Citing pandemic missteps, Philly health commissioner seeks stronger community connections in 2023

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

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, plenty of doses, and an online registration system that was supposed to restrict appointments to those who were most at risk from COVID. That’s not how it played out.

Vaccination efforts were already under the cloud of the city’s notorious partnership with a group run by a Drexel University student that mismanaged vaccine distribution. When the FEMA clinic opened, it was difficult to reach for some in the city’s most vulnerable communities. Those without easy online access, or those who weren’t adept with technology, struggled to get appointments. Some who were eligible for shots shared the registration links with people who weren’t. Getting vaccinated early hinged far too much on location, aptitude with technology, and whom you knew.

The majority of vaccines 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 inequitable access to health care due to poverty and systemic racism.

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

Strengthening relationships in underserved communities is a significant health department goal in 2023, the commissioner said. 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 for what was called monkeypox, being hosted by LGBTQ-friendly bars and clubs are a prominent example of what Bettigole would like to see more of — public health services delivered in collaboration with the people most in need of them.

» READ MORE: Remember monkeypox? Virus in retreat, but Philly needs more vaccinated to preclude a rebound

Done well, deeper community partnerships can help reach people at risk from endemic viruses like hepatitis A and HIV, and should allow a fleeter, more equitable response when the city faces a new health emergency.

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

The work includes bringing hepatitis A vaccines for the city’s homeless to the streets and developing deep relationships with the city’s LGBTQ communities to address their health concerns.

A challenge, she acknowledged, would be ensuring the department has the staff to do outreach effectively.

“It takes more time,” Bettigole said. “It takes more people.”

She declined to detail budget and personnel discussions with the mayor’s office. The department has a budget of about $810 million and more than 1,000 staffers, according to the city’s fiscal year 2023 budget.

Inequitable access to COVID tests and vaccines wasn’t unique to Philadelphia. In a 2021 paper, the National Academy of Medicine noted partnerships among health-care entities, community groups, and government withered after the 2008 recession, and the pandemic exposed the need to rebuild them.

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

For a host of public health problems, a closer relationship between the health department and community groups and leaders could make a difference.

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

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

The city health department’s collaboration allows him to relay to health personnel information he hears at symposiums ACT UP hosts that people might not say to a government official.

“People aren’t going to be as open and honest in dialoguing with someone from the health department,” he said.

The mpox outbreak that began in summer 2022, which predominantly affected bisexual, gay, and nonbinary men who have sex with men, was the health department’s first post-COVID test. Initially, community activists said, the department repeated the same mistakes that marred the pandemic response.

A limited supply of vaccine almost immediately went disproportionately to white Philadelphians, said Jason Evans, a Philadelphia consultant who last summer acted as a liaison between the LGBTQ-focused health organization Philly FIGHT and LGBTQ-friendly bars in the city, and he 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: The Future of COVID & Public Health | Presented by Independence Blue Cross

That changed, though.

The department started 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 relying on club owners and event promoters to pitch vaccine doses amid dance music and cocktails.

“I was happy to see the response, the willingness to get involved,” Evans said.

Despite the outreach, though, the city’s Black population continues to account for most of the mpox cases while remaining its lowest-vaccinated demographic. Building trust and converting it into effective policy, Bettigole said, take time.

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