On the 90th birthday of Sam Cooke last week, I found myself reflecting on the prophetic blues of his legendary anthem: “It’s been a long, a long time coming. But I know a change gonna come. Oh, yes it will.”
The most ambitious public health undertaking in recent history is sputtering.
But when? We’re at yet another crossroad in American history as the pendulum swings from the tumultuous Trump era to the Biden-Harris administration, and this country can’t afford to fail.
It’s clear that the inequities crystallized by the Covid-19 crisis demand seismic change. And yet, with the coronavirus pandemic still raging — the new director of the Centers for Disease Control and Prevention has projected 500,000 American deaths by mid-February — the most ambitious public health undertaking in recent history is sputtering.
Covid-19 vaccine distribution from state to state was uneven during the Trump administration. President Joe Biden’s administration recently released a new national Covid-19 strategy, but there’s another barrier: When it comes to the willingness to be vaccinated, people are still catching up.
Recent polls show some cause for hope as far as Americans’ willingness to get vaccinated. In December, a Kaiser Family Foundation survey found that 71 percent of Americans said they would definitely or probably get vaccinated if a vaccine were available, which was a rise from 63 percent in September.
But the survey also showed that Black people, workers who identified themselves as essential and those who worked in health care settings answered that “they definitely or probably would not get vaccinated” at comparable rates, 35 percent, 33 percent and 29 percent. (Of note, this survey was completed just before Pfizer/BioNTech’s and Moderna’s vaccines got emergency approval and nearly 17.3 million people in the U.S. were administered doses as of this week.)
That skepticism is at least in part reflected in the data from states that have released vaccination breakdowns by race and ethnicity, in which we can see Black people are on the lower end of the participation scale. The gap is for a host of reasons, not least of which is the epic levels of broken trust between Black communities and the health care system and clinical research more broadly.
A more massive public reckoning is needed if we are to beat back the pandemic.
But this isn’t an excuse for health care and public institutions not to transform. It’s an opportunity to demonstrate accountability and trustworthiness if trust is ever to be gained. These daunting truths are rooted in historical injustices and present-day disparities.
Still, the full-court press by the country’s Black and brown physicians, public health officials and community leaders has yielded some progress. This improvement is due in part to the open and honest dialogue around issues related to medical apartheid and education to dispel the misinformation and lies peddled throughout the pandemic. But dialogue can be patronizing if words don’t give way to credible action to solve pressing health inequities. It’s the legacy of not just our current pandemic, but one that’s centuries old.
Though the medical community hasn’t solved the trustworthiness equation, we are beginning to speak with more social and cultural fluency, therefore registering more in historically excluded communities. The Biden-Harris plan to tackle this crisis, for example, hits many of the right notes and represents a much-needed departure from the inertia and reckless apathy of the previous administration.
I and many others in the field have welcomed these strategies. But I’ll remain vigilant. We need to achieve equity with a vigor and pace adequate to protect the most vulnerable. We need to speed the distribution and administration of vaccines in those neighborhoods and communities that the pandemic has devastated the most.
A more massive public reckoning is needed if we are to beat back the pandemic. The federal government, in partnership with state and local communities, must deploy neighborhood resources, block by block, to engage, inform and encourage residents. We must build up health literacy.
We need to decode the process and the science behind the vaccine.
The goal here is not to convince. The goal is to catalyze understanding in plainspoken terms. We need to decode the process and the science behind the vaccine. We need to explain how the arrival of the current vaccines, though miraculous, wasn’t purely magical; it demonstrates what happens when scientific breakthroughs across decades culminate and the federal government invests smartly and wisely in the public good. Those conversations also need to include what people should expect from the Biden presidency and how it will drive equity and urgency in this process and beyond.
Coronavirus relief must be a twin priority alongside coronavirus vaccination. People need to know how the administration will tackle other upstream issues, like food insecurity, access to safe and thriving communities, equitable opportunities in education and jobs, and high-quality, affordable housing — all the factors that made outcomes associated with Covid-19 worse for certain groups. All of this is part of the ecosystem upon which public trust, and thus public health, is nurtured or eroded. The decision to vaccinate must be presented as the balance of scales between the risks of exposure, infection, hospitalization, lingering morbidity and death versus the comparatively lesser risks of adverse outcomes associated with vaccination. It must be said clearly what is known about routine side effects and what remains to be answered, like how long immunity lasts. And in Black and brown groups where the burden of Covid-19 has been shouldered disproportionately, the conversation must not veer toward public shaming. We must seize on the same intention of the heroic and outsize roles Black voters and social justice movements by people of color have played in rescuing the American republic and giving the country a double-fisted chance to rise from the ashes of the Capitol riots and the wholesale devastation caused by the pandemic. By invoking our collective power, we will be crucial to forging a road map and tying our destinies to one another. This is true whether you’re talking about universal masking or mass vaccinations. This will require patience and some pain but urgency and moral courage, nonetheless. It’s easy to feel powerless in the face of this health crisis. I recognized my power in volunteering for a coronavirus vaccine trial and in the public health advocacy I do daily. Our power is not only in demanding answers to our questions and fears, but also in demanding access to the tools to save our families and neighborhoods, to being partners in finding a solution and to everyone’s respecting and valuing our humanity. Then, and only then, can America call itself a resilient nation. Only then can the change that Sam Cooke prophesied in his legendary anthem finally come. The pendulum is in motion. But the forward momentum we hope and pray for can easily swing back again. Now is a time when racial equity and health justice call for dismantling the pendulum altogether. In its place, the U.S. needs to erect new axes of power and enduring fairness. We cannot afford to miss out on that change.
Dr. Chris T. Pernell
Dr. Chris T. Pernell, MD, MPH, FACPM, is a public health physician and health equity champion. She is a fellow of the American College of Preventive Medicine, the daughter of a father lost to the coronavirus pandemic and the sister of a Covid-19 long hauler. 
