Outside a college basketball arena in Philadelphia, a few hundred individuals line the block, waiting to get their Covid-19 vaccinations. Inside, between laughs and music, surgeon Ala Stanford gives instructions for the day to a team of doctors, nurses and volunteers.
They represent part of the Black Doctors Covid-19 Consortium (BDCC), a group of around 200 healthcare professionals who are looking to eliminate health disparities during the Covid-19 pandemic.
Even though they have been up since 6 a.m., or earlier, the staff’s smiles have not faded as they thaw vaccine vials, prepare syringes and register individuals. As opening time approaches, patients, many of them elderly and Black, trickle inside. By the end of the day, the BDCC had vaccinated around 1,000 individuals—about 70 percent of them were Black patients.
This particular day, approximately 50 BDCC team members helped out, including a practicing nutritionist, an anesthesiologist and a retired gastroenterologist. Other volunteers and staff also help with administrative issues, testing and delivering vaccines.
Since being founded by Stanford last spring as the pandemic entered its first wave, the BDCC has been serving Philadelphia’s Black community. Back in March 2020, Stanford noticed the lack of Covid-19 testing in low-income and communities of color in Philadelphia, who also happened to have the highest positivity rates, an observation that was eventually supported by data from the city’s Drexel University. She left her role as a pediatric surgeon to work full time to address health disparities in Black communities during the pandemic.
She fielded calls from patients suffering from Covid-19 symptoms who were being turned away from testing. Although Stanford wanted to help, particularly the communities that were being hardest hit by the pandemic, she lacked a way to do it. “There was nothing for me to help with because nothing exists,” she recalls thinking before she formed BDCC.
According to data from the CDC, as of this week, Black patients represent approximately 11 percent and 14 percent of Covid cases and deaths, respectively, nationwide, while representing about 13 percent of the population. Although these rates are now comparable, in the beginning of the pandemic the disparities were starkly different: back in May 2020, Black patients represented 22 percent of Covid cases. Additionally, Black Americans are 2.8 times more likely to be hospitalized and 1.9 times more likely to die due to Covid-19 as compared to white Americans. Data from the city of Philadelphia, where African-Americans represent almost half of the population, show similar results. Many social factors including healthcare access, occupation and income gaps contribute to these disparities.
Now Stanford’s organization has turned its focus to vaccinations, both with education campaigns and the shots themselves. Around the country, Black Americans have been vaccinated at lower rates than their counterparts. Available data from the CDC on race and ethnicity shows that of those that have been fully vaccinated in the United States, only 8 percent are African-American. In Philadelphia, Black citizens make up only 21 percent of those vaccinated with at least one dose.
For Stanford, it’s all about equitable vaccination, the idea that public health officials address disparities among different racial groups and vulnerable communities in their vaccine distribution plans. “We're going to make a huge push to vaccinate them first, because that ultimately helps everyone if we're reducing the transmissibility and the community,” she says.
They are off to a good start. To this day the organization has vaccinated more than 43,000 individuals, 86 percent of whom are from communities of color and, within that, 78 percent of those vaccinated are Black Americans. They have proved that equitable vaccination can be achieved with community-led initiatives and may provide a blueprint for other cities to imitate.
The underlying reasons for ethnic and racial disparities in healthcare and vaccination are complex and multifaceted. Although vaccine hesitancy and medical mistrust are factors, health equity researchers highlight bigger, more influential problems. “Structural racism is a fundamental cause of health inequities,” says Rachel Hardeman, founding director of the Center for Antiracism Research for Health Equity at the School of Public Health at the University of Minnesota. Jaya Aysola, physician and executive director of the Penn Medicine Center for Health Equity Advancement, identifies a “myriad of structural inequities that result in delayed care, access to less optimal hospitals and increased comorbidities.”
These structural inequities include economic, infrastructure and social barriers that hinder Black communities from having access to healthcare and, more recently, vaccinations. Barriers to vaccines—lack of internet access to make a vaccination appointment, unreliable transportation options for reaching far-away vaccination sites or clinics—disproportionally impact Black communities. “There are other barriers to access beyond hesitancy, and for many groups, those barriers have to be addressed simultaneously,” says Aysola.
To remove these barriers, communities of color have to be at the forefront. “What I found is that [equity] is an afterthought,” says Stanford. Government efforts have focused on all eligible populations, rather than seeking out the communities most impacted and suffering disproportionately from the pandemic, she adds.
In its programs, the consortium prioritized Black communities and communities of color. Stanford witnessed that testing sites were being set up in communities with more resources, which are typically white neighborhoods. In contrast, the BDCC went to citizens’ doorsteps and churches in the community to test individuals who were not being served by inaccessible centers and clinics. “We had to go to people,” says Stanford.
Now BDCC is doing something similar with its vaccination effort. While the Federal Emergency Management Agency (FEMA) set up clinics in areas that do not have a high case count of Covid-19, the BDCC sets up its vaccination clinics in hard-hit zip codes composed of Black Philadelphians. The group intentionally set hours for individuals who work during the week and designed the clinics to be walk-up with no appointments required.
The messenger also matters, says Aysola, when it comes to discussing vaccine concerns and vaccine hesitancy. Studies regarding Covid-19 messaging have shown that Black Americans are more likely to trust messengers from their own group. Aysola stresses that the diversity of populations being vaccinated requires different messaging, which could mean having individual messengers that reflect their background, culture, language and race or ethnicity. Stanford was purposeful with the name Black Doctors Covid-19 Consortium and to have Black physicians, such as herself, at the forefront of these efforts.
However, the lack of government focus on equitable vaccination places the burden of having to establish initiatives to reduce health disparities on the same communities that have been hardest hit, usually without support. “We [black doctors] take great pride in caring for our communities,” says Uché Blackstock, herself a Black doctor who also is founder and CEO of Advancing Health Equity and a contributor for Yahoo Medical News. “But we need the resources and funding and infrastructure to do so.” Though the city provided the BDCC with funding for testing, it has not provided any financial support to the BDCC for their vaccination clinics according to Stanford. As a result, the group has had to rely on its GoFundMe page, private donations and grants.
Stanford, who was born and raised in Philadelphia, knows her community well. She understands the access barriers individuals face such as not being able to get to a primary care doctor, using an emergency room for wellness visits for children and having to take public transportation for medical care. “[My patients] didn't need to explain the experience,” she says. “I understand it.”
When Time magazine named frontline healthcare workers as Guardians of the Year for 2020, they featured one of the BDCC’s very own, Shelah McMillan, on the cover. McMillan works as an emergency room nurse at Einstein Medical Center and volunteers her time at the BDCC. Like Stanford, she strives to tackle inequality. “McMillan and others have been doing what they can to bring health—and equity—to these communities,” Time magazine wrote.
Between having the medical expertise and fostering long-standing relationships with communities, Hardeman believes groups like BDCC deserve more attention. “They should have all the resources they need to do the work because they have the work of building the trust,” she says.
Now similar communication initiatives that aim to build trust are popping up across the country. The Black Coalition Against Covid is a Washington, D.C.-based organization that seeks to bring information to Black communities. Although the group is not directly vaccinating individuals, it provides platforms to ask Black doctors and nurses questions about the vaccines, an effort named Between Us About Us.
Although there are initiatives to vaccinate vulnerable communities in places like Minnesota, vaccination efforts on the same scale as the BDCC have not been widely replicated across the country. “Small scale attempts and ‘pop up’ vaccine equity clinics are models being used in many cities and states, but resources are needed to make these efforts sustainable,” Hardeman points out. In addition to resources, organizations need a diverse workforce and leadership that is willing to center and prioritize vulnerable communities, she says. If not, the country risks worsening already existing disparities in both Covid-19 and health in general. The BDCC has now provided a blueprint to follow, which could potentially expand to other underserved communities such as the Hispanic community, who suffer from 2.3 times the death rate from Covid-19 compared to white individuals.
Back in March, the famous singer-songwriter Patti LaBelle got her second dose with the BDCC in North Philadelphia. Now Stanford and her team have become celebrities and heroes in their own right. As Stanford walks down the line of individuals waiting to get their vaccine outside the basketball arena, many stop her to thank her and even take pictures with her. Some even confess they are there because of the BDCC and even Stanford herself, as one woman reveals: “You’re the reason why I am getting this vaccine.”