Melissa Harris-Perry: Welcome back to The Takeaway where we continue our discussion of the current realities of the COVID-19 pandemic.

Dr. Céline Gounder: "Every morning I go through the list of patients and I say, okay, who needs to be vaccinated? We offer vaccinations, and it's very rare anybody says no. These are not anti-vaxxers. These are people who have barriers to accessing healthcare, who have some reasons for disorganization in their lives where this is perhaps not the first priority. We really do need to figure out how do you reach out to those populations and recognize not every unvaccinated person is against vaccination."

Melissa Harris-Perry: That's Dr. Céline Gounder, Infectious Disease Specialist and Epidemiologist at Bellevue Hospital in New York City. Dr. Gounder joined The Takeaway recently and stopped our whole production team in our tracks when we heard her evoked vaccine access rather than vaccine hesitancy as an important reason some communities remain so vulnerable and unvaccinated.

When Dr. Fauci stopped by The Takeaway, I asked him if he thought vaccine access remained part of the explanation for why some Americans still haven't had that shot.

Dr. Fauci: "We're falling a little bit behind on the people who are vaccinated and getting boosted when you talk about disparities and ethnic and racial. I don't think one can say that vaccines are not easily accessible. Vaccines are highly available. They're highly effective, they're safe, and they're free."

Melissa Harris-Perry: According to the Mayo Clinic's vaccine tracker, nearly 63% of Americans have had at least two doses of Pfizer or Moderna, or one dose of Johnson & Johnson vaccine. Another 12% of Americans are at least partially vaccinated. What's going on with everybody else? Is it hesitancy? Is it accessibility? With rapidly spreading Omicron variant, just how exposed are we all?

Rachel Hardeman is the Blue Cross Endowed Professor of Health and Racial Equity, and Founding Director of the Center for Antiracism Research for Health Equity at the University of Minnesota School of Public Health. Welcome to The Takeaway, Rachel.

Rachel Hardeman: Thank you for having me, Melissa.

Melissa Harris-Perry: All right. Let's just start with this. How important is access right now relative to our unvaccinated rates?

Rachel Hardeman: I think access is incredibly important, but I think about access a little bit differently than how Dr. Fauci described it, which is simply saying that they're available, they're free, they're safe. It's not just an issue of access being availability, but if access doesn't also include the right knowledge and education. If access doesn't include the right or the trusted provider to administer the vaccine. If access doesn't include time away from work, paid leave. If side effects or reactions to the vaccine happen, then we can't say we truly have access. I think that's the crux of the issue is that there's a lot of other barriers surrounding vaccine access that we haven't addressed to truly make them accessible in communities, and particularly in communities of color.

Melissa Harris-Perry: Dr. Hardeman, is there an example of a place where access on all the different fronts that you have identified there seems to actually have moved the vaccination needle?

Rachel Hardeman: I don't know that I can name a specific place. We certainly see that there are states that are doing really well with their vaccination rates. States like Vermont, for instance, is doing an excellent job, and then there's other states particularly in the south that are lagging behind. I think there's little pockets of communities across the country where there are incredible leaders, community leaders, community physicians, church leaders, and things like that who are really improving access for the folks that they serve in their community. I think that those efforts are the ones that have to be commended when we talk about improving access and really having those critical conversations with folks about why vaccination is important.

Melissa Harris-Perry: My husband and I were joking this morning that if you look at a scale in our community which is a southern community and a pretty religious one, but at the top is God, Jesus, the church, and then next is the principal of our school. [laughs] Only because the principal of our school has managed throughout the past two years to be a great communicator about what's going on to keep parents up to date, to make good choices. Quite honestly, to keep our little independent school open for nearly every day of this, and once we went back in the fall after that very first pivot. That sense of like a trusted local person I absolutely get. I'll also say it's a community of relative privilege of parents and principal who speak the same language in terms of education, all of that thing. What happens when you have to have those communication points around vaccines where there isn't that kind of similarity?

Rachel Hardeman: We actually live in a very similar scenario to the one that you just described where our daughter and the head of her school has done an incredible job of communicating and messaging, and building trust right within our community. There's so many areas and so many pockets of communities where that's not the case, and that's where we have a lot of work to do.

It also means that we have to be thinking about not just COVID, and not just COVID vaccination, but how other social factors and social determinants are impacting both health and well-being, but also the day-to-day lives and how people operate with different systems and different institutions whether it's healthcare or education, and thinking about in all those points where people are accessing information and systems, and leverage that to build relationships, and that takes time. I think some would argue, well, we don't have time. People just need to suck it up and get the shot, but it's really a matter of taking a step back and having those conversations, finding out the why.

So many people have a story behind perhaps why they haven't been vaccinated. For some, it may simply be that they weren't offered a vaccine. For others, we hear a lot of this wait-and-see mentality. This felt like it was rolled out really quickly. I just want to wait a few more months and see what happens.

Being able to respect that, to have those conversations, and to talk about vaccination without shaming people I think is incredibly important.

Melissa Harris-Perry: Now there's some specific communities, those who are without homes, those who are without internet access, and those who are without citizenship or legal status documentation. How do we close the gap around vaccination for those communities?

Rachel Hardeman: We're seeing a lot of work happening in cities across the country where outreach to unhoused folks has been an incredibly important initiative and is gaining some success around the country, which is great. I think the challenge is with those who don't have citizenship, who are undocumented, who have that fear of engaging with our systems is a bigger challenge. That means we have to have trusted community health workers and community leaders who can say this is safe.

We don't require any of your information. We just want to make sure that you are able to live a healthy life and have access to the things that you need. I think that requires going into community with the folks who are already there, and really engaging folks who know and are trusted within the community to do that work. We're seeing the same with language barriers as well, and really being intentional about how we create messaging in different languages to reach out to communities in culturally appropriate ways.

Melissa Harris-Perry: Let's talk for a second about data. I feel like the past two years must be an extraordinary moment of data collection. Not all of it could possibly have all been analyzed yet with the speed which it's coming in. How comprehensive and reliable are data right now, particularly about those harder-to-count communities and their vaccination rates?

Rachel Hardeman: There has been a huge push over the past couple of years. Really since the pandemic began to make sure that we were not just collecting data, but being able to collect the racial and ethnicity data that is necessary to understand if a disproportionate burden of COVID-19 was falling upon certain communities. The same goes for vaccination as well. I think we have certainly made strides since two years ago or even a year ago when vaccines were rolled out. We still have a long ways to go to really say that we have robust data for each state. In most cases, I would say about 75% of the data around race and ethnicity and vaccine rates is accurate.

We have even more issues when it comes to understanding the data for vaccination rates for kids, for instance, between the ages of 5 and 11. Right now, the CDC doesn't actually report race and ethnicity for vaccinated children. The data is incredibly important. I always say we can't change what we don't measure. By measuring these things and asking these questions, that allows us to, as you said, you really dig into these pockets of communities that need more help, that need access, or need access in a different way than perhaps we've been typically defining it. The data is critical for us to be able to intervene in those ways.

Melissa Harris-Perry: I'm wondering at this moment also just about the questions of collective social pressure. When I think about barriers to access, as a political scientist, my first thought is always the ballot box, polling. One of the things that helps folks get over that and find a way pass a lot of really tough barriers is this sense of collective push. We are all going to vote. Come on, folks. Here we go and linking it to identity. I'm wondering if there are ways that the anti-vaxxing hesitation actually does create an access problem for those who might not normally be hesitant, but where there might be social pressure not to get vaccinated.

Rachel Hardeman: I am not a political scientist, but we are seeing some of that. Certainly there's a politicization of vaccination, and you even can see that in the way that the states rank among vaccinations. Some of the least vaccinated states are states that voted, for instance, for Trump in the 2020 presidential election. I think that that's no coincidence. There is folks who have jumped on this bandwagon and decided, "I'm anti-vax," but we also have folks who just need some time to really think this through and have opportunities to access information. What we've seen actually over the past couple of weeks is that more people have begun to initiate that first dose.

It certainly slowed down now, but I think the Omicron surge actually pushed people along that pathway. Some of it is messaging around the urgency of Omicron and this collective responsibility that we're all in this together, and we need to keep the people who can't get vaccinated safe, especially the little ones under five years old. I think that there is a lot to be said for this collective action and this collective power, but also it only gets us so far unfortunately.

Melissa Harris-Perry: I'm also really interested in how this might be showing up in the medical community. We know a lot about long-term social determinants of health and the ways that sometimes physicians, nurses, medical community will look at Black bodies and non-English speaking patients, and will make certain assumptions. I'm wondering in this time of COVID really burdening hospitals and care workers, if there's actually a similar kind of almost discriminatory or a stereotyping going on with folks who are not vaccinated and present in hospital with a serious COVID illness, and if that has any effect ultimately on what happens next in their cases, as we know it does with racial discrimination, for example?

Rachel Hardeman: I think that the jury is still out. Certainly we hear some anecdotal stories around discrimination, and certainly racism with respect to accessing COVID-19 care during the hospitalization phase, but I think there's a lot still to be learned around the stigma around being unvaccinated and what that means when it intersects with race and ethnicity or other marginalized identities. It's hard to say right now, but certainly given what we know about how healthcare systems operate, the impact of racism and discrimination and healthcare delivery. I think it's an area that needs a lot more research and inquiry to be able to dig out what's going on there.

Melissa Harris-Perry: What do we think about the responsibility for equity? Who is ultimately responsible? Is that CDC? Is that the Biden administration? Is that local government? Is that Walgreens? [chuckles] Who should we be looking to here for solutions?

Rachel Hardeman: I always say as a health equity researcher, as an antiracist researcher, health equity and equity is all of our responsibility. I think it's important to think about it from that, even as everyday citizens, asking the question of, how can I create equity when it comes to COVID exposure? Meaning, wear your mask, and wear a good mask, making sure you're socially distanced, making sure you're staying home when you're sick.

On a bigger picture, it's the responsibility of, of course, the Biden administration, of the CDC, and of the states and cities, and our local leaders to really ensure that we make decisions that lead with equity. What that means is that everyone has the opportunity to attain their highest level of health. It means that we are allocating resources according to need and not just giving everyone the same thing.

I think a perfect example is the recent rollout of sending COVID-19 antigen tests to homes. The question is, what about those who live in multi-generational households where you only get these four tests that go to one address? That's not going to be enough for many of our communities of color, many of our low income communities, where there are multiple families living in the same home or under the same address. Thinking about how equity plays a role there and really leading the decision-making and the policy-making with that equity lens is incredibly important.

Melissa Harris-Perry: Rachel Hardeman is the Founding Director of the Center for Antiracism Research for Health Equity at the University of Minnesota School of Public Health. Professor Hardeman, thank you so much for your time today.

Rachel Hardeman: Thank you so much for having me, Melissa.

Copyright © 2022 New York Public Radio. All rights reserved. Visit our website terms of use at www.wnyc.org for further information.

New York Public Radio transcripts are created on a rush deadline, often by contractors. This text may not be in its final form and may be updated or revised in the future. Accuracy and availability may vary. The authoritative record of New York Public Radio’s programming is the audio record.