Memories of Philadelphia’s failed COVID-19 vaccine distribution in early 2021 still haunt the city’s health commissioner, Cheryl Bettigole.
That March, the Philadelphia Department of Public Health and FEMA opened a mass vaccination clinic at the convention center. It offered a central location, adequate doses and an online registration system that was supposed to limit appointments to those most at risk of COVID. But in fact, it’s not.
Vaccination efforts have been clouded by the city’s notorious partnership, run by a Drexel University student, that mismanaged vaccine distribution. When FEMA clinics opened, some of the city’s most vulnerable communities were hard to reach. Those who don’t have easy online access, or those who aren’t tech-savvy, can struggle to get an appointment. Some who were eligible for the injection shared registration links with those who were not. Getting vaccinated early depends largely on location, technical ability, and who you know.
Most vaccines have been given to white Philadelphians, even though the city’s black and Hispanic populations bear the heaviest burden of the virus. That massive clinic administers thousands of doses of vaccines a day, but the people who stay are mostly the same people who often lack equitable access to health care because of poverty and systemic racism.
“We need to create human-centered connections to understand how to work better and build trust,” Bettigore said in an interview last week.
Strengthening relationships in underserved communities is a key 2023 goal for the health department, the commissioner said. The department conducted community outreach before the pandemic, but those efforts were often isolated and poorly coordinated. mpox vaccination clinic, what is it called now Called Monkeypox, hosted by LGBTQ-friendly bars and clubs, it’s a prominent example of what Bettigole would like to see more of – Partner with those most in need to deliver public health services.
» Read more: Remember monkeypox?Virus is ebbing, but Philly needs more vaccinations to prevent rebound
Done right, deeper community partnerships can help reach populations at risk of endemic viruses like hepatitis A and HIV, and should allow for faster and more equitable responses as cities face new health emergencies .
“These relationships are going to really help us build what we need to build in the next few years,” Bettigole said.
This work includes bringing the Hepatitis A vaccine to the city’s homeless population on the streets and building deep relationships with the city’s LGBTQ community to address their health concerns.
One challenge, she acknowledged, is making sure the department has the staff to carry out outreach effectively.
“It will take more time,” Bettigole said. “It takes more people.”
She declined to elaborate on budget and personnel discussions with the mayor’s office. According to the city’s fiscal year 2023 budget, the department has a budget of about $810 million and more than 1,000 employees.
Inequities in access to COVID tests and vaccines are not unique to Philadelphia. In a 2021 paper, the National Academy of Medicine noted that partnerships between healthcare entities, community groups and governments shrank after the 2008 recession, and the pandemic exposed the need to rebuild them.
“I think COVID is a clear example,” said Ana Martinez-Donat, a professor of community health at Drexel University and founder of Latino Health Collective in Philadelphia. “To respond quickly to emergencies, you need to have the structures and relationships in place for an agile response.”
For many public health issues, closer relationships between the health sector and community groups and leaders could make a difference.
Martinez-Donate said the health department sought feedback from members of her coalition as it developed an online service to help people find a primary care doctor.
Jose Demarco, an organizer with ACT UP Philadelphia, an HIV and AIDS advocacy group, described an ongoing struggle, especially among black and Hispanic men, to expand access to the drug PrEP, which provides reliable HIV prevention Protect. A 2021 study in the medical journal JAMA found that black and Hispanic people at risk of HIV exposure “need more targeted and culturally appropriate” outreach to encourage them to take PrEP.
Collaboration with the city’s health department has allowed him to convey to health personnel what he hears at ACT UP-hosted workshops that people might not tell government officials.
“People are less open when they’re talking to people in the health department,” he said.
The mpox outbreak, which began in summer 2022 and primarily affects bisexual, gay and non-binary men who have sex with men, is the first post-COVID testing by health authorities. Initially, community activists said the department was repeating the same mistakes that hurt the response to the pandemic.
The limited vaccine supply almost immediately went disproportionately to white Philadelphians, said Jason Evans, a Philadelphia consultant. The Department makes policy decisions without consulting the LGBTQ community.
“In my experience, they’re always behind the eight,” Evans said.
» Read more: Health Report: COVID and the Future of Public Health | Presented by Independence Blue Cross
However, things have changed.
The department launched an mpox resource group, which includes Evans, that is refocusing this year to address a range of LGBTQ-related health issues in a city that still relies on club owners and event promoters to pitch in dance music and cocktails vaccine dose.
“I’m excited to see the reaction and the willingness to participate,” Evans said.
Despite the outreach, the city’s black population continues to account for the majority of mpox cases, while remaining its least vaccinated population. Building trust and translating it into effective policy will take time, Bettigole said.
“We need to do more,” she said. “Make sure people are talking on a regular basis, make sure we’re aligned in community groups.”
