How One Health System Inoculated a Population
Kenyatta Elliott, MBA, MHA
Even in the earliest weeks of the pandemic’s ascent, health systems nationwide began aggressively shoring up infrastructure to undertake what we knew would be one of the most prodigious health campaigns in American history: vaccinating millions of individuals as quickly as possible. What’s more, we (correctly) assumed that the communities most vulnerable to the virus would be the hardest to reach, logistically and psychologically, given inequitable distribution of primary and ambulatory care facilities in urban and rural neighborhoods, as well as well-deserved skepticism from a population historically disenfranchised (or worse) by health systems.
As a Black healthcare executive at one of the most esteemed medical institutions in the country, I knew we had a moral and practical imperative to prioritize this population. I am, after all, part of the population, and a native of the Durham/Raleigh area where I serve.
In fact, where I serve, Black residents make up around a third of the population of the city, but more than half of all COVID-19 infections, comprising the greatest portion of deaths by the disease. In a report issued by the Partnership for a Healthy Durham, those living in neighborhoods that were subjected to redlining practices from the 1930s through 1968, had a far higher COVID-19 risk than people in neighborhoods that weren’t. Statewide, Black individuals are also uninsured at a rate more than twice that of whites, meaning that many of the underlying conditions that exacerbate COVID-19 have gone untreated. In short, the disparities are deep and multifactorial.
So how do you rapidly dismantle generations of structural racism in and mistrust from communities exploited by the system?
With vaccination rates considerably lower in the historically marginalized districts of Durham county, our health system created a patient COVID-19 Vaccine Equity Advisory Committee led by Katie Galbraith, MBA, FACHE, president of Duke Regional Hospital and interim head of community health. In underserved communities, we stood up testing and vaccination sites, deployed mobile units, and protected doses specifically for those most at risk.
But it wasn’t about what Duke did; none of this was possible without the support of our community’s trusted leaders―barbershop and salon owners, pastors, nonprofit leaders, and others. We partnered with popular radio programs like Radio One, K97.7, 103.9, and 104.7, delivering critical health messaging through a panel of Duke leaders who actually reflected the very audiences they sought to reach.
The results were almost as remarkable as the process it took to achieve them. Through Duke Regional, Duke Raleigh, Duke Primary Care, and our community partners, we were able to vaccinate more than 22,000 people.
All these efforts were radical in the context of corporate healthcare. They continue to challenge our thinking about how we creatively partner with communities to ensure that no populations fall through the cracks. The work we undertook also raises important questions about how best to restructure care systems, provide community frameworks, and continue the critical work of relationship-building to heal generations of mistreatment and mistrust.
And yet, our efforts were also, frankly, obvious. As a community conditioned for self-reliance and tenacious self-determination, Black leaders know better than anyone the power and practice of community organizing. And while there’s no question that we have a long way to go, this experience is a reminder that we have allies in the fight for equity, to paraphrase poet Amanda Gormen, “If only we’re humble enough to see them.”
Kenyatta Elliott, MBA, MHA, is the Associate Vice President of Duke Primary Care. She is a 2021 Fellow of The Carol Emmott Foundation.
