In a wide-ranging conversation covering health determinants, trust in the COVID-19 vaccine, and solutions to health inequity, panelists Dr. Yolandra Toya ’88, Dr. Chris Pernell ’97, and Dr. Owen Garrick ’90 gathered on Friday to discuss the disproportionate impact of COVID-19 on marginalized communities.
The event, titled “Race in the COVID Era: A Disparate Impact,” was the second webinar in Princeton’s Equity, Inclusion, and COVID-19 Series, sponsored by the Office of Institutional Equity and Diversity and the Office of Communications. Deputy Vice President for Communications and University Spokesperson Ben Chang moderated the event.
Chang explained that both offices wanted to co-sponsor the event in order to continue community-wide conversations on two of the country’s most important issues this year, COVID-19 and race.
“Our offices are focused on bringing a wide range of voices and perspectives to bear on issues of importance not only to Princetonians but to a diverse range of audiences. We are committed to further convenings, collaborations, and conversations as we look to the new year,” Chang wrote in an email to The Daily Princetonian.
“We wanted to examine COVID-19 through a health equity and racial justice lens and do so through the eyes of three distinguished Princeton alumni, each medical experts who brought years of experience — both personal and professional — to bear on these issues.”
Systemic racism and COVID-19
A prevailing topic of discussion was the role of systemic racism in amplifying the effects of COVID-19 in Black, Latinx, and Indigenous communities.
“We're actually seeing the collision of two pandemics … a collision of the fast pandemic and slow pandemic,” explained Pernell, the Chief Strategic Integration and Health Equity Officer at University Hospital, New Jersey’s only public hospital and largest provider of health care for uninsured people.
“That fast pandemic brings this novel infectious agent which seems to have exploded out of nowhere onto the global scene,” Pernell continued. “But then there's that slow pandemic that's collided with this fast endemic, and that slow pandemic is systemic racism. Systemic racism has been with us for over 400 years; it's in the root of our soil,” she added.
Pernell shared that she has suffered personal losses as a result of the collision of the two pandemics. Her father, “a Black man who endured the Jim Crow South, a self-taught research scientist,” could not escape the pandemic, and after landing in the hospital for unrelated causes, he was exposed to the virus and died.
Pernell also lost her cousin, an essential worker, to the pandemic. Her sister, a retail worker, contracted COVID-19 eight months ago and is still struggling to remain off supplemental oxygen.
She explained that racism has functioned as a pre-existing condition for COVID-19 through “exposure and vulnerability,“ whether this increased exposure is due to living conditions, work environments, or “chronic health conditions rooted in social determinants of health.”
To Toya, a physician and community pediatrician who works with both Native and non-Native populations, the social determinants of health in Indigenous communities include unequal access to health care.
“I'm in New Mexico where we [Native Americans] make up 9 to 10 percent of the population,” Toya said. She went on to note that Natives were disproportionately affected in both total COVID-19 cases and morbidity rate.
Many tribal governments in New Mexico implemented safe practices like social distancing and border closing months before the rest of the state. Toya noted the statistics were in part due to the “chronic underfunding” by the federal government of Indian Health Services (IHS).
“Most people think that Indian Health Services is an insurance plan, and it's not. Native American people, by far, are the biggest group that are not insured in this country,” she said.
Keely Toledo ’22, a member of the Navajo Nation and co-president of Natives at Princeton, agreed with Toya.
“Even though we have IHS, it doesn't mean that there's equitable health care and that the health care we’re getting is quality,” she said. “We understand that there’s structure, but as I learned within this panel conversation, those systems are embedded in racism.”
Building trust in health care
The panelists also discussed building trust between health care workers and communities of color, both during vaccine creation and before vaccine distribution.
To address the issue of people of color being underrepresented in clinical trials, Garrick, President and CEO of Bridge Clinical Research, stressed the need for representation among health care professionals to increase the diversity of trial participants, particularly in COVID research.
“You can't completely be sure that new drugs and new therapies work in individuals that are not first tested in a study,” Garrick stated.
“If you look at coronavirus,” he continued, “overburdened from a disease perspective of Blacks, Hispanics, and Native Americans, what that should mean is there should be more people from those backgrounds in a clinical trial.”
But pointing to a COVID pneumonia study his company conducted earlier in the year, where 85 percent of the study population was Black, Hispanic, or Latin American, Garrick felt it showed that studies can include diverse populations.
“We as a research enterprise go to places and individuals like Dr. Pernell and Dr. Toya that have trusted relationships with their community,” Garrick explained. “And those are the physicians and research scientists that we went to in this study and got over-representation because their patients of color trusted them.”
Pernell herself participated in a vaccine trial and tried to encourage others within her community to do the same.
“I was faced with skepticism in my community when I first started this conversation around participation in the coronavirus vaccine trials,” she said, citing the Tuskegee Syphilis Study and the case of Henrietta Lacks, the unwilling and unknowing source of an immortal cell line, as examples of Black Americans being exploited for medical advancements.
"We in health care have to demonstrate trustworthiness,“ she added. “Trust is not going to be built overnight, but trust can be cultivated through a series of actions that says to a community, ‘Your priorities matter.’”
Beyond the “Native bubble”
Toya commented on the conflicted relationships between tribes and communities beyond the “Native bubble,” particularly with the federal government.
“[I]t wasn't unexpected, but this year there has not been a focus on the federal relationship with tribes,” she noted. “We're the only politically defined minority with trusts and treaties with the U.S. government, and we’re supposed to be afforded health care in these treaties.”
“Of course we all know that that did not happen ... but that being said, with 500 years of resilience, we're going to get through this,” she said.
Toya also noted the complex relationship between the 22 reservations in New Mexico — which each have their own sovereign government — and the state government.
“The work with the state has been very helpful,” Toya said, before explaining that some communities had chosen to receive vaccines from the state instead of the Indian Health Service.
Yet she pointed out that communities did not get enough vaccines from the state. “For small communities of 2,800 to 3,000 people, we got 55 doses to 65 doses, so that was barely enough to vaccinate the clinic staff,” she said.
During an attendee Q&A, Nancy Lin ’77 asked Toya if she had “suggestions for specific activities and programs that we can support to improve the health care situation for Native Americans.”
Toya first stated that individuals advocate for seeing Native Americans not as “historical relics,” but instead should “talk about this country and its diverse format.” She then mentioned supporting Johns Hopkins University’s Center for American Indian Health’s vaccine program.
“In Arizona and New Mexico, they actually are looking at the COVID vaccine’s impact on Navajo Nation. And I think that's amazing. And if people want to help at that level, that would be a great program to support,” she said.
A student attendee asked how students could not only “tune into conversations ... but actively battle these health inequities in marginalized communities.”
Chang, before handing it over to the panelists, noted that this work was already “underway in the Princeton community,” pointing to the School of Public and International Affairs professor Heather Howard’s Junior Project Taskforce.
“[Heather and her students] did research on vulnerable populations during COVID and presented it to the New Jersey Department of Health,” Chang said. “Among the populations they focused on were New Jersey prisons, as well as nursing home residents in congregate care settings and also migrant farmworkers living in dormitories.”
Garrick called upon students to be involved in thinking about the issues.
“Students are the ones that interact on the ground and have a more updated sense of the real issues that are happening in the community,” he said. “Help us think through what are the real challenges.”
In closing the event, Pernell encouraged students to “continue to get in good, necessary trouble.”
“I am hopeful that we are at a point that we don't regress where we're fighting for the public's attention, or the infrastructure necessary to answer these persistent health equity issues,” Pernell said. “I hope that this becomes a larger and larger lens around, not just the coronavirus pandemic, but around those conditions that make life outcomes more problematic for certain groups.”
“Let's look to make health equity the staple of all of our interactions and not just that thing we talk about when a crisis emerges,” she concluded.