Philly Health Commissioner Cheryl Bettigole Wants Community Connections in 2023

The memory of Philadelphia’s failed COVID-19 vaccine distribution in early 2021 still weighs heavily on the city’s health commissioner, Cheryl Bettigole.

That March, the Philadelphia Department of Public Health and the Federal Emergency Management Agency opened a mass vaccination clinic at the convention center. It offered a central location, dosing lots and an online registration system that seemed to restrict appointments to those most at risk from COVID. That’s not how it played out.

Vaccination efforts were already under a cloud of the city’s infamous partnership with a group run by a Drexel University student who mismanaged vaccine distribution. When the FEMA clinic opened, it was difficult to reach some of the city’s most vulnerable communities. Those who did not have easy online access, or were not tech savvy, struggled to get an appointment. Some who were eligible for shots shared registration links with those who were not. Getting vaccinated early depends a lot on location, ability with technology, and who you know.

Most of the vaccine went to white Philadelphians, even as the city’s black and Hispanic populations bore the heaviest burdens from the virus. Thousands of doses were administered daily at that mass clinic, but those left behind were largely the same people who routinely experience unequal access to health care because of poverty and systemic racism.

“We need to make those people-centered connections to do our jobs better and understand how to build trust,” Bettigoole said in an interview last week.

The commissioner said that strengthening relationships in underserved communities is an important goal of the health department in 2023. The department did community outreach before the pandemic, but those efforts were often isolated, with little coordination. Vaccination clinics for mpox, the name now used to be Called Monkeypox, which is being hosted by an LGBTQ-friendly bar and club, a prime example of what Bettigoley would like to see more – Public health services are provided in collaboration with those most in need.

» Read more: Remember monkeypox? Virus is retreating, but more vaccines are needed to prevent Philly from coming back

Done well, deep community partnerships can help reach those most at risk from endemic viruses such as hepatitis A and HIV, and should allow a nimble, more equitable response when a city faces a new health emergency .

“It’s those human connections that are really going to help us build over the next few years,” Bettigoole said.

This work has included bringing hepatitis A vaccines to the streets for the city’s homeless and developing deeper relationships with the city’s LGBTQ communities to address their health concerns.

One challenge, she acknowledged, will be ensuring the department has the staff to effectively conduct outreach.

“It just takes longer,” Bettigole said. “It takes more people.”

She declined detailed budget and personnel discussions with the mayor’s office. As of the city’s fiscal year 2023 budget, the department has a budget of approximately $810 million and more than 1,000 employees.

Unequal access to COVID tests and vaccines was not unique to Philadelphia. In a 2021 paper, the National Academy of Medicine cited partnerships between health care institutions, community groups and the government after the 2008 recession and the pandemic highlighted the need to rebuild them.

“I think COVID was a clear example,” said Ana Martinez-Donate, a Drexel University professor of community health and founder of the Latino Health Collective of Philadelphia. “To respond quickly to an emergency you need structures and relationships that allow for agile response.”

For a host of public health problems, a close relationship between health departments and community groups and leaders can make a difference.

Martinez-Donate said the health department sought feedback from members of her coalition when developing an online service to help people find primary care physicians.

Jose DeMarco, an organizer with the HIV and AIDS advocacy group ACT UP Philadelphia, described the ongoing struggle, especially among black and Hispanic men, to expand use of the drug PrEP, which protects against HIV. Provides reliable prophylactic protection. A 2021 study in the medical journal JAMA found that black and Hispanic people at risk of HIV exposure need “more targeted and culturally appropriate” outreach to encourage them to take PrEP.

Cooperation with the city’s health department allows him to relay information to health workers he hears at ACT UP’s symposium that people cannot say to a government official.

“People wouldn’t be as open and honest in a conversation with someone from the health department,” he said.

The mpox outbreak, which primarily affects bisexual, gay and nonbinary men who have sex with men, began in the summer of 2022, the health department’s first COVID test. Initially, community activists said, the department repeated the same mistakes that plagued its response to the pandemic.

Jason Evans, a Philadelphia consultant who last summer served as a liaison between the LGBTQ-focused health organization Philly Fight and LGBTQ-friendly bars in the city, said the limited supply of the vaccine would almost immediately become disproportionately white. went to the people of Philadelphia, and observed the health department making policy decisions without consulting LGBTQ groups.

“In my experience they’ve always been behind the eight ball,” Evans said.

» Read more: Health report: COVID and the future of public health | Presented by Independence Blue Cross

That changed though.

The department launched an mpox resource group that included Evans, a group that is refocusing this year to address a range of LGBTQ-related health concerns, and the city is still working on club owners and event promoters. It’s up to them to pitch a dose of vaccine amid dance music and cocktails. ,

“I’m glad to see the response, the willingness to be involved,” Evans said.

Despite the outreach, however, the city’s black population accounts for the majority of mpox cases, while remaining its least-vaccinated demographic. Building trust and converting it into effective policy, Bettigole said, take time.

“There’s more work we need to do,” she said. “Making sure that people are in regular conversation, making sure that we’re coordinated across our community groups.”


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