White House Covid Adviser Keeps It Local

Marcella Nunez-Smith’s three public appearances on Monday:
• White House national Covid press briefing, with Fauci.
• Community Foundation of Greater New Haven race & health-justice roundtable.
• New Haven sickle-cell town hall.

Nunez-Smith is the chair of the White House’s Covid-19 health equity task force, tapped for the role by President Joe Biden.

She’s also an associate professor at the Yale School of Medicine and a practicing internal medicine physician of 20 years.

Her schedule on Monday included virtual stops at a White House press briefing, a Community Foundation for Greater New Haven roundtable, and a local Sickle Cell Disease Association of America town hall. It showcased just how direct of a link she is between New Haven and the Covid-19 policymaking frontlines of this new presidential administration.

It also underscored how she sees her broadest national responsibilities and her most hyperlocal of commitments intersecting during the ongoing Covid-19 pandemic.

“I want everybody to know: The lines of communication are wide open,” she said to the roughly 15 New Haveners who dialed in to the sickle cell-disease town hall. ​“I’m bringing greetings from the Biden-Harris Administration.

“President Biden and Vice-President Harris, they’re showing up. They’re showing up to make sure that we see equity not just now in Covid-19, when we need it so desperately, but beyond. I wouldn’t be there if they weren’t showing up.”

She told the New Haveners present that she is committed to making sure that questions, stories, and ideas raised at such local gatherings inform the federal government’s ongoing response to the pandemic.

“The worst thing,” she said, ​“is a bunch of people sitting in a room, making policies, who don’t know” what it’s like in communities that have been hit hardest by Covid-19 so far. ​“That’s the worst thing.”

11 A.M.: White House Press Briefing

Dr. Marcella Nunez-Smith of White House COVID team says 47% of race and ethnicity data on vaccinations is missing

​“Those dynamics don’t just hurt our statistics. They hurt the communities that are at the highest risk and have been the hardest-hit” https://t.co/9T8aUPjUrs pic.twitter.com/t7GtxmhVfJ

— CBS News (@CBSNews) February 1, 2021

Nunez-Smith’s highest profile virtual stop of the day came at 11 a.m., when she was one of three top White House officials to present at the Biden Administration’s latest Covid-19 virtual press briefing.

The other two presenters were Anthony Fauci, Biden’s top Covid-19 medical adviser, and Rochelle Walensy, the new director of the federal Centers for Disease Control and Prevention.

During that online press conference, Nunez-Smith described how race and ethnicity data are completely missing from 47 percent of the vaccination-related information that states currently provide to the federal government.

“We cannot ensure an equitable vaccination program without data to guide us,” she told the nation.

She called on states and the country as a whole to treat this missing racial and ethnic data as an ​“urgent priority” in the coming days, weeks, and months of the ongoing nationwide vaccine rollout.

She said that the lack of federal coordination during the Trump Administration, the uneven vaccination rollout among the states, and ​“inconsistent emphasis on equity in the early stage of vaccination” have all contributed to these large gaps in the nation’s understanding of who exactly has gotten vaccinated so far.

“Those dynamics don’t just hurt our statistics,” Nunez-Smith said. ​“They hurt the communities that are at the highest risk and that have been the hardest hit.”

6:30 P.M.: Community Foundation Roundtable

The White House task force chair delivered that same message about the need to fill in racial and ethnic data gaps around vaccinations Monday night when she was one of six participants in a virtual roundtable hosted by the Community Foundation for Greater New Haven.

This time, she was in conversation not with the nation’s top public health experts, but rather with New Haveners on the frontlines of responding to the local disparate racial impact of Covid-19. Fellow speakers included Citywide Youth Coalition Executive Director Addys Castillo, Southern Connecticut State University Associate Professor Khalilah Brown-Dean, and Community Foundation for Greater New Haven President Will Ginsberg.

The spark for the virtual conversation was the Community Foundation’s new $26 million ​“Step Forward” initiative to invest in grassroots leaders of color.

Much of the hour-long talk focused on broader concerns around what kinds of financial and institutional investments are necessary to achieve a future where, as panelist and Tsai Center for Innovative Thinking at Yale University Managing Director Onyeka Obiocha put it, ​“everyone is at the table. Everyone has power. And everyone is able to deploy that power to create communities where they can thrive.”

Nunez-Smith said that many on the panel, whether they be healthcare providers like herself or community organizers working in the area of racial justice, have not been surprised as Covid-19 has disproportionately hurt Black and brown Americans and New Haveners. Just as she outlined during a local NAACP town hall last spring, members of these communities disproportionately work low-wage, essential jobs, have limited access to high quality healthcare, live in dense residential settings, and have a greater burden of co-existing conditions like diabetes and asthma.

“Moving forward, our obligation and commitment has to be to disrupt the predictability of that pattern, in New Haven and beyond,” she said.

She also cited medical surveys where respondents of color overwhelmingly answered that they were confident they would not get the same quality of care as a white patient would if they went to a hospital to be treated for Covid-19. And she noted skepticism in some parts of the Black community towards getting a Covid-19 vaccine.

Part of that wariness comes from the ​“very, very dark moments in the history of medical experimentation” in this country, including such cases as the Tuskegee Syphilis Experiment and the exploitation of Henrietta Lacks. Some come from Black people’s experiences of discrimination by doctors and at hospitals that date back just a week or a month.

“We have to be able to name the bias that people have experienced” before more equitable health outcomes can be achieved, she said.

Nunez-Smith added that she is ​“trying to be humble in this moment, trying to listen as we reckon with these realities.”

Brown-Dean said that she has returned again and again to the writings of James Baldwin as she grapples with how this country, and this city, must go about addressing Covid’s disparate impact. It must start with exactly what Nunez-Smith described, she said: Listening, honesty, conversation, and self-reflection.

“Not everything that is faced can be changed,” Brown-Dean said, reciting the words of the late, great Black writer and thinker. ​“But nothing can be changed until it is faced.”

7:30 P.M.: Sickle Cell Disease Town Hall

After the Community Foundation roundtable wrapped up, Nunez-Smith hopped directly into perhaps the most intimate public appearance of her day: A 15-person virtual town hall hosted by the Dwight-based Sickle Cell Disease Association of America, Southern Connecticut Inc.

She fielded questions directly from Black New Haveners about Covid-19 vaccination access, data, and prioritizations.

Debra Bond (pictured) introduced herself as psychologist in New Haven and the mother of a child with sickle cell disease, an inherited red blood disorder that disproportionately affects African Americans.

“I’m very concerned about when sickle cell patients are going to be prioritized” in the state’s phased vaccine rollout plans, she said. ​“How long is that going to take?”

Nunez-Smith said she’s not involved with the Connecticut vaccination process. Phase 1b, which the state is in the early stages of, will include Connecticut residents with certain pre-existing health conditions, but sickle cell disease is not one such condition.

“From my vantage point,” Nunez-Smith said, ​“people who are well-organized are getting heard.” Jim Rawlings, who heads the local sickle cell disease association, promised to to take the lead in organizing interested New Haveners in reaching out to state leaders to make sure that those with sickle cell disease make it into Phase 1c.

Frank Tavarez-Mora (pictured), a first-year medical student at Quinnipiac University, asked if Black and Hispanic people are getting vaccinated at lower levels than white Americans because of a lack of confidence in the vaccine, or because of a lack of access to the vaccine.

“That’s the $64,000 question,” Nunez-Smith said. ​“We have both challenges right now.”

She said she hears plenty from people who are ready to get vaccinated and in an eligible prioritization group, but who find it too difficult to get connected to providers who are administering vaccines.

“It keeps me up at night when people say that,” she said. “‘I don’t have an email address and can’t register.’ Or, ​“My grandparent is trying hard, but she doesn’t speak English.’ Those are some of the structural things we have to get ahead of.”

She said the federal government will be prioritizing increasing the number of vaccination sites across the country, especially in Black and brown communities.

The second issue, she said, comes down to ​“trust building.” There are big racial gaps in who’s getting vaccinated right now, including when you look at people who work at nursing homes, she said.

“That’s about confidence in the vaccine. From a national level, there’s a full public education campaign. But it also has to be hyperlocal. People are going to listen to their neighbors. They’re going to listen to their church leaders and community leaders. When asked, they have to have the right information.”

She stressed that she is ​“not here to sell a vaccine.” But rather to listen to why people might be hesitant, or why they might be having difficulties accessing available supplies, and then helping the Biden-Harris Administration craft solutions based on that grassroots input.

Maraya Clark (pictured) said she’s a recent college graduate who aspired to get a doctorate in clinical psychology. She also has sickle cell disease.

“I’m just curious,” she said, ​“after you do get the vaccine, is that going to be considered proof of not having Covid? Or are you still going to need to get tested every couple weeks?”

Nunez-Smith said that, first of all, the two vaccines that have been approved for emergency use authorization in the United States so far are incredibly effective at preventing severe illness, hospitalization, and death from Covid-19. ​“That is the endpoint,” she said. ​“We want to keep people out of the hospital. We want to keep people from dying.”

What’s less certain right now, she said, is how effective the vaccines are at preventing one from getting infected with Covid-19, or communicating Covid-19 to someone else.

“We have to act as though you can still catch it and still transmit it,” she said. That means, for the time being, everyone should get as comfortable as possible with regular mask wearing, social distancing, and getting tested.

“A mask is my friend,” she said with a smile.

Clark responded with a smile of her own.

She thanked Nunez-Smith for taking the time to address the small group, and for sharing her experience and expertise with fellow New Haveners.

“I saw you on TV this morning,” Clark added. And while watching Nunez-Smith in the national press briefing, Clark said she thought to herself: Wow. I’m going to get to ask her a question later today.