Testimony by RWJF Executive Vice President Julie Morita, MD, on Health Equity and the U.S. Vaccine Rollout Delivered Before the U.S. House of Representatives Committee on Energy and Commerce Subcommittee on Health

The following hearing testimony was delivered by Robert Wood Johnson Foundation (RWJF) Executive Vice President Julie Morita, MD, to the U.S. House of Representatives Committee on Energy and Commerce Subcommittee on Health “Road to Recovery: Ramping Up Covid-19 Vaccines, Testing, and Medical Supply Chain.”

Chairman Pallone, Ranking Member McMorris Rodgers, Chairwoman Eshoo, Ranking Member Guthrie, and Members of the subcommittee:

Thank you for the opportunity to testify. My name is Julie Morita. I am the executive vice president of the Robert Wood Johnson Foundation, the nation’s largest health philanthropy, and I served on the COVID-19 Transition Advisory Board in my personal capacity. Previously, I served as: commissioner and chief medical officer of the Chicago Department of Public Health; an Epidemic Intelligence Service officer at the Centers for Disease Control and Prevention; and a member of the CDC’s Advisory Committee on Immunization Practices. 

Our Foundation believes everyone deserves a fair and just opportunity to live the healthiest life possible. The pandemic—with more than 26 million Americans infected and 440,000 lives lost—illustrates the critical nature of our mission. 

Vaccines offer real hope to eventually end the pandemic, but we must improve distribution by adhering to three fundamental principles: equity, accessibility, and coordination.

Equity

We must begin with equity. People and communities of color are disproportionately impacted by COVID-19. These populations historically and currently face discrimination, marginalization, and neglect. As a result, they are more likely to be denied basic necessities like a living wage, health insurance, and paid leave. 

The CDC recommends that frontline and essential workers—predominantly people of color—be among those prioritized for vaccination due to high exposure risk. But today the country is consumed with total allotments and weekly averages instead of whether shots are getting in the right arms. 

We must course correct quickly. Our Foundation believes an equitable response to the pandemic starts with collecting and reporting all COVID-19-related data by race, ethnicity, and socioeconomic factors. Yet most states do not publish vaccine data that includes race and ethnicity. Among states that do, the share of vaccinations among Black people lags behind their share of cases and deaths.

We can no longer accept the systemic racism that drives these disparities. Congress and the administration should encourage and enable all states to vaccinate priority populations first and to report vaccine data by race, ethnicity, occupation, and neighborhood. 

Accessibility

Second, we must increase accessibility. Vaccines are only as effective as people’s ability to obtain them and willingness to take them. 

Across our nation, those with means and privilege are increasingly getting vaccinated before those with the highest exposure risk. Necessities that some may take for granted—an Internet connection to make an appointment online; a car to drive to a large-scale vaccination site; the time it takes to navigate complex systems—are unaffordable for millions. 

A fairer approach simplifies appointment systems and brings vaccines directly to priority populations. In Chicago, during the H1N1 pandemic, we partnered with pharmacies and federally qualified community health centers that provided care to the uninsured in neighborhoods with less access to healthcare providers. More than 700 locations in Chicago ultimately received more than one million H1N1 vaccines during a critical 12-week stretch. 

We also established meaningful connections with trusted community partners to address vaccine hesitancy, which remains an issue today. More than one-quarter of Americans report they will not or likely will not get a COVID-19 vaccine. Notably, hesitancy rises to 1 in 3 among rural residents, Black adults, and essential workers. 

Community groups, faith organizations, and other neighborhood pillars of trust play a pivotal role in helping people make appointments and understanding and addressing their concerns. Our Foundation is providing grant support to state and territorial health officials and community organizations to address vaccine hesitancy. As we await additional doses, funding and supporting critical local efforts will help us move to vaccine confidence and equitable distribution. 

Coordination

Third, the incredible complexity and urgency of this vaccine rollout requires coordination and illustrates the unique role of the federal government. 

I’m proud of how Chicago handled H1N1, but we did not do it alone. CDC’s clear guidance, additional funding, and technical assistance were invaluable. Without that support, our vaccine rollout would not have been as successful.

I’m encouraged that the administration—particularly Dr. Rochelle Walensky, the new CDC director—is committed to improving coordination at the federal level. Open lines of communication, increased transparency—such as more specific, accurate, and timely estimates of state allotments of vaccines—and ramping up our public health workforce will all help state and local health officials perform their heroic work. 

Conclusion

The Robert Wood Johnson Foundation is invested in creating a more equitable nation during this pandemic and beyond. In the short-term, America’s ability to weather this crisis will require wearing masks, social distancing, washing hands, and additional support from Congress to help those hit hardest. Vaccines will eventually lead us to this pandemic’s end, but saving the greatest number of lives will require a recommitment from all of us to equity, accessibility, and coordination in vaccine distribution and all facets of our response.

About the Robert Wood Johnson Foundation

For more than 45 years the Robert Wood Johnson Foundation has worked to improve health and health care. We are working alongside others to build a national Culture of Health that provides everyone in America a fair and just opportunity for health and well-being. For more information, visit www.rwjf.org. Follow the Foundation on Twitter at www.rwjf.org/twitter or on Facebook at www.rwjf.org/facebook.