January 14, 2021

Appearing via video link, Dr. Marcella Nunez-Smith during a news conference last month in Wilmington, Del.Chip Somodevilla/Getty Images

By Alisha Haridasani Gupta

Gender Reporter

“It is a structural problem that people don’t have access to high-quality health care.”

— Dr. Marcella Nunez-Smith, associate professor of internal medicine, public health and management at Yale University, and chair of President-elect Joseph R. Biden Jr.’s Covid-19 Health Equity task force

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In early December, a Black doctor, Dr. Susan Moore — then hospitalized with Covid-19 — posted a video online complaining of inadequate care by her white doctor. After her video was shared widely, the problem was corrected, but just weeks later, Dr. Moore died of complications from the disease.

The news lit up the group chats of Dr. Marcella Nunez-Smith, whose friends pointed out just how painfully familiar Dr. Moore’s experience was.

“There were so many text threads with my friends saying, ‘Yes, this happens,’” explained Dr. Nunez-Smith, a practicing internist, an associate professor at Yale University and the founding director of Yale’s Equity Research and Innovation Center. After the inauguration, she will also chair President-elect Joseph R. Biden Jr.’s Covid-19 Health Equity task force.

“So often, even I have to declare I’m a physician, almost out of this desperation to say, ‘Hey, pay attention to me, listen to me,’” she said in a recent phone interview.

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“If it’s this hard for me, then what is it like for our patients who aren’t part of this system, who have a million other competing priorities, who don’t speak the language of health care?”

Dr. Nunez-Smith has noted that even when she’s functioning as a physician, some of her patients don’t take her seriously, handing her their meal trays or assuming that she has come to empty the trash.

This kind of inside-out, top-to-bottom racism in the health care system and the inequities that lead to poor health outcomes have been the focus of much of Dr. Nunez-Smith’s research. In her newest role, she has been tasked with drawing up a pandemic recovery plan that is both efficient and equitable.

In Her Words caught up with Dr. Nunez-Smith over the phone to discuss the vast racial health disparities of the pandemic and what the next few months will look like.

What frustrates you most about the conversations around gender and racial disparities in the health outcomes of Covid-19? Have there been moments where you’ve just buried your head in your hands?

Yes, I do have those moments! We have to counter the personal blame narrative. Things like, “These people haven’t taken care of themselves well enough, that’s why they have comorbidities” and other such notions that really are blind to the underlying reality.

It is a structural problem that people don’t have access to high-quality health care or to even think about early diagnosis and appropriate treatment for chronic conditions. What about the environments where people live? Is it really possible to get out there and do physical activity? Is it safe? Are there environmental toxins? Are we talking at all about who has the privilege of staying home? These things are not accidental. They are the results of policies that have been driven by a legacy of racism in our country and all the other -isms.

We know that certain groups, Black and Hispanic communities for example, have been particularly hard hit by the pandemic. What are some of your policy priorities moving forward to address these inequities?

One of the things we have to commit to is the disruption of that predictability. We have to have conversations around access to high-quality health care pathways but also conversations about educational and economic opportunities.

In the short term, though, as we think about Covid-19 and recovery, we have to ask what it looks like to have equitable access to testing, tracing, supportive quarantining and isolation, treatments and access to vaccination.

Yale University, via Associated Press

What does it look like?

First, we need better data. This is a huge thing that I spend a lot of time on: We have incomplete data right now, across the country, and we need better data to inform and drive policy.

Then it becomes an exercise in operations and logistics, but it’s also about understanding the lived experiences and realities of people.

So think about something like testing. So much of the testing in our country is drive-up testing, so obviously you need a car. And what are the hours of those facilities? Or, think about vaccinations that require special handling and cold chain storage. Where are we setting up those kinds of facilities and how far are they from the hardest hit? We also have to make sure there is no cost for the vaccine.

But really, the road map begins with data; it’s foundational.

Are there systems in place to make good data available? Is it just a matter of someone at the top — like you — asking for it?

I’m trying to get that understanding myself. I’m sure you’ve seen that our conversations and communications in terms of the transition are a bit … well, they are what they are … so we don’t have full visibility of everything that exists. But do I think it is possible for us to collect the data we need? Yes.

We need to collect data along the lines of sex, gender, race, ethnicity and geography. And kudos to all of the jurisdictions that are figuring out how to collect this data in a really robust way. But for the places where that might be hard, I think the federal government has a role to play in terms of technical assistance and guidance.

There are so many studies that show that men and women have different reactions to vaccines, but when I was looking through the data of the two vaccines that have been greenlit by the F.D.A., I found little information on the sex differences in adverse events (side effects) and immunogenicity (immune system reaction). Does that concern you?

You’re right, sex is a biological variable, and I think it’s really important for there to be transparency. But keep in mind where we are — we’re in emergency use authorization, we’re not in approval — and more of this information will come; I do expect to see more subgroup analyses.

The communities we’ve been talking about — racial minorities, women and LGBTQ folks, for example — have little trust in the health care system already because of how they’ve been treated in the past. What kind of messaging will help rebuild that trust when it comes to the vaccine?

It is completely rational for the groups that you listed to have a healthy degree of skepticism. We have to start the conversation there and acknowledge that there are groups in our country that have not really received the respect and the fair treatment that they deserve. It is very frustrating when people are like, “Oh these folks aren’t educated.” We need to understand why people have this apprehension.

We need to find out what questions people have and try to answer them. Let us be honest and transparent, and when we don’t know the answer, we won’t make it up. We’ll say, “We don’t know yet.”

Then we need to ask, well, who do you want to hear that answer from? That matters a lot. We know that information moves through different groups and populations differently. Maybe it’s their doctor or maybe it’s their neighbor who is a nurse. People text me all the time, not as a person involved with the advisory board, but simply as a doctor they know. So we have to make sure that the trusted messengers have answers and consistent messaging.

So far, the vaccine rollout has been slow, and we’ve been seeing stories of haphazard and even unfair rollouts in different states and institutions. What are your plans to ramp up the speed of the vaccine campaign in an equitable way?

We’re already seeing some places where there are concerns that there aren’t enough vaccinations for their health care workers. And in other places, they’ve moved on to other groups that haven’t been prioritized by the Advisory Committee on Immunization Practices.

I feel very confident there hasn’t been political interference in the work that the A.C.I.P. is doing, advising the C.D.C. and the F.D.A., and that these guidelines are considering equity. I’m very reassured when it comes to that.

But what the C.D.C. provides to states is guidance, and states do have discretion to adjust. So what has emerged is this patchwork of lots of different things bubbling up. There is a lot more that can be done in terms of federal coordination.

Write to us at inherwords@nytimes.com.

What else is happening

Here are three articles from The Times you may have missed.

Meena Harris.Maria del Rio for The New York Times

“Phenomenal Woman.” Kamala Harris’s niece Meena Harris, a lawyer and former tech executive, used to make statement T-shirts as a side job. But during a summer of mass protests against racism and injustice, Ms. Harris’s apparel took on new resonance. [Read the story]
“Indecent.” Egypt overturns jail sentences for two women who gained fame on TikTok. Convicted of inciting debauchery and violating family values, the women were caught up in a conservative backlash as the authorities tried to enforce strict social norms. [Read the story]
“That’s when I got really suspicious.” Is remote work making us paranoid? Maybe everyone is actually judging your house on Zoom. [Read the story]

In Her Words is written by Alisha Haridasani Gupta and edited by Francesca Donner. Our art director is Catherine Gilmore-Barnes, and our photo editor is Sandra Stevenson.

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