Rebekah Fenton is a pediatrician and adolescent medicine fellow at Northwestern University and Ann & Robert H. Lurie Children’s Hospital of Chicago.
These numbers, and my experience providing testing, have reinforced an important lesson: There is a big difference between “available” and “accessible” when it comes to medical treatment. The United States should keep this in mind as it prepares for a vaccination campaign unprecedented in our history.
Availability, after all, is merely the presence of a resource. Accessibility includes the factors that allow for and contribute to its use. Unfortunately, there are many barriers that state and local health authorities will have to overcome to ensure that coronavirus vaccines are truly accessible.
Several of these obstacles were apparent during my time helping with covid-19 testing, as it became clear that many vulnerable populations cannot easily present themselves at pharmacies or clinics. Some are experiencing homelessness or other forms of instability. Many have limited access to information and cannot easily find out where to go for preventative medical services. Others have a hard time getting to testing and vaccination sites. They may be homebound, suffer from physical or intellectual disabilities, or unable to afford transportation to their nearest health facilities.
Still others may not have opportunities to be tested or vaccinated during clinics’ and pharmacies’ operating hours. They may not be able to get time off work or find someone to watch their children. They may need assistance to leave the house or get translation, and their usual companions may not be free between 9 a.m. and 5 p.m.
Then there is the question of cost. By most accounts, the vaccine will be free. But to ensure that it is accessible to millions of uninsured and low-income patients, public health authorities will need to mount a large-scale messaging campaign to communicate that, in this case at least, expense should not be a deterrent to care.
Even when clinics are affordable and nearby, people may not have a medical home — a place where they regularly receive care from a consistent provider. This contributes to another major barrier to accessing a coronavirus vaccine: skepticism and fear of medicine because of historical harm against minoritized communities. It’s not just a coincidence that a key factor related to higher vaccination rates is having a medical provider you trust.
Government authorities should keep this in mind. The most respected members of a community may not be those with the most education or the fanciest titles. Churches, community organizations and health-outreach programs often know the needs of the people they serve, have long records of meeting them, and have established strong bonds of trust. They know if residents will come to a hospital and how best to get them there, or whether the community needs a mobile vaccine clinic and, if so, where it should stop. Public health officials should respect these leaders’ commitment to service and involve them at the planning stages, instead of just relying on them to spread the word after decisions are made.
In Chicago, I saw how creative partnerships can help bridge the accessibility divide. I worked with Howard Brown Health, a local network of community clinics that responded to the crisis by setting up mobile testing sites on the city’s South and West sides, in predominantly Black and Latinx communities. I performed testing at churches, homes for the elderly and disabled, and even community events. Covered in personal protective equipment, I saw the city like never before, visiting neighborhoods that are often overlooked.
The testing program I worked with trusted that local organizations knew those they served best. They advised us on timing for testing and the best places to set up, and even took charge of messaging. Our job was to show up where we were needed and provide an invaluable service. Through this partnership, we were able to reach many people who may never have been tested otherwise.
In my brief interactions, I heard stories of lost family members, hospitalized friends and triumphs of personal recovery. I met each patient for only a minute or two, but I have never received such gratitude in my practice. People were thankful that we came to their neighborhoods, worked with their communities and saw them as individuals with individual needs.
After months of watching marginalized and underserved populations bear the brunt of covid-19, vaccination programs now present our country with an opportunity for redemption. Partnering with community groups to ensure that these lifesaving vaccines are not just available, but also truly accessible, to the people who need them most is the best way to start.