Mass General Confronts Vaccine Racial Inequity Rooted in History

Mass General Brigham, one of the largest health systems in the Boston area and renown for its medical innovation, decided to take action to narrow the health inequity gap in its own organization.

So when vaccines became available, the hospital worked to get its roughly 80,000 employees inoculated. Physicians fanned out to answer questions and explain the science behind the vaccines in seven languages. Staff scheduled appointments for workers who needed help. Up to 20% of doses were withheld so supply would remain available.

Even with all that effort, the results along racial and ethnic lines were uneven.

Mass General Confronts Vaccine Racial Inequity Rooted in History

Six weeks into the campaign, about 70% of the health system’s
80,000 workers have been immunized. But the racial breakdown is
worrisome. While 77% of White and 76% of Asian employees have
been immunized, only 56% of Hispanic and 42% of Black employees
have received shots. Of those who primarily speak a language
other than English, the rate falls to 56%.

“This mistrust has been built up over more than 500 years, and we’re not going to solve it this month,” said Tom Sequist, MGB’s chief patient experience and equity officer.

The uneven results in trying to ensure an equitable vaccine distribution in a place that has thrown itself into the problem show how difficult it will be to solve at a national level. To guarantee that vaccines reach communities that are most in danger from the coronavirus, authorities must overcome not only daunting logistics but also deep historical fissures that trace back to the U.S.’s founding.

Mass General Confronts Vaccine Racial Inequity Rooted in History

Boston, too, has a complex history of racial strife and distrust. The city gained international attention during the 1970s when its public schools were under court order to desegregate through busing, which led to “White flight” to the suburbs, and protests and riots. This past June, Boston Mayor Marty Walsh, whom President Joe Biden has chosen to be U.S. labor secretary, declared racism a public health crisis, saying he would reallocate $3 million from the city’s police department to public health.

Communities of color are less likely to trust the medical system because they have been mistreated and ignored for years, Sequist said. Some people may wait to see how other people handle the vaccines, said Joseph Betancourt, senior vice president of equity and community health at Mass General. Those communities have also been hit the hardest, and people who had the virus may want to let others access vaccines first, Betancourt said.

Online Misformation

None of Ivan Andrade’s 27 employees wanted a Covid-19 vaccine. Andrade is a manager in environmental services, overseeing a team responsible for daily cleaning, biohazard-waste management and other tasks at Mass General.

His staff was nervous about how quickly the vaccines were introduced, citing frightening stories they had read online. Andrade, though, wanted the vaccine to protect himself and his family, even though he says he was scrutinized for choosing to be a guinea pig.

“We can all get caught up with the misinformation,” Andrade said. “A lot of Facebook, Instagram on a daily basis and you end up getting consumed by things and you don’t have a base.”

Betancourt and Sequist knew mistrust would present a key challenge to vaccinating workers, especially those from communities of color. They recruited doctors who could answer questions and serve as so-called trusted messengers within the hospitals.

Mass General Confronts Vaccine Racial Inequity Rooted in History

Adeline Boatin is one of them. An obstetrician and gynecologist with a focus on global health equity at Mass General, she heard the hospital was looking for Black employees to volunteer. Boatin led a session in English. More than a dozen people joined her in a conference room while more people tuned in remotely.

Attendees asked whether the vaccines were safe for people with allergies or other medical conditions. She told the audience that she had already been vaccinated. They asked about side effects and how vaccines might or might not change virus-mitigation measures like social distancing.

“I was worried it would just be me standing there and there would be a lot of silence,” Boatin said. In reality, his concern was unwarranted.

“People had questions, they had concerns and they wanted to be able to ask those. This was an opportunity for them to do so,” said Boatin, who is also an assistant professor at Harvard Medical School.

Meanwhile, Andrade kept talking to his team. He answered questions about how he felt after being immunized. It helped that Andrade, originally from Cape Verde, speaks English, Spanish, Cape Verdean Creole and Portuguese.

Now 25 of his 27 employees have received at least one dose, Andrade said. Another has an appointment scheduled. One person still doesn’t want the vaccine.

Racial Gap

National surveys previewed the challenge. At one point last fall, 40% of non-White respondents said they wanted to be immunized, compared with 54% of White people, according to Gallup.

Betancourt and Sequist used those numbers to shape their strategy. They focused on creating awareness, facilitating scheduling and setting aside doses. The idea is to inform people vaccines are available and ensure they can access them when they’re ready. Actually closing the gap could take time.

“Our numbers are not going to look equitable out of the box,” said Betancourt, who is leading MGB’s equity and community health Covid response team.

Mass General Confronts Vaccine Racial Inequity Rooted in History

Yet, the numbers are improving. Of MGB’s Black employees, 42% are now vaccinated, up from the low 30s, Betancourt said, while 56% of Hispanic workers are immunized, an increase from the upper 40s to low 50s.

The trends align with research showing those communities weren’t interested in going first, Betancourt said. While it might not happen immediately, vaccination rates among Black and Hispanic people should improve.

Nationally, 62% of non-White people say they want a vaccine, compared with 67% of White respondents, according to Gallup’s latest survey.

The experience at MGB shows how much work it will take to ensure vaccines are administered equitably. Already, the national data, while limited, show White people are being immunized at far greater rates than other racial and ethnic groups.

In Massachusetts, the percentage of Black and Hispanic people who have received at least one dose are lower than their respective representations, according to a state report. Race and ethnicity data are unknown for about 20% of vaccine recipients, clouding the demographic picture.

Counseling Colleagues

Vaccinating Black and Hispanic residents will be vital to blunting the virus.

Nationally, American Indian, Asian, Black and Hispanic people are being infected, hospitalized and dying from Covid-19 at higher rates than Whites, according to the Centers for Disease Control and Prevention. In Boston, that translates to the bulk of cases being isolated to a few Zip codes.

East Boston, Dorchester, Hyde Park and Roslindale are among the neighborhoods with the highest cumulative percentage of positive Covid tests, according to the Boston Public Health Commission. Those are also the areas with the highest concentrations of Black and Hispanic people in the city, according to Census data.

Andrade, the environmental services manager, anticipates vaccination discrepancies will continue as most people won’t receive the same attention employees in the health system did.

“Unless if they make it available to have folks that speak Creole, Spanish, going to small places and trying to explain the goods of getting the vaccine, why you should get it, why you should wear your mask in the first place because it’s still a taboo in a lot of places,” Andrade said.

MGB plans to send doctors into the hard-hit communities to answer questions about the vaccines, similar to the sessions it hosted internally, Betancourt said. One day, the system hopes to even schedule immunization appointments at those events.

Boatin intends to join those community efforts. She’s considering how she might adjust her introduction and answers to common questions. At the hospital, she continues counseling colleagues who are unsure about the vaccine.

Ultimately, racism is the biggest challenge, Sequist said. And that fact should underscore vaccination efforts.

“It takes some courage, whether you’re a public-policy official, a state or federal government official to say actually yes, that’s the risk factor,” Sequist said. “It’s uncomfortable for many people to take that leap.”

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