is an
area that your group has be e n focused on , the collective
trauma of the pandemic and its impact on mental health. Is
there a public health approach to this as well , or is it about
trying to get up more of our traditional clinical services? What
is your team thinking about as you look at the impac t? And
here we are speaking of both adults and certainly childre n
where we understand the data is , if anything , even more
troubling .

Dr. Monica Schoch - Spana: Right. It is important to think about a broad ar ray of
psychological difficulties that have been exacerbated by the
pandemic. For many people , it is the ongoing p rotracted
distre ss associated with the pandemic’s financial and physical
impacts. So there is that ongoing stress. There are individuals ,
who , outside of the pandemic , have their clinical conditions
well under control , but because there ha s been an interru ption
in delivery of services , and for some , tele health may not be the
most beneficial form of the delivery of mental health care ,
t here are folks f or whom their symptoms are being
exacerbated because of interruption of care , in addition to this
distress. We have children of adults who a re struggling often
times to balance household budgets when there ha s been an
interruption in employment and food and security , a nd we also
have health care workers and public health workers of all kinds
who are being stretc hed to their limits in terms of the actual
work, in terms of hours , b ut also the trauma of for instance
being present a n d caring for a patient who is dying and cannot
connect with their family , and just to witness that type of
human suffering can w ear away at folks. So there are
workforce resilience issues.

So there is a lot of different needs. All that is happening against
the backdrop in our country of lack of parity between mental

Dr Mona Schock - Spana

health and physical health, lack of a well - developed workforce
with variou s skills. There is also our financing mechanisms are
there more to shore up physical health needs than mental
health needs in terms of insurance. And so, we have systems
that on a good day are not meeting everyone’s needs ,
h appening at the same time that w e see a spike i n a variety of
mental and behavioral health needs. Colleagues and I have
talked about we see the epi c urve that shows the numbers of
cases related to COVID - 19 , but there is a shadow pandemic
that doesn’t have quite the same representation th at’s more of
a mental health impact , a nd that will be lingering despite of
vaccination coming around to interrupt transmission and
reduce physical health burdens. We don’t have , as you said, a
vaccination that’s going to offset the mental trauma.

Mark Mass elli: You know , I want to pull the thread on the issue that you were
just addressing around needs , and there are a number of them .
We certainly talked about the behavioral health needs
amongst the full population, the social determ inants of health,
housing , food and security, the lack of adequate workforce ,
which sort of brings me to talking about the new
administration, the new she r iff s in town , and also a new
opportunity, new leadership team , a nd also a large
commitment that looks like it’s around the cor ner $ 1.9 trillion .
And I wanted to get some of your thoughts about what
recommendations you might have , certainly using the lens of
equity. I know the Biden Administration put for th an initiative
to bring a million vaccines a week to community health
cente rs, to really focus in on the BIPOC community throughout
the nation. But as you look at and size up the administration in
terms of its personnel , any recommendations that you have as
the new administration navigates through all of these issues ?

Dr. Monica Schoch - Spana: I think what’s important , and this we try to convey to state and
local officials in the Equity in Vaccination Report , is that there
are these urgent needs that have to be met . At the same time,
we really should be engaging in a more integrate d cross sector
recovery planning process that gets at the multiple needs and
the systemic improvements that are necessary. So if we take
the example of public health, could we be generating systems
both locally and nationally that put more people o f color in
leadership positions? Do we have our local community colleges
developing degree programs that can create spaces both in
emergency management and public health more for
underserved communities of many kinds ? Start the long term
recovery strategizing now, don’t postpone it. It should be
taking place simultaneously with the response.

Dr Mona Schock - Spana

I know people look at vaccination sort of kicking off recovery.
Personally, I look at it as sort of containing the acute crisis , and
that longer term recovery we really do need to pay attention
to . So we need mental hea lth, public health, health care ,
education, social services, emergency management all at the
table , t hinking about these longer term issues, getting more
people of color in decision making positions , including tho se
who are making decisions about financing I think is a long term
goal that we need to have in mind. With mental health, it isn’t
just meeting the needs for instance of hard hit communities of
color. Are they being treated by physicians and therapist s who
have roots in their communities, BIPOC communities? And so,
those workfor ce development issues I think are quite critical.

Margaret Flinter : And we have been speaking today with Dr. Monica Schoch -
Spana . She is the Co - Chair of the Working Group on Equity i n
COVID - 19 Vaccination , or CommuniVax , and they have a new
report “Equity in Vaccination: A Plan t o Work w ith
Communities of Color t oward COVID - 19 Recovery and
Beyond . ” Follow their work . See the full report by going to
www.centerforhealthsecurity.org , or you can follow them on
Twitter at JHSPH for John Hopkins School of Public Health ,
_CHS . Monica , we want to thank you for your tireless efforts to
shin e a light on these incredibly important public hea lth issues
now and well into the future , and for joining us today on
Conversations on Health C are.

Dr. Monica Schoch - Spana: Thanks Mark and Margaret, my pleasure.

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Mark Masselli: At Conversations on Health Care, we want our audience to be
truly in t he know when it comes to the facts about health care
reform and policy. Lori Robertson is an award - winning
journalist and Managing Editor of FactCheck.org, a non -
partisan, nonprofit , consumer advocate for voters that aim to
reduce the level of deception in US politics. Lori, what have you
got for us this week?

Lori Robertson: The v irus , SARS - CoV - 2 , can lead to illness with the disease
COVID - 19. A virus is an infectious agent that requires a host
cell in which to replicate. A disease is the result of the vir us
replicating in a body and making someone sick. Dr. Anthony
Fauc i, Director of the National Institute of Allergy and
Infectious Diseases, explained this distinction between
infection with the virus and the disease , in an interview on
CN N , saying that wit h vaccination against COVID - 19, “ You
could be prevented from getting clinical disease and still have
the virus that is in your nasopharynx because you could get

Dr Mona Schock - Spana

infected.” A viral video that has r a cked up hundreds of
thousands of views , distorted those com ments , falsely
suggesting that a COVID - 19 vaccine , authorized in the US ,
doesn’t “ protect you from COVID. ”

The vaccine does protect against the disease COVID - 19. Fauci
was cautioning that it may not prevent someone from
contracting the virus. Specifically, the Pfizer - BioNTech Vaccine
was tested in a Phase 3 randomize d trial in which people were
counted as having COVID - 19 if they developed at least one
symptom of the disease , such as a fever, cough or shortness of
breath and tested positive for the SARS C oV - 2 v irus within four
days. Vaccine was 95% effective in preventing COVID - 19
disease in adults. Moderna ’s vaccine was similarly effective,
94.1% based on a COVID - 19 definition of at least two systemic
symptoms and one re spiratory symptom , along with a positi ve
test for SARS C oV - 2 .

The trials , however, did not immediately evaluate how all the
vaccines were able to prevent infection. This is relevant
because while many people develop at least some symptoms,
some people do not. So Fauci and public health experts have
advised the public to continue to wear a mask and follow
public health precautions after being vaccinated. There is a
good chance that the authorized COVID - 19 shots will help limit
transmission to some degree . That is common with vaccines
that cannot shield against infection but do defend against
illness. But it remains an open question for the COVID - 19
vaccine. An d t hat's my fact check for this week. I'm Lori
Robertson , Managing Editor of FactCheck .org.

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Margaret Flinter: FactCheck.org is comm itted to factual accuracy from the
country’s major political players , and is a project of the
Annenberg Public Policy Center at the University of
Pennsylvania. If you have a fact that you’d like check ed , email
us at www.chcradio.com . We’ll have FactCheck.org’s Lori
Robertson check it out for you here on Conversations on
Health Care.

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Mark Masselli : Each week , Conversation s highlights a bright idea about how to
make wellness a part of our communities and everyd ay lives.

Students of public health are often tasked with devising
interventions for addressing some of health’s biggest
challenges , a nd for Harvard T.H. Chan School of Public Health

Dr Mona Schock - Spana

Students, Dan Wexler and Priya Patel , their idea netted an
award, and lau nched a business idea at the same time . The
students were tasked with addressing food insecurity in underserved
parts of the world including neighborhoods in their own backyard,
families living in high poverty, low resource area , and finding fresh,
afforda ble, healthy food in neighborhoods with no grocery stores or
food markets. They thought of the current trend of healthy meal or
meal services like Blue Apron and wondered what if we modified
that business model to serve the needs of those living in food
de serts. Wexler and his partner sourced food delivery companies
that could provide prepackaged meal kits with all ingredients
included , even spices, dressings and recipes . And i nstead of home
delivery approach, they design ed refrigerated kiosks that could ea sily
be placed in local neighborhoods. Wexler says they wanted to make
the idea of healthy eating and meal preparation as simple as
possible.

Dan Wexler: I think the biggest change is that there is no delivery system door -
to - door per s e, and that by going and setting up these k iosk s in
the community you can have a very lean design, you can have -
- you don’t need a storefront, you don’t need to pay for
shipping, you don’t need to have inbox refrigeration , and you
are very much addressing the need of access b y physica l ly
saying, “Hey, here is healthy food, it’s convenient because
everything you need is in the box . The directions are simple,
and very picture - based . ” There is a lot of literacy issues . And so
just really thinking about how can we take all those l ean design
principles to facilitate access , that really I think make it a
solution that has a potential for impact.

Mark Masselli : And they also conducted research with local ethnic groups to
create recipes that would resonate with their families.

Dan Wexl er: Then we just went down to the community and did taste
testing at the farmer’s market, and talk ed to people , and said
you know do you like this , what do you want to be able to eat
for dinner , h ow do you want to cook? So basically we have
some dishes tha t ha ve similar textures, similar spices. One
thing that we found is there is a little bit of contention
between parents , who want to eat more traditional food , and
kids who want to eat more American food , and we tried to
alleviate that and bridge those gap s . So, on e of our recipes for
instance is c hicken pot pie pasta. So it’s kind of American, it’s
fun - sounding , but also we use a lot of traditional seasoning s
and spices.

Mark Masselli : Customers can simply walk to the k iosk and purchase their
meal kits wit h the snap cards or cash and the added benefits .
The k iosk will be run by the residents of the neighborhood ,
giving them an opportunity to purchase the k iosk and run them

Dr Mona Schock - Spana

like a franchise , offering an economic benefit to the
community as well . A low cost, portable healthy meal service ,
placed in portable k iosk in food desert neighborhood s, offering
families a simple solution to address the problem of poor
nutrition , n ow that’s a bright idea.

[Music]

Mark Masselli: You've been listening to Conversations on H ealth Care. I'm
Mark Masselli.

Margaret Flinter: And I'm Margaret Flinter.

Mark Masselli: Peace and Health.

Marianne O’Hare: Conversations on Health Care is recorded at WESU at Wesleyan
University, streaming live at www.chcradio.com , iTunes, or
wherever you listen to podcasts. If you have comments, please
email us at [email protected] , or find us on Facebook or
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by the Community Health Center.

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