Featured topic and speakers
In today’s COVID-19 Update, Jerry Abraham, MD, MSHP, and Michael Knight, MD, MPH, discuss equity challenges with vaccine distribution, the work they're doing to bring more vaccines to Black and brown communities, including documenting their own journey in getting the COVID-19 vaccine as a way to fight vaccine misinformation and hesitancy.
Learn more at the AMA COVID-19 resource center.
Speakers
- Michael Knight, MD, MSHP, assistant professor, medicine, George Washington University School of Medicine and Health Sciences
- Jerry Abraham, MD, MPH, director, Kedren Vaccines, Kedren Health
Transcript
Unger: Hello, this is the American Medical Association's COVID-19 Update. Today we'll discuss equity challenges with vaccine distribution, and how two physicians are part of the solution. I'm joined today by Dr. Jerry Abraham, director of Kedren Vaccines at Kedren Health in Los Angeles, and Dr. Michael Knight, assistant professor of medicine at the George Washington University School of Medicine and Health Sciences in Washington D.C. Dr. Knight also serves as vice chair and National Medical Association representative on the AMA Minority Affairs Section Governing Council. I'm Todd Unger, AMA's chief experience officer, in Chicago.
Dr. Abraham, you are coming to us live from an actual vaccination center. This is a first for the COVID-19 Update. I want to talk to you first about your experience trying to correct the problem of equity in vaccine distribution. You in fact, at Kedren Health, couldn't secure at first vaccines and so you had to take matters into your own hands. Can you tell us what that was like?
Dr. Abraham: Sure. It kind of goes back to, historically, who we are. Kedren was started in the 1960s, during the Watts riots here in Los Angeles, especially when Black people had nowhere to go for mental health care, especially when in crisis. And during that time that's when 22 Black psychiatrists came together and formed Kedren. That's who we are, and that's kind of our mission ever since. We've been that beacon, that light on a hill.
And when COVID hit, we knew as early as March 2020, we had to be a part of the COVID testing strategies. So we supported the city and the county with that, and opened up to the public to test. And then December 2020, when the FDA met and then the EUA went through, we were looking around at each other and going where's our vaccine. Kind of like many of our patients are right now. And we started knocking on doors. And door after door, phone call after phone call, we finally realized we had been forgotten about. Something that has happened in the past for historically Black institutions, but we weren't going to focus on that, we were going to focus on the solutions. And we drove up there with our little Kedren minivan and we said, "Department of Public Health warehouse, we're not leaving until we got some." And they sent us on our way with a hundred vaccines.
These conversations started Christmas Eve Eve of 2020. By New Year's Eve Eve we'd administered 50 doses into the arms of our own Kedron staff. We have 400 employees, but we knew that wasn't enough. We needed vaccines to help Black and brown essential workers who were shut out because they weren't a part of big systems. And so we did that. And then the next thing we said is, when seniors were eligible, we were going to do the same. So from those 50 first doses to over 40,000 today, that's kind of how we started. But that's part of our heritage, it's ingrained in our DNA. We've always believed you got to stand up and shout, and you've got to say, "Give me mine now." And that's the strategy we took with these vaccines.
Unger: That's amazing. Did you think when you got into this, you'd be strolling through a facility with Governor Newsom, showing him the extent of your efforts?
Dr. Abraham: No, that was really exciting. I think the truth is that, we went to the Department of Public Health and we said, "Do not give us these vaccines unless you are committed to giving us more, because it is not about us and just our staff." We had nurses and patients with COVID. We were highly disturbed that we, as a small little outfit and operation, had not received vaccines. And so, maybe that was the mistake I made, was to say, "Make sure you give us an endless supply." But that's kind of how it started was, absolutely, we were going to put on our oxygen mask, and they were going to turn to our neighbors, right and left, and make sure they got their oxygen masks on. And somehow, miraculously, now we're starting putting oxygen masks on all the planes that are flying.
And people took note. We don't have enough vaccines, we don't have enough help, we don't have enough resources. However, what we do really good with the very little that we've been given. Since 1960s, we do a lot with very little. And so with this very limited supply, we do a high volume of vaccines as equitably distributed and administered, and as accurately and timely reported back, so that planning, preparation and allocations can be made. And because of that, we continue to be rewarded with Moderna, and now with Pfizer, and with those snow storms, of course that's affected our cold supply chain, but we're very excited to see what's happening with Johnson & Johnson. And we're ready to take any vaccines that are given to us and get them into the arms of Angelenos. We've got to end this epidemic now.
Unger: Absolutely. Well, you've become kind of a high profile role model for a real commitment to getting vaccines to the most vulnerable. Are there any kind of tips, learnings, that you would like to share with other people across the country who are making a similar commitment?
Dr. Abraham: Sure. I think one of the greatest successes of our story is physician leadership, it's clinical leadership. And that our president, Dr. John Griffith, a clinical psychologist, and our board, and our chief medical officer, they made sure that there were no institutional barriers in the way from a doctor doing what we do best, which is caring, treating, diagnosing, and in this case, providing life-saving essential medicines, this COVID-19 vaccine. And they did exactly that, instead of check boxes and Zoom meetings, they said, "Go with God, do good and do well." And that is exactly what me and my team have done.
The next piece is that we have wed clinical leadership, the physician leadership, with clinical operations. There is complete shared decision-making between me and my work husband, Mr. Sonny Tran. And all day long, you'll see us lock in step, they're getting tents up, I'm getting medicines out, and that's really a big part of our secret sauce here at Kedren.
Unger: That's fantastic. Dr. Knight, I've seen a lot of you on social networks. You've taken a really proactive approach to address misinformation and vaccine hesitancy, by documenting your own journey in getting the vaccine. Can you tell us about the decision you made? Why did you make that decision, and why do we need more physician voices talking about vaccines now?
Dr. Knight: Sure. This pandemic has really taken a toll on our country, but particularly in marginalized and minoritized community. Obviously, I'm a part of the African American community, and when the COVID-19 pandemic first started, people said this would be the great equalizer. And unfortunately, those of us that know real medicine know that that was never going to be the case. The communities that have continued to deal with the burden of disease, chronic disease, infectious diseases, unfortunately, again, were disproportionately affected by COVID-19.
A part of that was also a pandemic of misinformation, a infodemic, if you will. And that started off in the spring. And I even heard it within my patients, my family members, about ways to avoid COVID, ways to treat COVID, that were not really scientifically sound. And that's when I started being very proactive, getting on social media, talking and dispelling some of the myths, and really connecting patients to factual information. Also, understanding that it's easy to believe things, what you see online, with something that is new. So we're not telling patients, "No, you're totally wrong for believing this," but saying, "How can I empower you as a patient to be proactive and identify real information?"
So when I heard the vaccines were coming, I said, "This is our opportunity to get this to our community." And once again, the false information started, and I said, "You know what? I'm going to be front of the line. I'm getting my vaccine. I'm going on camera." I've documented my journey. I posted on YouTube, posted on Facebook. People started sharing it and talking about it. Our local television station here in Washington, D.C., picked it up as well. And I had patients contacting me like, "Dr. Knight, I just saw you on TV. Now I'm definitely going to get the vaccine."
And it's an opportunity for us to say, go forward. One thing I said in my interview was, "You know what, let me be your guinea pig, okay? I will get it. Okay. Let's have a conversation." And that's what we have to do. Let's not blame patients who have doubts. It's okay to have doubts, but let's counter that with integrative and intentional actions to really address misinformation.
Unger: So, we are seeing concerning levels of vaccine hesitancy in the Black community. Do either of you have any kind of experience or tips that you have found successful in countering that high level of misinformation and hesitancy?
Dr. Abraham: Dr. Knight, if I could jump in really quickly, I just want to applaud you for doing what you did. That's exactly what we need to do. We need to roll up our sleeves, and get our shot as publicly as we possibly can. On camera if we can. We've had Black pastors and bishops come and get their vaccines, and live stream it to their congregants. We've had Black doctors come, and now their medical assistants, and their patients are proud to get their shot. So I can't thank you enough. And that really is the solution.
First and foremost, I just have to strongly... and just cry, do not confuse lack of access to vaccines for Black and brown hesitancy. And that really is a big part of some of the data that we see, is "What shot? I was never offered a shot."
And then just as Dr. Knight pointed out, being able to engage and to educate, and then vaccinate...Black, brown, white, or yellow, whoever you are, as Dr. Knight just mentioned, there are many reasons to be afraid of new technologies, of mRNA vaccines. You mentioned the word guinea pig. This is not Tuskegee. This is not Henrietta Lacks. There were Black people in the study, and the National Medical Association had eyes watching every step of the way. And we applaud them for providing that assurance to our Black and brown community that this is by no means... In fact, this is your shot, your taxpayer funded shot. And when it is your turn, you're going to roll up your sleeves and get your shot.
So that's what we have to say is when you spend the time, as Dr. Knight just mentioned, when you really answer people's questions, legitimate ones, when you tell them that we don't exactly have all the information or all the right answers, but this is what we know today. I promise you, and we've seen that less than 1% hesitancy in the Black and brown health care workforce here at Kedren, less than 1% hesitancy in the Black and brown seniors that have come through. What they do instead is they come here proudly, roll up their sleeves and get their shot. And then they'd go out there and they bring us 10 more. And that's how we end this epidemic.
Unger: Fantastic. I can't see it or hear it in the background, but I hear that you have created kind of a special atmosphere at your vaccine center, to make it either less scary, or more enjoyable. What is that like?
Dr. Abraham: Well, we are just so excited to be a part of the solution. We're smiling, we're dancing, we're air high fiving and hugging. We just want to get back to normalcy. We want to get back to work, get back to school, get back to loving our loved ones, hugging and kissing and seeing grandma again. And in order to do that, we have to do this. So yes, we blast dance music, and we are dancing and moving. And we're just really having a good time, because everyone here knows that a part of the solution, every volunteer, every patient, everyone who comes her and interfaces with us is helping end this epidemic. And that's the energy and joy we feel.
We believe that, just like #ThisIsOurShot, we are all together creating a movement, an optimistic movement, that the day of this pandemic is numbered. And we are at war with COVID-19, and we are winning. So you better believe everyone is excited, and we're so happy to be here every day, doing our part. We just ask that everybody does theirs, wear your masks, socially distance, and when it's your turn, roll up your sleeves and get your shot.
Unger: Well, I can feel the energy. Dr. Knight, a lot of the efforts that you've been making are in lockstep with an organization that you founded nearly nine years ago to improve health in urban communities. Can you tell us more about that Renewing Health Foundation?
Dr. Knight: Sure. So the Renewing Health Foundation was founded in 2012, actually, when I was an intern in internal medicine there in New York City. And after medical school, I've been very involved with the Student National Medical Association, and other organizations that were doing health education programming. And when I went to residency, I'm from New York City, so I was coming home, I was in my community. And even though I was very, very early in my training, I said, "What can I do to get into the community?" And I knew I needed a 501(c)(3), so I can get some funds. I knew I needed to be able to build a community and a team. And so we founded the Renewing Health Foundation.
Since that time, we have worked extensively to address chronic disease, breast cancer, a number of issues that have affected African American community. And specifically also COVID-19. And I want to quickly mention something that Dr. Abraham brought up. When we talk about vaccine hesitancy, I think a lot of times we focus on, "Well, why don't these group of individuals trust us, as the medical field?" Instead, we should be thinking, "Well, what about the medical field is fostering this trustworthy issue, right? How can we become more trustworthy?"
And you are giving examples of what's being done at Kedren Health to engage with the community. When they walk into a facility and see individuals who are from their community, who look like them, who have been invested, not just coming when it's time for us to spend some grant dollars, but have actually put down roots in the community and build that care. Some of the data has shown that patients are much more likely to accept the vaccine from providers that they have relationships with. And so that is what we want to do, talk about building trust, because there's a lot of things that have happened in the past. And there are a lot of things that are still happening, that decrease the trust that patients may have in the health care system. As providers, as physicians, we need to be on the front lines of addressing that.
Unger: That's fantastic. Well, Dr. Abraham, your operation up and running, a role model for people across the country. How do you see yourself expanding from here?
Dr. Abraham: Yeah, that's really exciting. What I've described as Kedren 1.0, that includes that pre-registration, getting the right people in the door, registering and checking them in. It includes the vaccination itself. It includes the reporting, and all of the supply chain, and then that clinical leadership I mentioned, clinical ops. That's 1.0.
We're building a site closer to Compton now. That's 2.0, that will create and build public health infrastructure that we hope long lasts and outlives COVID. We need that public health infrastructure in this country. We need preventative medicine, and we need high quality primary care.
Then at the MLK Community Hospital and the Charles Drew University Campus, we're building Kedren 3.0, another main nerve center. But we really know that it's not these nerve centers that are effective, it's really roots in the ground. And so what we can do is build Kedren 4.0, a fleet of mobile ice cream trucks, where we take these vaccines out into the community, to the home bound, to the vulnerable, to the community center, to the church, to the library, the rec center. That's how we're going to get this vaccine out en masse.
And then lastly, Kedren 5.0, the mass vaccination events where we're going to make it #TheCoolShot, we're going to bring the celebrities, and the entertainers and the leaders, and we're going to engage, and we're going to educate. And we're going to create a Live Aid-like event where people come, roll up their sleeves, get their shot, so we can get on with our lives. And I think that's really the response, that's really the antidote, that's really the life-saving essential shot-in-the-arm, this whole country and society needs right now.
But to everything Dr. Knight said, I wanted to say, "Amen, and preach brother, because you are right on about everything." We're going to get there, and it's through that grassroots network. It's really meeting people where they are. It's not telling them to come to where we are, it's really understanding why, and where we got to where we are, and let's focus onto those solutions and we'll get there.
Unger: Well, Dr. Abraham, I loved that statement you made about not confusing hesitancy and access, and it sounds like you are really taking the vaccine to where people are. And that's such a smart idea.
Well, last question for both of you, many practices have been left out of the early vaccination efforts, with much of the supply going to large health systems and pharmacies. What's your advice to physicians who want to get involved, and be part of this effort? Dr. Knight, why don't you start?
Dr. Knight: Sure. I think it's unfortunate, some of the limitations that have been out there for physicians who have stakes in the community and don't have access to vaccines. We know that large academic centers, large medical systems, are not equitably placed in the community. There are many areas of Washington, D.C., for example, where most of our hospitals are located. And there are parts of our city that, unsurprisingly, are also where many of the marginalized communities live, that don't have such access. However, what is there, are doctors offices that have been there for decades that don't have access. So I definitely understand why we have a centralized approach, but as physicians, within our organizations, such as the AMA, we have been advocating at the state, local and county level, to have better access to our practices in an organized way. Yes, we got to be careful about supply. We have to make sure that the vaccines are getting to the right people. But we have to be able to empower our medical centers, our small physician practices, who want to get involved, to be able to do that.
Dr. Abraham: Yeah, I'd say, first and foremost, crisis is danger plus opportunity. And we know that luck is preparation plus opportunity. So really for me, that preparation, and I can't say this strongly enough, it's the time I have invested in organized medicine, but more importantly, what organized medicine has invested in me. My ability to speak publicly, my ability to speak with decision-makers regularly, my ability to understand medicine and stay up-to-date, my ability to know that I'm not alone, and I'm in the community of physicians and physician leaders who we will figure this out. All of those things were blessings of my involvement in my Los Angeles County Medical Association, my California Medical Association and our AMA, and that is critical.
And so I hope that everybody hearing this is not, "How did this little Kedren-that-could...?" Or, "Dr. Abraham in South LA is a one-off." No, it's because we've been preparing since that very first day of med school, probably even well before that, as pre-meds, that we have learned to take on challenges. We've figured out how to practice good, sound medicine. And we've learned how to tell that story to others. So that all those barriers that stand in our way, our colleagues, our politicians, our bureaucrats, understand, "Get those barriers out of the way, because Dr. Abraham and Kedren need to vaccinate."
And so that's where I would really say the message here is that everyone can do it, but build those relationships with your Department of Public Health, and your local jurisdictions and your authorities. Know your policy makers, get involved in organized medicine, so you're not alone and you feel connected. And when you don't know what to do next, just like I did, I reached out at every level, and along the way, every one of my organized medicine colleagues came with me. And so this is all of our success. And when we end this epidemic, it's because we all did it together.
Unger: That's fantastic. Well, I would like some of your energy and passion put in a bottle and given to me, along with my COVID vaccine, whenever I'm able to get that. I just want to say, thank you so much, Dr. Abraham, Dr. Knight, for everything that you're bringing to the table, for your leadership, and for doing what you're doing right now. It's just amazing.
Well, that's it for today's COVID-19 Update. We'll be back with another segment shortly. In the meantime, check out ama-assn.org/COVID-19 for more information about COVID. Thanks for joining us, and please take care.
Disclaimer: The viewpoints expressed in this podcast are those of the participants and/or do not necessarily reflect the views and policies of the AMA.
