In early February, seven vaccination sites opened in Boston’s neighborhoods, including Mattapan, Roslindale, Hyde Park, South End and Dorchester. Initially, this might be passed over as an expected result of the state’s vaccine rollout. The reality, however, is these seven represent a different effort—a pivotal stride in health equity.
Health inequity has been thrust into the spotlight since the onset of the COVID-19 pandemic. When prevalence and incidence data showed disinvested communities were being hit hardest by COVID, it reinforced the power of ZIP code as a predictor of health. The very factors that placed people at high risk for contracting the virus and having a more serious manifestation of it—chronic illness, living in multi-generational housing, jobs that require close interactions with others—were those that disproportionately affected minority groups.
“The statistics told us, time and again, about how social determinants of health mattered when it came to this virus,” explains Petrina Martin Cherry, vice president of community engagement and external affairs at Boston Medical Center. “We were seeing health disparities. People from Black and Brown communities were the sickest and dying more than others.”
During the initial surge of COVID cases in the spring of 2020, 40 percent of people diagnosed in Boston were Black—a sharp contrast considering only 20 percent of the city’s residents are Black. The issue was amplified at Boston Medical Center where 76 percent of patients admitted with COVID were Black and Latinx (42 percent and 34 percent, respectively). By comparison, 14 percent of patients admitted to BMC with COVID were white. What’s more alarming is 50 percent of COVID-positive deaths occurred in Black patients and 17 percent occurred in Latinx patients.
Despite the pandemic being widely reported as impacting minority groups more, the first vaccination site in Massachusetts was launched more than 20 miles from neighborhoods that would benefit the most. Overlooking such a glaring need is a symptom of an incongruent society and system benefiting some groups and oppressing others.
“Inequity is difficult to recognize because it’s in front of us all the time, but because it’s accepted as the status quo and not interrogated, it’s perpetuated. We become complicit in it. It’s a complete blind spot to even the most well-meaning of people,” explains Thea James, MD, vice president of mission at BMC. “Yet, travel a mile in Boston and the life expectancy [between high and low socioeconomic areas] is different by 30 years.”
Boston Medical Center set out to disrupt the status quo of inequity and ensure vaccines were reaching people with the greatest need. In partnership with community organizations, BMC spearheaded an initiative to set up vaccination sites in an equitable manner—while the desired outcome is the same (vaccinate as many eligible people as possible), the key distinction is there are varying needs to achieve it.
“If anyone is coming with solutions to address the issues that arose from the COVID pandemic, it’s BMC,” says Martin Cherry. “We are a safety-net hospital committed to serve communities that represent historically disinvested communities. Between our partnerships, our clinicians setting the standard for how to create opportunities and access for disparate communities with large numbers of determinants of health and the support of our leadership, we have the right combination of ingredients to build success for our patients and communities.”
Determining where to place the vaccination sites was a strategic and data-driven effort. Part of this included using variables from the CDC’s social vulnerability index (SVI)—defined in part as helping “identify communities that may need support before, during or after disasters”—to map out areas of highest priority.
“We used SVI data to plot where we needed to be—not just for the members of our health system but for everyone who was impacted the greatest,” Martin Cherry says. “We made sure people did not have to travel more than two miles, whether by walking or through public transportation. We were very intentional in our planning.”
Deep, robust community engagement before, during and after the sites opened played an equally important role. During the startup process, BMC heard from numerous voices including faith leaders, social impact influencers and school leaders.
“We provided information about the vaccine and asked, ‘What would [it] take to set up access in the community? What should it look like? What would it feel like? What would be welcoming to people?’” notes James.
A key takeaway from those conversations was that using familiar, well-known spaces as vaccination sites could help reduce barriers like anxiety and distrust. BMC followed suit by utilizing facilities such as churches and community health centers.
“There’s something sacred about seeing people come to a place where there’s already a sense of belonging. We wanted to provide access in places community members trusted,” Martin Cherry explains. “Every site is so special because they represent the uniqueness of each neighborhood—we seamlessly fit in because we’ve tailored each site and worked alongside leaders. It’s the coming together of a community.”
Besides literally opening doors, the effort is also opening figurative doors. In order to stamp out the very factors that made minority groups the de facto targets of the pandemic, BMC is doubling down on its longstanding mission to address the root causes and social determinants of health. The process forward involves a complete paradigm shift centered on removing gaps instead of filling them and facilitating economic mobility. However, the only way to make a sustainable impact is through close collaboration with communities—something only possible because of the trust and relationships built through the vaccination sites.
“Being in the communities is the best thing we can do to strengthen the bridge between community-based organizations and BMC—it is the backbone for all of our equity initiatives going forward,” Martin Cherry explains. “The fact that BMC is ‘here’ administering vaccines is a signal that we are also ‘here’ in bigger ways. We’ve deepened our relationships and created a bond that didn’t exist before. This trust is amazing, but it’s fragile. We have to continue to show up in the ways we’ve promised. We have to continue to be great listeners and learners.”
While the road toward health equity is long, one thing rings true: every step in this new direction is one step closer to reinvigorating communities with opportunities to thrive so history does not repeat itself.
“The most important word driving our work is intentionality,” concludes James. “With intentionality we will set the bar higher for everyone and alter the quality of people’s life course. We are empowering people to switch socioeconomic lanes—to get out of the lane of perpetual need. That is our true north.”