Two years later: Reflecting on the national response to COVID-19's racial disparities

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0:00:30.9 Luke Shaefer: Good morning, everyone. I'm really thrilled to be with you. My name is Luke Shaefer. I'm the Hermann and Amalia Kohn professor of Social Justice and Social Policy at the Ford School and director of Poverty Solutions. We're here for the second installment of our series, COVID-19 Reflections, a series on race, health and economic justice, two years later, reflecting on the national response to COVID-19's racial disparities.

0:01:00.0 LS: I am really thankful to my colleague and friend, professor Celeste Watkins-Hayes, Dominique Adams-Santos, and Sharanya Pai at the Center for Racial Justice here at the Ford School for including me and my team in this incredible series. They've brought us together for this, and I think all three events are gonna be incredible.

0:01:20.4 LS: Today, we get to hear from Dr. Cameron Webb. Dr. Webb currently serves as a senior policy advisor for equity on the White House COVID-19 Response Team. Previously, Dr. Webb was an assistant professor of Medicine and Public Health Sciences and director of Health Policy and Equity at the University of Virginia School of Medicine. A general internist, Dr. Webb has worked clinically in the university's COVID Unit since the beginning of the pandemic.

0:01:53.0 LS: Additionally, he's the Founding director of UVA's Health Equity, Law and Policy Research laboratory, and is a core faculty member at the university's Equity Center, an initiative for the redress of inequity through community-engaged scholarship. Prior to joining the faculty at UVA, Dr. Webb spent a year as a 2016 White House Fellow in the Obama-Biden Administration Office of Cabinet Affairs, where he served on the My Brother's Keeper task force in the White House healthcare team.

0:02:26.0 LS: Born and raised in Virginia, Dr. Webb received his BA from the University of Virginia, his MD from Wake Forest School of Medicine. And in what I can only imagine is to make us mere humans feel bad, received his JD from the Loyola University Chicago School of Law. Dr. Webb, thank you so much for joining us. We're really delighted to have you.

0:02:48.8 Dr. Cameron Webb: It's my pleasure. Thanks so much for having me today.

0:02:52.8 LS: I was wondering if you could just start by telling us a little bit about the White House COVID Response Team. What does it do? What are the goals of the team? And then maybe a little bit about your role as a senior policy advisor for equity.

0:03:07.5 DW: Yeah, absolutely. And so when President Biden and Vice President Harris were thinking through how they wanted the COVID response to live as they were doing the transition into the presidency, the thought process was really wanted to have a pretty robust apparatus within the White House building to coordinate the work across agencies and offices.

0:03:28.8 DW: There are a lot of different agencies across the federal government whose work touches and concerns the COVID response. So to have that kind of central nervous system to coordinate, I think was really the goal. Initially the COVID Response Coordinator was Jeff Zients, who has a long history in terms of being an operator in government, he's actually the guy who fixed healthcare.gov when it broke down years back, when when they first launched the website and the ACA.

0:03:53.9 DW: And so from there, they have somebody who's really skilled at navigating government and operations. We have, as our chief medical advisor, Dr. Anthony Fauci, who is at NIH, but is really intimately connected with our team, working closely with the CDC Director, Dr. Rochelle Walensky, working really closely with the Surgeon General, Dr. Vivek Murthy, and we all kind of form a broader team across our different entities to make sure we're all pulling in the same direction, 'cause there's a lot to keep coordinated.

0:04:21.8 DW: I think that that was the vision for the team itself. The number of folks on the COVID Response Team varies because we have some folks who are in in and out, but it was at its peak about 35, 37 individuals who were part of this team within the White House itself. I think that goes to show just how much of an investment. That would make it one of the larger offices in the Executive Office of the President, and that just showed the President's emphasis on the COVID response.

0:04:47.3 DW: I think at this point, and you asked specifically about the work of equity, and I remember it was three days after Christmas when I got a call from the administration asking me to consider coming in in this role. And my first question was, "Well, what does equity mean to you?" To Jeff and to the President.

0:05:05.8 DW: The idea was they wanted equity to really be the heartbeat of our response. They said that there's no success in addressing this pandemic unless all communities are able to see the benefit of the resources and tools, if all communities have the opportunity to not just survive and thrive through this pandemic. So that's really what the equity work was founded on in terms of its notion, was working closely with Dr. Marcella Nunez-Smith, who was chairing a health equity task force for COVID-19 out of HHS, and so we were kind of hand-in glove throughout all of 2021, she left the administration again at the end of 2021.

0:05:39.5 DW: So you put it together, we had a pretty robust mechanism for us to really invest and engage around equity, making sure that everybody had chances to succeed. It's hard work, it's never easy to do equity work, but the key here is making sure that that was always top of mind in any of our efforts across the response.

0:06:00.3 LS: I first just wanted to ask, as you were talking about this response team, I think you mentioned CDC, NIH, Health and Human Services, you've got all of these hulking huge agencies. I just wonder what is it like to court... I just imagine like herding cats is sort of afraid, what is it like sitting at the White House trying to make sure everyone's on the same page and make sure everyone feels like they have a place at the table and are part of decision-making, but it's also all going in the same direction? 

0:06:39.3 DW: Well, you named some of the challenges there, to ensure that you have exactly that. Everybody feels heard. Everybody feels like they're able to bring their expertise and the full weight of their office or their agency, and at the same time, we're all moving in the same direction despite lots of different opinions, lots of different perspectives.

0:06:56.4 DW: I think one of the benefits here is that President Biden was here for the ACA as part of the Obama-Biden administration, and so that ACA work, kind of health reform in 2009-2010, that really required a similar level of coordination across CMS, CDC, HHS. You had the Office of the National Coordinator in terms of the health IT space. There were so many different components that touched and concerned the Affordable Care Act and its implementation.

0:07:27.6 DW: And having that coordinated from the White House, I think also gave us some muscle memory, 'cause a lot of similar people were back at the table here in this instance. So that's the first thing. The second thing is, I always tell folks, it starts with who the leader is, and if you think about President Biden, there's an old quote from Vernon Jordan, "You'd be amazed what you can get done in this city, Washington D.C, if you don't care who gets [0:07:48.3] ____."

0:07:48.3 DW: That's kind of how President Biden is. His focus here is on, "Hey, we have one mission, is to keep the American people safe. Egos goes aside, how do we do that?" And I think it allowed us all come to the table a little bit differently, and so I think that that helped.

0:08:06.7 DW: Finally it's just, you gotta pick the right people, and I think between Secretary Becerra, Dr. Walensky, of course Dr. Fauci, Dr. Murthy, we've got folks who really are about the work and who could really care less about their office or their agency being upfront. It's more about, are we delivering for the American people? And we always try to hit that mark. So I think that helps us. That's really the glue. It's the ethos of the team that's at work.

0:08:31.1 LS: You were saying, this muscle memory of being a lot of the same players and also the organizations having done this work very collaboratively in the past, so people bringing rapport and bringing sort of a playbook, and then understanding that we can have the most success. I love that Vernon Jordan quote, you have the most successful when you don't care... When it's not about getting the credit, it's about doing the work.

0:09:03.4 LS: I was watching a radio interview of you and you were talking about, the folks were asking you the definition of equity, and I was wondering if you could just take us through in this role as you're doing your work, how do you define equity? And how could that play out in the types of policies that get implemented? 

0:09:25.3 DW: Right. Well, there's some really great researchers who've done a lot of work on this, defining these terms. Equity is the absence of disparities, disparities are the metric by which we track equity. So in the work like this, you recognize very early on we saw disparities emerged in COVID-19, in cases, in hospitalizations and in deaths. And then you factor in access to resources and the disparities there, it means that we've got a lot to do to ensure and to press toward that mark of equity every single day.

0:10:00.4 DW: And so for us, what that means is that we really use and leverage every bit of data that we have to identify which communities are getting access to the resources they need and having the outcomes at similar levels. There are a lot of challenges to that. So when we say "each community", certainly we talk about that by race and ethnicity, that's probably one of the foremost ways that disparities or inequities are described in health in the United States, so that's critical.

0:10:23.8 DW: But it's not the only one, because there's also by rural and urban geography, and pretty quickly significant disparities emerged in that space as well. There's also disparities by place, we think about congregate settings where those are, we think about correctional settings, group homes, shelters, there are so many different spaces. Then we think about by different sorts of status, so immigration status became a space where we saw that there were some disparities that emerged pretty early on.

0:10:57.1 DW: And so we had to map out essentially what are all of the different dynamics by which inequities persist, grew and persisted through the first year or so of this pandemic leading into this administration, and then we said, "And how do we work to address each and every one? How do we create systems to make sure that we're tracking and make sure that we're addressing?"

0:11:13.4 DW: I will say in the equity space, one of the biggest challenges we consistently have is data, it's the lack of visibility. Because it's not always the case, a lot of these data have to be collected at a very local levels, and so it's not always the case at the local or state level, or even federally, that we're collecting the information we need to track and intervene on equity. And so that's a big part of the work that we did over the last year, is just to try to terraform that data environment.

0:11:42.4 DW: The President put forth an Executive Order for what's called the Equitable Data Working Group, and has been working tirelessly over the last year to look at our government-wide kind of data systems and say, "What are we measuring, what are we not measuring, and how can we improve it?" And that gives us a better chance.

0:11:57.6 DW: Again, you can't treat what you don't measure, you can't address inequities that you don't see in terms of the data. We know that we can feel them, we can see them around our communities, especially if you're out and engaged in community, but equity work ultimately means that we're eliminating those disparities, that has to be the goal.

0:12:15.4 DW: So I think that's what a lot of our work has looked like, it's looked like making sure we have the data environment necessary to track success, creating the data systems to track that success, but then ultimately holding us accountable to that standard of saying, "Nobody is gonna be left behind in this."

0:12:33.0 DW: That essence of fairness really comes from us saying, "We're not leaving anybody behind." Even if you see gaps in our response or in the outcomes that we have right now, what that tells you is that those gaps that you see are probably indicative of the areas where we are accelerating the most in terms of putting resources, time and energy to address, and that's based on our approach to this problem.

0:12:54.2 LS: I wonder if you could take us back. You had mentioned access to data, and sometimes don't have the data to really know who's being impacted the most. I'm just curious if you could tell us the story of early in the pandemic, when you were first realizing that this was... This pandemic was disproportionately impacting people of color, disproportionately impacting low income and vulnerable folks. Where were you, what were you doing at that point? And was there data that sort of alerted you to that, or did you have a sense before that? 

0:13:33.6 DW: Well, so early on in the pandemic, so March of 2020 when really this was all coming to a head nationally, at that time I was working clinically at the University of Virginia as an internal medicine doc, as a hospitalist. And so our group was charged with standing up and staffing what became our COVID unit.

0:13:53.6 DW: At the same time, I was teaching, leading a health equity and policy research lab, so really helping at the state level to some extent with making sure we were measuring what we needed to measure in preparation. But at the same time, I was in the midst of a Congressional race, I was actually running for congress.

0:14:08.1 LS: Wow, I didn't know that.

0:14:10.6 DW: Yeah, in Virginia's 5th congressional district, I was the Democratic nominee. And so what ended up happening was we had to change our campaign pretty dramatically because we weren't going out and knocking on doors, which is the hallmark of a United States Congressional campaign, and we had to change to really this virtual environment.

0:14:26.3 DW: What it did is it gave me on a bunch of different fronts, the opportunity to engage people's experiences with COVID. So as a clinician, I'm engaging with it in a hospital setting, but at the same time as a candidate, I'm engaging with just people all across this district with 21 counties and two cities and hundreds of thousands of people, just hearing them talk about how the pandemic was affecting them.

0:14:49.9 DW: Very early on, you could hear that inequities popping up, you could hear how it was described. When things were shutting down, you could hear who had the privilege of staying home versus who were essential workers, a term that's, again, kind of dubious distinction there because it's deemed essential when you need folks to go in and put themselves in harm's way, but it's not essential necessarily, it hasn't been recognized as essential in terms of pay, in terms of recognition in society, in terms of resources. So kind of a unique dynamic that we saw there.

0:15:22.6 DW: I wanna point out that on the data front, I named that as one of the challenges that we face, the absence of data is never an excuse for the persistence of inequity. I think that what we recognize is that even in an inadequate data environment, we can perceive and we have to proceed with the awareness that there are gonna be some communities that are hit harder, and we saw that with COVID very early.

0:15:47.3 DW: If you look at the disease dynamics itself, we knew that it was, the people at greatest risk for bad outcomes were gonna be folks with a burden of chronic disease, and disproportionally that falls on Black and Brown communities, disproportionately that falls on lower income communities, disproportionately that falls on rural communities. So we knew COVID was gonna exact a really particular impact in those spaces.

0:16:11.0 DW: And so I think that's where for me, a lot of what I was doing was in our communities, helping organize testing campaigns at a local church, our testing drive was set up. That kind of work early on was really important, and it was important for us in our community. Then you fast forward through the shutdowns and through all those moments, and so by the time I was coming into the administration, I was no longer a congressional candidate of course, but at that point, you know what, I realized I was bringing a lot of insight from the ground, from the front lines into the work.

0:16:46.7 DW: I think that was really important because it helped inform the approach, it helped inform a lot of the insights that I had and that I was able to bring into a role focused on equity.

0:16:57.8 LS: I was just reflecting on... I can actually remember. So in Michigan, our chief medical officer was Dr. Joneigh Khaldun, she's gonna be joining us for the final one of these sessions, and I just have an incredible admiration for the job that she did at the state, and then I got to work with her at the City of Detroit too. I think Michigan was one of the first states in the nation to include in the publicly available data what we knew about race and place.

0:17:37.5 LS: I can actually remember the first time I looked at the information about folks who had the virus and folks who had died, and seen just the huge difference between Black and White Michiganders, and our large cities and other parts. So I really, I credit her for making sure that we have those data available.

0:18:09.0 LS: I know we didn't... It wasn't perfect data, as you were saying, but you said also this other I think really important thing, that just knowing what we know about health policy, even in the absence of data, folks, we could put together who this was gonna impact the most. And so making sure that you have an eye for that when something happens and are asking those questions seems really important.

0:18:37.5 DW: It does, and I have to have to take a moment of personal privilege and say Dr. Khaldun isn't just somebody admired by you. Admired by all of us. She's absolutely phenomenal. We were lucky enough to have her as one of the members of the Presidential COVID-19 health equity task force, which I mentioned Dr. Marcella Nunez-Smith was leading, and Dr. Khaldun done came in and helped lead some of the work around data and around how do we improve that data environment.

0:19:06.2 DW: So really brought that leadership, certainly from her insight in Detroit, her insight from the State of Michigan to this role. And I know she's kind of gone on and now is working at CVS, but I think that her work has been so critical, and it's folks like Dr. Khaldun who've really helped us really quickly accelerate what it means to be pressing toward COVID equity.

0:19:29.1 DW: I think of other great leaders, and there's no shortage of them at the University of Michigan, one of my dear colleagues, Dr. Riana Anderson, she's done some phenomenal work in this space as well, just kind of elevating people's awareness of some of the mental health impacts in terms of the inequities there, the impacts on children and families.

0:19:45.9 DW: I think that that kind of information, that kind of experience, that informs the broader response, and so there's a huge role both the academia, both local state government, all across the board, when you see those kind of shining lights around the country, that catches our attention in the White House and those are the places that we frequently go to inform what the future of the response is gonna look like.

0:20:07.1 LS: Yeah, wow. So tell me, let's talk about policy response. Well actually, right before we get to policy response, I just wanted to ask, so in this idea of whenever something happens sort of having the equity lens to figure out who's gonna be impacted most early on, you had mentioned jobs as one of the reasons why at the beginning of the pandemic, right? 

0:20:39.3 LS: Who has the ability to stay home was one of the reasons for disproportionate impact. Chronic health conditions is another one. Are there any other structural factors that really were at play in getting us where we were at the beginning? 

0:21:00.9 DW: Oh, absolutely, COVID outcomes aren't necessarily driven by hospital or healthcare settings, even though that factors in, access to healthcare is key. But COVID outcomes are largely predicated on where you're born, grow, live, learn, eat, play, and pray. That really drives everything that we were seeing in this pandemic.

0:21:20.6 DW: And so if you think about the impact of housing, you think about housing density, and you think about the role that plays in the disease that spreads as fast and as far as COVID-19. You think of the role of incoming equality, and I talk about that because for folks who are potentially facing poverty, who don't necessarily have the resources.

0:21:42.6 DW: Then suddenly what we run into is that they're having a different calculus around the decision to stay home because of some potential COVID symptoms, or to stay home because of a family member who has COVID, versus other individuals. We saw the way the pandemic had a dramatic impact on food access, and we saw the long lines in states all over the country, of folks trying to get access to resources at food banks, access to food and whatnot.

0:22:08.7 DW: And so you think across those social determinants of health, and we certainly saw a way that each one was driving outcomes in this pandemic in some way, shape or form. And I wanna be clear, you know COVID is... In some ways, it's a mirror to the country, for our healthcare system and for our society as a whole. COVID... You know, people are held faultless for COVID-19, this is a virus, a novel virus that came to our country and suddenly people are exposed to it and caused great harm. Especially in the pre-vaccine days. Now people do assign some blame, even though I still don't believe they should.

0:22:48.3 DW: But I think that what's interesting is in shining that light we said, "Wow, look at all these communities it's hitting so hard." But you can go back and say, "Well, you know, HIV AIDS hit those same communities hard. Diabetes hits to the same communities hard. Heart disease, cancer mortality, maternal mortality, infant mortality, rates of pneumonia."

0:23:05.1 DW: All these different factors, all these different outcomes are hitting these same communities disproportionately. And so the reason why we see that is because it's the same drivers in community, health happens in community. And so I think that suddenly we're left trying to cobble together a way to keep people safe from COVID, when really it's the entire...

[overlapping conversation]

0:23:28.6 DW: Construct. Exactly. And so I think that's why if people, if communities don't take this moment and say, "Wow, we didn't wanna see our people disproportionally die from COVID and therefore we invested these resources, these tools, this access." What else do you not wanna see your community dieing from? 

0:23:44.7 DW: 'Cause it's probably that whole range of conditions I just listed, and you should take a similar approach to making sure that people can navigate effectively, making sure people don't have to hurdle all of these social determinants just to stay safe and be meaningful contributors to your own society.

0:23:58.6 DW: So I think that's... For me, in so many ways, those factors have been really apparent, and I think that we can't let this moment pass without pointing to them and saying, "Hey, we need to address that too."

0:24:10.5 LS: I'll take this moment to plug Celeste Watkins-Hayes, my colleague's award-winning book, Remaking A Life, which is all about the HIV safety net and some of the great...

[pause]

0:24:32.9 DW: I think you went on mute.

0:24:40.3 LS: I'm sorry. I think I... I was... It got muted. I'm sorry. So did I, was I plugging Celeste Watkins-Hayes' book before...

0:24:47.3 DW: Yeah, I heard you mentioned the book, you were starting to describe it when it went out.

0:24:52.3 LS: Alright. I can't even... I can't hear you. So I'm gonna... It looks like you can hear me, so I'm gonna go ahead and do the plug-in and I'll ask the next question, hopefully I'll be able to hear again. But her book which won so many awards, it's hard to keep track, really focused I think on COVID and... I'm sorry, the HIV safety net, and how health policy as well as social, really focusing on social networks and social policy was the key to making some progress.

0:25:24.9 DW: Yeah, absolutely, absolutely. I'll have to check that one out.

0:25:28.0 LS: Dr. Webb, tell us a little bit... One thing that we do like to focus on is the concrete policies and programs that show success. So I wonder, as things, as we start to grapple with where we are in COVID, what were some of the things like some of the success stories that states, municipalities and the federal government put in place that you think really started to address some of the things we were seeing? 

0:26:02.2 DW: I mentioned data already, so I'll give a great data example. I'll point to the State of North Carolina that required that all of its vaccine providers in order to continue to get their supply of vaccine, had to report out on race and ethnicity in terms of who is receiving vaccinations. That reporting requirement led to over 98% of their vaccinations having race and ethnicity data. Which was tremendous. If you look nationally, that number is closer to low 70%.

0:26:31.4 DW: So North Carolina really led the way and became a model that we pointed to, and they really helped a lot of other states improve their data reporting systems. Because to this point, immunization information systems weren't always designed to capture race and ethnicity as a really critical input. And so I think seeing from a state policy standpoint what they did on data, was key.

0:26:54.7 DW: When we started in this administration in January of 2021, if you look nationally, we only had race and ethnicity data for 52% of our vaccinations, and so you can imagine that would make it impossible for us to know if there were inequities in the vaccine. But what we were able to do is then... I'm getting some feedback.

0:27:19.0 DW: Alright. Well, what we were able to do is we were able to take that number from 52% up to 75%. We still have some states that we're continuing to push, again, sharing some best practices or promising practices, but I think again, that's how the state dynamics and the federal dynamics can kind of dovetail.

0:27:38.5 DW: The next example I'll give is in the vaccination effort, which if you look writ large, we knew that there was a huge risk for inequities in vaccines, because we've seen inequities in vaccination efforts in other spaces, in influenza vaccines and pneumonia vaccines, and even in some childhood vaccines.

0:27:53.8 DW: And so we said, "This is gonna be one where it's only going to exacerbate the existing issues with disparities or inequities in COVID outcomes if we have these huge gaps in vaccinations." One of the first things we realized was that the initial recommendations around who is eligible for vaccines were predicated on age by and large.

0:28:13.6 DW: But what we know is that communities of color are sicker younger, because of that burden of chronic disease that's largely rooted in those social determinants of health. So when you put that together, we said really quickly, even though we had a limited supply, we had to get more and more people access to these vaccines as soon as possible, and by April 19th of 2021, we expand it to all adults all over the country were able to get access to these vaccines. T.

0:28:39.4 DW: That took a really step-wise process of making sure we're getting the vaccines into the right locations to make it possible. Again, vaccinating over 300 million people was the goal, and doing that in a short period of time, that's unprecedented. And so we built these mass vaccination spaces in partnership with states and localities, and that was really important, that was a way for us to locate those, and we specifically use metrics like social vulnerability index, which is a measure of social disadvantage, but we use those kind of tools to put our resources, our mass vaccination sites, our mobile clinics.

0:29:13.6 DW: We really expanded the role of federally qualified health centers by giving them vaccine and allowing them to go out and get the word out. There are over 1400 federally qualified health centers across the country, with over 13,000 sites. So that was a huge policy success. You add that all together and you couple that with other efforts aimed at really leaning into local trusted messengers, working with community-based and faith-based organizations to spread the word, to fight mis and disinformation.

0:29:40.1 DW: We even had a program called Shots at the Shop, working with barbers and stylists to get the word out through the places where people normally go in community, especially in communities of color. You add that all together and by late summer, August into September, we have equitable rates of vaccination for the primary series for Black, White and Latino individuals, where we had data to measure those three.

0:30:04.7 DW: It was really interesting because we usually don't see that kind of equity in the vacation effort, but we were able to do that because of the emphasis, and actually just this week, we got new data from the Kaiser Family Foundation showing similarly we've achieved equitable vaccination rates in terms of boosters.

0:30:18.2 DW: I say that because that's national data. If you look across the country it is there still are so many communities where you see gaps. And so what we've learned from it is that we can do this, we can build systems for equity, and it's not that this population doesn't wanna be vaccinated and that population does, it's that we have to find ways to make it accessible, acceptable, and make people ready and willing to receive something that's gonna be potentially life-saving. I think that's huge. So I think the vaccination effort is a huge testament to it.

0:30:48.8 DW: Last example I'll give you, even on things like our treatments, we have these new oral anti-viral pills that are really effective, decrease your rate of hospitalization and death in COVID-19 by 90%. And as soon as we heard about these medications, we said, "We don't want this going only to the richest of the rich or the sickest of the sick, we want this available in all communities to the people who need it."

0:31:11.0 DW: And so the way that we did is a model called a "reserve allocation", we set aside 15% of those treatments specifically for community health centers in the hardest hit highest risk areas. Off the top, we said that. And then the rest that we sent to states, we said they have to develop equity strategies to distribute their treatments and we've been tracking that. And as time has gone on, we've expanded it to pharmacy channels, and we put 50% of those pharmacy sites in those hardest hit, highest risk communities, the highest SPI communities.

0:31:40.6 DW: Those are things that we do from a policy standpoint to make it possible to give people that chance to access these things, and it makes a difference.

0:31:48.5 LS: I just wanna track back to this thing that you said about vaccine take up and booster take up having in a fairly short amount of time, reached sort of parity. I mean, that's an incredible policy success. I also... I wonder how many among our audience was aware of that, or how many around the country was aware of that? I remember seeing a lot of articles early on noting racial disparities in vaccine take up, but I don't remember quite as many articles coming out saying like, "Hey, like the government... The government responded, and we got there in a fairly short amount of time."

0:32:32.4 DW: Yeah, that's kind of the peril of the way that our media plays out. People are always gonna highlight the things that are bad. And so they're gonna say, "Oh there these gaps and it's unacceptable," but we've been shouting from the hilltops that this is a big deal. Part of the reason, and I wanna be clear, part of the reason why I talk about the equitable vaccine uptake across communities of color, in the primary series in particular, is because it's notable, right? 

0:33:01.1 DW: You've got 85% roughly of Black, White and Latino adults each, who've been vaccinated with the primary series, Messenger RNA vaccine. That's incredible. I always joke with folks, "Getting 85% of people in this country to do anything."

0:33:15.4 LS: Anything.

[chuckle]

0:33:17.1 DW: Is unheard of. But to take a jab in their arm, that is incredible. And I think what I heard, 'cause I did a lot of traveling around the country, and I'd be in South Carolina, Florida, Georgia, Alabama, Texas, Louisiana, and what you hear from people is, "Well, you know Black people aren't getting these vaccines, so why should I?"

0:33:34.7 DW: And so really quickly I said, "The inability of our spaces to tell the story that actually, we are. Actually, communities of color are being vaccinated at a hight rate." That is critical because what it does is it makes it less of an anomaly, makes people feel more like, "Well, if other people are being vaccinated, then maybe some of this information I'm hearing isn't the truth, maybe I'm the one being left out because I'm not vaccinated." I think that made a huge difference.

0:34:03.2 DW: So we do try to spread that message, but again I think that we can't expect that that's what different outlets are gonna be eager to report on, but it's our job to try to really push and tell that story, because it does impact the way the communities think about vaccines, think about boosters, think about vaccinating their kids.

0:34:20.7 LS: Right.

0:34:20.7 DW: And that's a huge issue that we still have to work on.

0:34:23.8 LS: Yeah, yeah. I think there's so much focus on the fraction who haven't gotten vaccinated, but as you say like 85%, that's an incredible number. And the parity is just a really incredible policy success. There's some corollary, I'll just... I'll take a little side route on the anti-poverty work during the pandemic, where the federal government... As a property expert, I completely underestimated the public health crisis early on, and was really concerned about the impact on livelihoods and who was gonna have a spell of hardship.

0:35:16.0 LS: And the federal government really responded in ways that were unprecedented, between expanded unemployment insurance, economic impact payments, a host of other things, doing a lot of smart things like Medicaid recertification, right? Where they said, "We're just gonna... We're not gonna make you re-certified," because that's when you go in and, just for the audience, report your income, and a lot of people lose benefits at those moments. So that was sort of delayed over a period of time.

0:35:51.1 LS: So much so that actually poverty fell in 2020, and we were able to stem the tide on rising food insecurity, but it's like the most impossible story to tell, because people... A reporter friend of mine was saying he was writing a story about poverty falling, and his editor actually crossed it out and said, "You mean poverty was rising."

0:36:19.9 LS: Obviously it's complicated and there's, lots of people are in a bad place, but recognizing... We don't recognize policy successes and the number of people who were helped. It's hard for us to sort make sure that the next set of policy, the next response to the next pandemic or whatever it is, takes the lessons that we learned about what worked.

0:36:45.9 DW: That's absolutely right. And I'll tell you that's one of my biggest concerns right now. As we're currently, and it's pretty widely public, we're engaged in a deep discourse with Congress about needing additional funding for the COVID response. We asked for $22.5 billion. What we said is that this money is specifically for us to keep doing the things that we need to do, and to do the things that we learned we should have been doing to keep people safe during this pandemic. We can't just be in an emergency posture, we have to be in a preparedness posture.

0:37:19.9 DW: And that's something we made that case, and it's had some trouble getting interaction. Because I think that this is, so often we're much more reactive. I think when you don't tell the story of the impact of things like the American Rescue Plan on a downward deflection in terms of poverty, improving people's access to really critical resources, keeping people covered when you think about Medicaid.

0:37:40.4 DW: Those things are gonna go away. Those resources, those policy interventions that had a positive impact, they will go away without the positive attention to the impact or the effect of that policy. So that's why it's so important, it is important for us to continue to press and say, "Here's the good that came out of that intervention. Perhaps we don't just do that in war time, so to speak."

0:38:04.0 DW: Perhaps we do that as a policy of the United States of America, because less poverty has tremendous positive impact on society, on education, on health and well-being, on mental health, on social cohesion. All these different factors are positively impacted when you have that policy that helps to combat poverty.

0:38:26.6 DW: So I think it's so important for us to tell those stories, especially because these are stories that were born from a pandemic, but it does give us the opportunity to say, "Hey, these policies work, and maybe they should be standard operating procedure for our nation."

0:38:39.9 LS: Yeah, my favorite data point right now is at the end of 2021, the number and fraction of Americans with bad credit fell to a 16-year low. I can only say 16 because I don't have data that go further back than that, it could be forever. If you had just told me that two years after losing 20 million jobs, that credit card debt would be down, the number of people sort of late on their mortgage payments would be down, that people's credit would be better, and then all of the other markers that have to do with financial health with that, I would have said it was, honestly would have it was impossible.

0:39:21.2 LS: But I do worry that during this time, like with vaccines, if people's main point is people don't take up the vaccines, what does that do for the next time around? So I wanted to just ask you to talk a little bit about moving forward, right? Well, let me ask you first, I'd love to get your thoughts on where we are in the pandemic and how people should be thinking about it.

0:39:53.7 LS: Obviously, we've had this huge decline in cases, it seems like maybe they're starting to go up a little bit. It seems like the vaccine has been particularly effective and keeping people who get it from being hospitalized or death. Is this just something that's gonna be a part of our life going forward? What does the future look like in terms of COVID-19? And then let's talk about the policies around that.

0:40:29.2 DW: Sure. I always start by saying that we've all learned some level of humility and that we don't have a crystal ball when it comes to this pandemic, so it's really different.

0:40:39.1 LS: I'm not gonna hold you to any... [chuckle]

0:40:44.9 DW: But I think that even still, what we know is that we're in a moment right now where yes cases, hospitalizations and deaths are down relative to where they were a couple of months back, but what a lot of people don't realize was that the high water mark, the point of this pandemic where we have the highest number of Black individuals hospitalized was in January of this year. Just three months ago.

0:41:07.7 DW: And so we know that things like an Omicron variant that can have a tremendous impact on the number of cases can also have huge effects, so we're not completely out of the woods when it comes to this pandemic. I think that what we see is right now in May of 2022, we have more resources than we ever had, more tools than we ever had to fight the pandemic.

0:41:30.7 DW: Because we've got vaccines we need, we just have to get all those shots into arms. We've got the boosters that we need, we just need to get everybody that highest level of vaccine coverage, that highest level of protection, up to-date vaccination, if you will. That includes our kids, right? That includes hopefully soon kids under five. But those are things that are gonna be really important.

0:41:46.9 DW: The part about where we are right now is we have treatments for COVID-19, so if you do get COVID, we have really effective treatments that can keep you out of the hospital.

0:41:53.7 LS: These pills.

0:41:55.9 DW: Keep you from dying. The other thing we have is we've got at-home COVID tests that are pretty much free for almost anybody. You can get tests from COVID tests.gov. So you can go and the government will send you tests. Or if you do have health insurance, Anthem, Aetna, Blue Cross, Blue Shield, whoever it may be, your insurance provider since January 15th of this year is required to cover eight free COVID tests per month, per covered individual in your family.

0:42:23.5 DW: So those are tests that you should be taking advantage of. Under the name of my six-year-old son, he has gotten his eight tests per month since January. I think that's important because we keep our house filled with COVID tests. Once allergy season hits, it could be allergies, it could be COVID. And so we test. We test regularly.

0:42:41.7 DW: Testing is prevention. Testing is a mitigation strategy. Having high quality masks, we know now in May of 2022, that COVID is spread by droplets, by air, and so it's so important for people to have high quality masks that they can wear, N95s or K95 masks. We've sent out 400 million of them.

0:43:06.8 DW: But I tell everybody, the moment that we're in is a moment of preparedness. Take advantage of these resources, make sure you have them on the ready, make sure you know whether or not you have COVID, make sure you know whether or not you would benefit from a treatment. Make sure you are vaccinated to your fullest extent.

0:43:20.6 DW: And that's how you stay safe in the weeks and months to come because you're always gonna hear some more alphabet soup. VA 2.1, 2.1, whatever it may be. We got BA4, BA5 on the way, these are sub-lineages of the Omicron variant. You're always gonna have new numbers, new letters coming your way about COVID-19. How you stay safe is you make sure you're taking full advantage of the tools that we have, and that you're benefiting from those.

0:43:42.4 DW: So that's a message we're having to get out to every community in every space. I think that so often what gets left out is that that requires affirmative outreach, and I try in every talk to make sure that I mention. There are certain communities in this country that just have been historically left behind, underserved, under-resourced.

0:44:04.4 DW: I think about tribal communities, often about how hard it is for us to get resources there because of just this long legacy of us really not doing our duty to tribal communities. And so that relationship, that work with tribal leaders, with healthcare leaders in those communities, with IHS, that's work we have to do right now to prepare for what's coming in the future. And let's all hope that there's not another huge surge of cases, but I just remind people, par of why we've had this moment of improvement is because we saw CO prevalence data, a lot of the country has had or been exposed to COVID-19, and a lot of the country has been vaccinated.

0:44:41.9 DW: But we know that vaccines, the kind of length of time that it really protects people from infections is a couple of months. Natural immunity, same thing, a couple of months. So we're gonna come into a season again where that protection that we had from the beginning of this year is starting to wane, we're gonna have to think again about what are you doing to make sure you are optimally safe.

0:45:01.6 LS: I just took one of the free tests that we got from the federal government, so thank you. Let me just... Yeah, I took it a few days ago, 'cause as you were saying, I was feeling a little under the weather and thought... I didn't think I had COVID, but thought it was worth checking out. So, encouraging people to get tests and make that decision to take it sooner rather than later maybe, to continue to stay up to-date on shots, and then be aware of these other tools that we can use to manage it, if you get it.

0:45:42.5 LS: You said "affirmative outreach", I think, and I heard you talk about one of the big successes with the vaccination was sort of finding those trusted intermediaries and figuring out where are people most comfortable. I wonder if you could talk anymore about successful affirmative outreach strategies and whether it be about COVID or about something else, what are the things people should be doing when you wanna talk to or communicate about important health policy issues to the groups that, as you were saying with Native American tribes have often not been treated well by our healthcare system or have been left out? 

0:46:32.3 DW: Well, I think so much of it starts with knowing who is at the proverbial table and doing an honest assessment and say, "Who's missing? Who have we been omitting from this table for generations?" And I think that's been so critical. We built a lot of new tables in this pandemic. I've got a group that I meet with every other week. It's a lot of community-based organizations and faith-based organizations that have a footprint across the country, to make sure that they're really in lockstep, that they know everything about the latest with COVID-19, both in terms of outcomes and in terms of resources.

0:47:06.1 DW: Because they can then use their networks to spread the word, they become a lot of those local trusted messengers. We talk to local public health providers, local healthcare providers, to make sure that they're really well-informed. The way that we do that is by saying, "These are folks who haven't traditionally been at the first to come to mind for a briefing from the White House on what's happening with any given thing."

0:47:29.0 DW: But for us, that has been kind of standard operating procedure, is to say, "Let's stay really close. Let's not just call you when we need something. Let's make sure we're in regular communication." And it's bi-directional communication. That's another really key piece. What I hear back from community-based organizations, what I hear back from faith leaders about the experiences with COVID, those become really the threads that I pull on to say, "Is there a problem here? Is there something that we need to look more into? Is there some additional data?"

0:48:00.7 DW: I can't tell you how often I've called state leaders and said, "Well, actually, I heard this was going on in this community, in this county, and I wonder if it's indicative of a larger challenge?" I think of an example of a time when a community leader in a part of Birmingham, Alabama called and said, "We don't have access to any vaccines at all where I live."

0:48:18.7 DW: And so we went back to the state and they said, "No, we actually have vaccines in Birmingham. Here's the map, Birmingham has vaccines." And then we went back and we did a zip code level analysis and we said, "South Birmingham has the vaccines. North Birmingham does not, and that's the predominantly Black community."

0:48:35.7 DW: And so what it did is allow us to say there's a different level of analysis to do, we never would have gotten to that challenge or to that community in that way without hearing from community what was happening. So I think that so often people say it's hard to do that kind of deep stakeholder engagement and listening.

0:48:55.0 DW: We can do hard things, it's critical that we invest in that way, that we have that listening posture. I think that really has to be one of our big goals. But I think that by and large, the work looks like mapping out who your stakeholders are, mapping out who your assets are in terms of people and resources who you can engage, and make sure you do that work. It's not easy, but I think it is gonna be really critical.

0:49:18.7 LS: So does this take the form of a monthly Zoom call where folks from all over the country log in and maybe you spend the first a little bit talking about where we are and delivering some messages and then take some questions? Is that what it looks like? 

0:49:36.6 DW: Well, I would say it's more like daily Zoom calls for me, [chuckle] because I've been having large meetings where I'm talking to people. If you think about the number of people you would need to have in one call if you're doing it once a month, nobody would be able to talk back to you. So what we had to do is a lot of the smaller guys.

0:50:00.0 DW: And so what that's done is we have tables of 12 to 15 folks, we do a couple of them each day over the course of a month, and that level of engagement really gets us back to, "Okay, here's what I'm hearing from this community, from that community." We keep track and then we say, "Let's circle back."

0:50:16.0 DW: Let's make sure that we're saying, "Oh, we heard you didn't have access to tests for this community in Puerto Rico, and it was because of this unique challenge with zip code entering, so we're gonna follow up on that." That level of engagement has really helped us see a lot of challenges coming down. And I'll say, it doesn't mean that we get everything right, and I wanna be really clear on that.

0:50:35.8 DW: There's a lot of humility you have to take into the work if you're doing equity work, because it's not a muscle that is well-developed in our federal government. So our systems and our structures from our federal government standpoint weren't even designed to deliver equity. And so that's where we say, "Alright, we're gonna say... " We don't ask people to assume good intent, but we know where we're coming from in this, so we're just like, "Tell us where we're missing the mark, and so that way we can focus in our energy on hitting that mark."

0:51:03.7 DW: What I can tell you is that any time I bring a problem like, "Hey, this community doesn't have access to this necessary resource," the answer is always, "We'll get it to them. How do we get it to them? Let's make sure we deliver on that."

0:51:16.3 LS: Yeah, I think that's a really great point of going in presuming... Not presuming that everything is gonna be done perfectly at the start, but really trying to focus on... It sounds like just a really strong focus on responsiveness and trying to make sure that you're always listening.

0:51:36.3 LS: And then responding when somebody raises like, "We don't have vaccine in our community," and then the local leaders say, "Yes, they do," and then delving even deeper into it, in the case of Birmingham. It's like an iterative process, it seems like.

0:51:53.3 DW: Right, that's right. It is iterative, and it does take a lot of time, but I think that when you build trust, when you build relationships with groups, the good news is that call or that insight wasn't because I was on a call with a bunch of leaders and some folks from Birmingham happened to be there, it's because we had built the relationship and the leader from Birmingham just reached out to me separately and said, "This is what I need."

0:52:18.8 DW: I think that we have our apparatus in the White House for that. HHS, CDC have their own outreach that they're doing. So when you layer those on top of each other and then we kind of cross-pollinate, it becomes really powerful. And imagine the same things happening across the states, it can be really, really nice.

0:52:38.4 LS: And I think that's how it seems like that's how government can build trust in communities too. That some folks raised an issue to the White House, and you guys responded and something changed as a result. That sort of says, "Okay, like when I say things, something happens. That a change is made." So that follow-up seems really important.

0:53:07.7 DW: Also, I should mention that I've said a couple of times, the Presidential COVID-19 Health Equity Task Force, the Dr. Nunez-Smith lead, and that Dr. Khaldun ws a part of, that task force came back with over 300 recommendations. They came back with 55 core recommendations that they wanted the administration to act on, and they turned that report in November. By December, we had taken action on over 80%.

0:53:35.9 LS: Wow.

0:53:37.4 DW: Now we're in motion, we're really trying to address every single one of those recommendations in a meaningful way. They had five core recommendations that they wanted us to attend to. We're working across all the different agencies to make sure we're delivering on that.

0:53:51.9 DW: So even when people don't see the work, again, it's not always about people seeing what we're doing at all times, but we're gonna have a report coming out in the next few months about our follow-up, from that really what we think was a seminal report on health equity in this pandemic, and showing how our attention to it, our intention and making sure we're doing something meaningful, matters. I think that's really what it comes down to. That's what keeps trust. You can ask people to trust you, but you maintain that trust by delivering on what they're asking you to do.

0:54:21.5 LS: Is that report publicly available? 

0:54:23.7 DW: The Health Equity Task Force report is. It was transmitted in... Let's see, November 10th is what it was. I'll send it over to your colleague and you guys can send it out the students. It's a great report, and I think it tells a really powerful story across all the different dimensions of this pandemic in terms of the equity impact. So I think it's a good one for people to know about.

0:54:45.9 LS: Yeah, I think it would just be a great model for, government brought some experts together, they thought deeply about what changes should be made. And then implementing 80%, that's a really high fraction. Relative to how these reports are often implemented. [chuckle]

0:55:09.9 DW: And I'll tell you that leadership matters and Vice President Harris, it was her brainchild it was something that she initially proposed when she was then Senator Harris. And so coming in, she was... She continued. Every time we interact with her, she's like, "How are things going with those recommendations?"

0:55:31.1 DW: That leadership from the top really makes a huge difference in terms of priorities. I think it gives, for somebody like me who's in a role where I focus on equity, that's the wind in my sails. To say... That's my top cover. "Vice President asked me." I call and agency and I say, "Where are you with this?" And they're like, "Well, we've got these other priorities." And I'm like, "Well, the Vice President wanted to know where you are with this." That's a different conversation, and I think it makes a difference.

0:56:00.5 LS: Yeah. I got two more questions just on the COVID experience, and then I'd love to just wrap up hearing a little bit about your professional journey for our students. When you think about communities of color not just surviving, but perhaps even thriving in the midst of the pandemic, are moving forward as we go along, what do you think's been most impactful? What are the things that sort of have maybe lifted communities up even beyond just trying to mitigate our challenges? 

0:56:33.7 DW: So I think a few things. I'm a clinician, so I'm always thinking in terms of health outcomes, and I will say the vaccination effort and the equity we've achieved through that vaccination effort has prevented countless deaths. If you look writ large, the vaccination effort has prevented 2.2 million deaths, at last count, which is as of the end of March.

0:56:55.9 DW: If you think about even the, we're coming up on a million deaths from COVID-19, which is an unfathomable number of people who die from disease, but even coming up on that, we know that about 25% of those deaths could have been prevented with vaccines. And so the thing that I'm reminded of is that the vaccines have saved countless lives, disproportionately lives in communities of color, and that makes a huge difference.

0:57:21.2 DW: I think about our work to get schools open safely, 'cause we think about learning loss that we've seen in some of the schools that didn't have the resources to have really robust virtual learning, or that didn't have the broadband access to have really robust virtual learning, or just how critical schools are from a social-emotional standpoint for young people, and I think that in communities of color, schools being spaces for meals, for caring adults, for people who make a difference in shaping the future for young people, that's so critical.

0:57:49.4 DW: So our ability to get schools open and keep schools open safely has been really the key. The investment we're doing in ventilation around schools, the technical assistance we're doing with school districts, that stuff makes a huge difference. I think that there are so many different pieces, but it's hard for me even to answer that question because my mindset is always on, what are we missing and what do we still need to do? 

0:58:10.8 DW: I know for a fact there's still so much work for us to do in communities of color, in some of the hardest hit, highest risk areas. And even though things look better in this moment, how do I get more tests to those communities? How do I get more masks to those communities? How do I continue to message the importance of childhood COVID-19 vaccination in those communities? How do we make sure people have access to the treatments in those communities? 

0:58:34.0 DW: Yes, we've got some good policy successes, but for me, we have an ongoing chart. It's the reason why I said I was coming in to take this job for nine to 12 months, here I am, it's 38. [chuckle] Because as Kobe Bryant once said, "Job's not done until... "

0:58:49.0 LS: You're satisfied.

0:58:50.4 DW: Not satisfied. Gotta keep working.

0:58:53.2 LS: Alright, well, I've got you for one more minute, I just... Maybe I'll just ask you two very interrelated questions. One, any advice in terms of your own trajectory, being a practicing MD, a law degree, worked two stints at the White House now, an academic appointment. Do you sleep? And then the second question is, any advice to our students who will be embarking on their careers? 

0:59:28.1 DW: Well, sleep is critical. Make sure you get sleep.

[chuckle]

0:59:32.4 DW: And so, yes, yes I do sleep. Efficiency with your time becomes critical, so learning how to be efficient, how to make the most of your time, makes a huge difference. In terms of advice I'd give the students, I know this may sound kind of basic, but the truth is mentorship matters and your relationships matter.

0:59:51.5 DW: I say I have a life board of directors. Those mentors have guided me at every step in my path, from which med school to choose, which residency to choose, what jobs to take. Is they are people who've grown with me over time. They know my story, they know where I wanna go, and they've helped me kind of find my way. So mentorship matters.

1:00:08.2 DW: But I mentioned Dr. Riana Anderson because she's one of my close friends who I talk to about where I'm going. So those are the relationships, you are the company you keep. So being close to people who are similarly passionate about issues that you care deeply about, it becomes a network and environment of learning, of co-creating, and that is the space that's life bringing.

1:00:32.2 DW: So find things that you love, invest wholeheartedly in them, and really immerse yourself in a community of like-minded individuals who are gonna help you achieve and be your highest and best self. I think that makes the big difference.

1:00:45.3 LS: What a great place to stop. So, Dr. Webb, thank you so much for spending the hour with us. I learned so much. I know that our audience learned a great deal. We're so appreciative of your work, and hope you'll come back again sometime in the future and update us on your work.

1:01:03.8 DW: I'd love to. I'd love to actually come to Ann Arbor next time so let's end this pandemic. [chuckle]

1:01:08.5 LS: Okay, good. Well, we can make that happen. And to our audience, make sure we've got one more in this incredible series. Again, thanks so much to our colleagues at the Center for Racial Justice who put this together. Dr. Joneigh Khaldun, you heard a little bit about her amazing work here. We'll get to hear more from her at the beginning of June, so stay tuned for that.