Response to Hosangadi et al,Current State of Mass Vaccination Preparedness and Operational Challenges in the United States,2018-2019

The authorship team of the Health Security article ‘‘Current State of Mass Vaccination Preparedness and Operational Challenges in the United States, 2018-2019” ¹ comprehensively describes essential strategies for future mass vaccination preparedness efforts. I appreciate the authors' special attention to certain high-risk populations such as children and pregnant women. Black Americans should also be specifically highlighted as a priority population. Systemic racism has often left this group with lower vaccination rates, ² poorer health outcomes, and insinuations on the perceived value of their lives.

The authors' share that “interviewees most commonly cited children and pregnant women as priority populations, as they are often at high risk for severe disease and complications.” ¹ The same is true for Black populations, and the lack of acknowledgement of this group by the interviewees is both concerning and reaffirms the often disregard of the experiences of the Black community. Additionally, the authors state that “every interviewee acknowledged that gaps remain with respect to incorporating vulnerable populations into mass vaccination preparedness”—this is clear neglect for the protection of special groups and demonstrates how systemic racism manifests in the practice of health security in the United States. The inadequate societal preparation for the current pandemic, inconsistent and delayed government responses, and lack of special attention to the Black community has exacerbated the poor health outcomes of this group.

The lack of racial diversity in the public health workforce has a role in mass vaccination efforts, as the public trust in health institutions—particularly for Black patients—has eroded. Some of that trust could be restored if more Black people could be vaccinated and cared for by clinicians from their community. While I agree with the authors' short-term solution of “partnering with local community organizations to establish trusted relationships with vulnerable communities and respond to their unique needs,” ¹ a longer-term strategy is needed. For example, because specialized training and licensing is required to administer vaccinations, recruiting more Black clinicians and ensuring ongoing training and support while in the healthcare profession is vital. Sustained funding and commitment to creating a pipeline for Black students to enter and remain in the healthcare field is also needed. ³

As the authors acknowledged, “mass vaccination plans must ensure equitable allocation and access to the vaccine.” ¹ While I concur that access and allocation are both of paramount importance, it cannot be overstated that building relationships with Black communities and ongoing reciprocal partnerships are also essential ways to address the systemic racism that was revealed during the pandemic. We must now look to intentional antiracist recovery efforts from COVID-19 and be proactive in our equity-focused approach in planning for future outbreaks and mass vaccination events.