Editor’s Note: Dr. Julie Morita, a pediatrician, is executive vice president of the Robert Wood Johnson Foundation in Princeton, New Jersey. She was formerly a medical director, the chief medical officer, and then commissioner for the Chicago Department of Public Health for nearly two decades. The opinions expressed in this commentary are those of the author. Read more opinion on CNN.
With each passing day, more headlines seem to tout the promise of a vaccine that may herald the end of the coronavirus pandemic.
While researchers are racing to develop a vaccine, public health officials across the US — and certainly in Chicago, where I spent two decades at the city’s Department of Public Health — are beginning to map out their own vaccine distribution plans.
A patchwork of these vaccine distribution initiatives has been announced. But state and local health departments cannot develop their plans in isolation, and the optimal and equitable distribution of vaccines will require a coordinated response led by a federal agency with experience and established systems to build on. Although vaccine distribution is described as a “joint venture” between the Department of Defense and the Centers for Disease Control and Prevention, the CDC is the agency with the most expertise and the only existing system for managing vaccine distribution in large outbreaks.
The federal government must enable the CDC to take the lead in coordinating the nation’s Covid-19 vaccine planning. The CDC can support community engagement and education, upgrade existing vaccine ordering and tracking systems, and map out the effective and equitable distribution of a vaccine. Without its leadership orchestrating such an effort, states and communities will be left to fend for themselves, competing for vaccines and supplies, and, in some cases, possibly neglecting those most likely to become infected and die in communities of color.
Without swift action and federal funding, existing health inequities will play out again in the distribution and uptake of a potential vaccine. Black Americans and Latinos have been hit hard by Covid-19, with infections and deaths far surpassing their share of the population. This disparity will persist if we do not address the public distrust of vaccines and carefully develop and implement a distribution plan with the urgency it requires.
What I learned as Chicago’s chief medical officer during the H1N1 pandemic in 2009 is that time is not on our side. In public health, as in politics, it’s necessary to build a “ground game” — years of data-diving and research allows public health officials to connect with real people in every neighborhood and every zip code in order to build trust. This involves spending time with everyone from faith leaders to community organizers to local business owners. These relationships can mean the difference between life and death — especially in Black communities plagued by a distrust of vaccines, health care providers and health care systems due to a long history of medical racism in this country.
During the H1N1 pandemic in 2009 — and every major public health emergency since then —my colleagues and I joined regularly scheduled media briefings and healthcare provider webinars led by trusted CDC officials that provided clear and consistent updates, guidance and messages. The CDC needs to do the same this time around and be transparent about Operation Warp Speed and the federal distribution plan in order to build trust in the Covid-19 vaccine program.
I experienced the hesitancy toward vaccines among Black and Latino communities firsthand in 2009. Although the rate of hospitalizations of Black and Latino Chicagoans was 2.7 to 3.4 times higher than among White Chicagoans, demand for H1N1 vaccines was relatively low at Kennedy King College, which is located in a predominantly Black and Latino community on the south side. In contrast, demand exceeded supply for vaccines at Truman College, located in a predominantly White community on the north side. We went deep into Chicago’s neighborhoods to battle such disparities, committing ourselves to ground-level work that seemed almost as vital as the vaccine itself.
Yet as important as this local work is, equitable distribution of vaccines is not possible without seamless coordination with the CDC. The robust system operated by state and local health departments and overseen by the CDC is capable of ramping up to distribute the Covid-19 vaccine quickly and equitably to healthcare providers, ensure safe handling, storing and administering of the vaccine, track vaccine supplies and adjust distribution accordingly. This system, already used to distribute millions of vaccines for other illnesses to all states and territories, ensures clear and consistent communication about the value, safety and efficacy of new vaccines — critical information to establish public trust.
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Although the Defense Department has expertise in logistics, the White House needs to give the CDC the authority to lead this distribution effort, alongside state and local authorities. Additionally, Congress must fully fund these efforts. State and local governmental leaders need to accelerate their planning now, by engaging in communities and with vaccinators and by identifying vaccination sites. Healthcare providers should talk with patients about the vaccine and then think about the barriers that might stand between their patients and a vaccine. And, finally, the public should demand that credible sources inform public health decisions and actions.
It is not too late. Since 2009, the CDC, state and local public health agencies have improved the nation’s vaccine system, including cultivating relationships deep into our communities. Protests for racial justice have opened new doors to drive community engagement efforts further. If the planning begins now — and I mean now — the communities most affected by Covid-19 can be involved in strengthening the vaccine system, ensuring that everyone, regardless of race, location or wealth, will have a fair and just opportunity to receive a safe and effective vaccine.