The Invisible Shield

As a result of the crumbling infrastructure of public health surveillance systems, we currently do not have the ability for both the states and the CDC to properly report COVID-19 data.

We now have seen real-time what happens when you ignore public health.

A lot of people are going to die.

In February of 2020, we started hearing from local jurisdictions of excess mortality among African Americans.

These were not small gaps.

These were big ones.

And it turned out that that excess wouldn't be limited only to African Americans.

We've seen it among Latinos, American Indian Alaska Natives, Native Hawaiian Pacific Islanders.

They've paid a high price.

Having vaccines for COVID-19, I think, that's a game changer.

The first vaccine for coronavirus here in the U.S. has just been approved by an FDA advisory panel.

People have been toying with this idea of developing mRNA vaccines for a number of years, but it was unproven.

The sheer intensity of the crisis, the ever-increasing terrifying body count of those early days forced us to accelerate the development of a potential solution because we didn't have a lot of other options.

It led to an unprecedented breakthrough.

Thousands of doses will be given to frontline workers as early as Monday.

We're just about to watch the first nurse at U-Dub Medicine receive the first COVID-19 vaccine in our state.

I'm really excited to do whatever I can to show our people that we believe in the science that is currently out there.

Is it emotional a little bit?

Uh, I feel like I'm so overwhelmed by everything we have to do.

Everything is a big, huge emotion.

We'll do whatever it takes to ensure that our people are not disproportionately impacted by COVID-19.

Developing a vaccine is the first challenge.

Getting people to accept the vaccine can be even more challenging.

We've really seen an erosion in trust towards the health care system.

That includes public health recommendations.

It's in the middle of a pandemic where I think the messaging has been very muddled with regards to what we're asking people to do: masking, social distancing, et cetera.

And then you have the new vaccine.

I think we're just never going to get fully around some pockets of resistance because vaccines are an intervention that is given to people who are not yet sick.

There's a multitude of reasons why people don't want to get the vaccine.

And a lot of it has to do with things that are not related to health at all.

Many, many people are afraid.

We can't say enough about how unmoored and untethered all of us are.

We've become much more polarized.

A local group of protesters surrounded the governor's mansion in Olympia.

You do not get to keep your authority when you take our rights!

There's been a rise in this anti-science denialism movement.

That is something that we will be grappling with for years and decades to come.

I revile these acts of sedition and intimidation.

We will continue the work we're doing to protect the health of Washingtonians.

There are social and economic issues.

There are individuals still dealing with historical trauma.

We need to look at these different social factors.

Health is not just a biological construct.

Hey.

Peaceful?

Everything peaceful?

Yes, sir.

Good, good, good, good, good, good.

All right, good afternoon.

Happy Martin Luther King Jr. Day.

We have some really exciting news about multiple fronts on our efforts to bring vaccinations to everyone in the State of Washington.

Today, we are announcing the start of what we think of as the second stage of our vaccination initiative.

We are now moving from a limited number of Washingtonians to a rather broad scale, where mass vaccinations are now possible, called for, and are going to be implemented.

Effective immediately, all Washingtonians who are 65 and older will be eligible to receive vaccines.

This means thousands of more Washingtonians can and will be protected.

With that, some comments by Dr. Shah.

Thank you, Governor.

Today is a really important day for the people of Washington.

The announcements we just heard represent the forward progress that we all are looking for.

As of January 16th, we've given almost 295,000 doses of vaccine.

That's the good news.

But we need to do more.

Our goal is to vaccinate 45,000 people a day.

With something like vaccines, in many ways, the distribution part of the equation is just as important as the invention of the vaccine itself.

We had the smallpox vaccine for 160 years before we even started thinking about the capabilities to actually eradicate smallpox on a global scale.

In the 1960s, more than 2 million people died from smallpox every year.

Just over a decade later, that number was zero, thanks in part to Dr. Bill Foege.

In one remote Nigerian village, after vaccinating 2,000 people in a single day, Bill asked the local chief how he had gotten so many people to show up.

And the chief explained that he had told everyone to come to the village and see the tallest man in the world.

He's pretty tall.

I was looking for a mentor in global health and could not find people that had any interest in it.

And I realized anyone interested in global health has to make their own way.

And so in 1962, I entered the Epidemic Intelligence Service.

And they announced the Peace Corps physician in India was sick, and they were looking for a three-month replacement while they recruited.

And so, by chance, I went to India.

And that's when I saw smallpox for the first time.

It's still much worse than you can imagine.

It hurts to move.

And if you move, you break these pustules.

And the pus ends up giving a stench of decaying flesh.

You could smell smallpox before you entered the room.

And on two occasions, I think I was able to diagnose smallpox on the basis of smell.

One time, it was fairly easy as I walked down the corridor of a hospital and suddenly felt that smell.

The other time was in a slum in Karachi, Pakistan.

And so the smell is competing with other smells and I still was able to detect it.

And we found the house and we found the smallpox cases.

We don't know when and how it started, but it can be traced back at least 3,000 years to Ramesses V, who appears to have died of smallpox.

In Europe, it was much more common as a childhood disease.

60% of all children would have smallpox.

Voltaire had smallpox.

Mozart had smallpox.

His sister had smallpox.

I mean, it's just incredible how many people had smallpox.

In the United States, however, it would come and go.

And people would go 20 years in a village and never see smallpox and so they'd forget about it.

It wasn't until 1721 when an outbreak in Boston caused a man by the name of Cotton Mather to try to figure out why is it that the slaves are not getting smallpox at the same rate as the whites.

And so he asked his slave, who described variolation, where, in Africa, India, and China, people discovered if you transmit smallpox through the skin, it had a far lower mortality rate than if you got it naturally by breathing it.

But it wasn't until 1796 when Edward Jenner, a practitioner in England, became interested in smallpox because a milkmaid supposedly said to him, "Oh, I'll never get smallpox because I've had cowpox."

Edward Jenner had no idea of the germ theory, no idea of vaccinology, anything.

But he was trying to imitate nature.

So he took material from the hand of Sarah Nelmes, a milkmaid, and he inoculated it into the arm of a small boy.

And then weeks later, he tried to give the boy smallpox.

And it did not succeed.

And this was the first vaccination.

As soon as Jenner came out with cowpox vaccine, the first anti-vax group developed.

You saw cartoons of people having cow heads growing out of their arm and that sort of thing, so the anti-vax movement is very old.

A new poll shows support for vaccinations has dropped 10% in the U.S. over the past two decades.

The World Health Organization called skepticism about vaccines one of the top ten global health threats in 2019.

It's become worse in recent years because when the diseases disappear, people forget what the risk was of the disease and all they see is the risk of the vaccine.

My beautiful nephew, who started having febrile seizures after his MMR.

Does the recent outbreak concern you at all given your children aren't vaccinated?

No, it doesn't concern me one bit.

I believe we have these illnesses and these sicknesses for a reason.

We have to be--our bodies need to be immune to them.

When I meet with anti-vax parents, and I used to do that, I never blamed them.

They were not trying to hurt their children.

They actually believed they were doing the right thing.

We're sick and tired of being abused.

We're sick and tired of living in fear.

This is a fascist overreach of the government.

Get on the ground now!

But I have seen anti-vax efforts change from individuals who are really concerned about their own children to people taking this on as a philosophical or political resistance.

USA!

USA!

USA!

It's disturbing that there is so much pushback because I see vaccines as the very foundation of public health.

The latest tally of vaccinations is 3 million doses administered.

That's nowhere near the 20 million vaccinations goal set by Operation Warp Speed for the end of 2020.

And U.S. infections have soared past a new milestone, now topping 20 million.

Within about a week, a combination of the Washington National Guard, Safeway, the Department of Health, the people who run the fairgrounds have put together--an operation was done over 700 vaccinations just each day in the last couple of days.

There are three other sites that we've also stood up, Tri-Cities, Wenatchee, and Spokane.

We want to get everybody who wants a vaccination vaccinated.

We just could not be more delighted about how functional this operation has been so quickly to bring so many vaccinations at such a critical period of time.

America tends to go for technological solutions to big problems.

So in the case of diseases, we try and go for vaccines and drugs rather than social fixes.

The problem is that epidemics and biomedical solutions flow in opposite directions.

Epidemics seep downward into society's cracks, taking out the most marginalized and most vulnerable people first, whereas biomedical solutions rise upwards into its penthouses.

People with privilege and power and money and connections get earliest and easiest access to things like vaccines.

And then, being safe, they move on.

And they decide for everyone else that the problem is over when it, in fact, is not.

This is just one location for, you know, basically the greater southwest region of Washington, and also in terms of access and equity.

Yeah, this is a drive-through site which we are working right now with local transit to figure out how we can accommodate folks who might not have a car.

But a community center which folks are used to going to or partnering with other community partners might be a better modality.

One of the purposes of the Book of Revelation is to divulge God's own purpose.

God's purpose is to lead people to repentance and salvation, to lead them to the glorious inheritance of the great redemption that is to be given to all true followers of the Lord Jesus Christ.

Look at Him!

God is not a mean God sitting up high just waiting on us to mess up.

That's why He gave us Christ!

Look, God don't want us to fail!

God want us to make it!

Not only does God want us to make it, but God want us to make it with joy!

Church, to the Black community, is crucial.

Dr. Brazill was a firm believer that the Bible should stay up here until he's getting ready to use it.

And as Dr. Brazill.

The late Dr. ES Brazill, he kind of set the Shiloh Church up to be a church in the community.

You know, if someone needed his service and if he could help them, he would.

When he passed, I kind of, you know, just inherited the church.

By the grace of God, I knew I was walking into that type of ministry, that whoever was going to pastor Shiloh just can't be the pastor of Shiloh.

The pastor has to be able to be connected to the community.

Our members and people in the community don't trust Walgreens, don't trust Safeway, you know, but they still trust the church.

COVID-19 is a test, you know, and how God is calling us to be faithful even in this pandemic.

I have a responsibility to be as candid with the people as possible.

I was sharing with the church, you know, "Well, when the vaccine come out, I won't take it."

The stats are staggering.

Nearly one-third of Black Americans remain hesitant to get the vaccine.

It's the amount of vaccination we're doing is not enough to bend the curve.

We need to get up to, you know, 70%, 80%, 90% of people vaccinated.

There are issues around access that we know about.

And then you layer on top of that, you know, the historical injustices and suspicion of government and suspicion of health care.

So there are people who really need the vaccine but they're afraid to get it.

Government has never been friendly to African Americans.

The trust level is broken.

In 1932, Black men who had syphilis were recruited into a government study and told they would be treated for their syphilis.

Unfortunately, there was never an intent to treat these men.

It was intended to follow them.

But what's really horrific is that 15 years into that study, they actually came up with a treatment for syphilis, an effective treatment, and it was not given to these men.

And this study went on for 40 years.

And what people don't know is the Office of the Surgeon General actually oversaw that study, the United States Public Health Service.

So every day I walk into my office, I walk past a wall of men who actually did this to people like me.

And I'm sorry, it makes me a little bit emotional when I talk about this, but this is something that we have to acknowledge.

I'm saying today to think of those who did not survive and whose families will forever live with the knowledge that their death and suffering was preventable.

A lot of folk want to point to the Tuskegee syphilis experiment as a source of the mistrust of science and the medical establishment.

But added to that are a variety of other things having a great deal to do with the experience that many people of color have in a doctor's office.

We have plenty of evidence to show us that there is differential treatment between Black patients and white patients, that physicians often under-prescribe medication for Black patients and falsely think that we have thicker skin than white patients and therefore can tolerate more pain, which is directly connected to slavery.

Many folk who study the history of slavery will tell you doctors often did all sorts of experiments on African American slaves.

So the idea that there is a long, deep history passed down from one generation to another, that combined with their own experience of problems with the medical provider, indifference on the part of a medical provider when you're trying to describe a problem, means that at a moment when we need people to believe us, when they need to trust the word of a researcher, when they need to trust the word of science, you are still going to see this legacy that's going to block our ability to make those communications have an impact.

My fears center around people losing trust in public health.

And that's what has to happen, is that we get the trust back of the public, and that we deserve the trust.

The talk about eradicating smallpox had gone on for some years, but it was always at the periphery.

The first time this was proposed, only three countries voted for it at the World Health Organization.

It wasn't until a scientist from the Soviet Union, Professor Zhdanov, got American scientists involved in this.

And when both countries presented it, this time, it passed.

The first part of the program was to eliminate smallpox from 20 countries of West and Central Africa.

I was already in Nigeria working for a church group when CDC asked if I would be a consultant to the program.

At that time, so many hospital beds in Africa were actually supported by church groups.

But they weren't doing community health work.

They weren't doing public health work because they were using health as a way of proselytizing.

I was trying to introduce a public health approach to church groups.

They needed to work with government.

They could no longer be working on their own.

The colonial period was over.

Going into another culture, one can actually appear to be obnoxious, that you're coming to tell people what to do.

And one of the things I learned is when you tangle with culture, culture always wins.

And so you have to go in and find out what is it that people want, and then see if you can provide that rather than tell them what they should want.

In eastern Nigeria in 1965, there was an anthropologist who described smallpox as being like water, that it permeated everything in the culture, and that people were afraid to talk about it and they were afraid to talk to each other and how it disrupted life... And so they lined up for vaccinations.

In December of 1966, I had a radio call from a missionary saying, "I think we have smallpox in Ogoja province."

That was the first case I had seen in Africa.

We were trying to figure out what to do because we didn't have our supplies yet.

We had a small amount of vaccine, but not enough to do a job like this.

So we got on the radio that night with maps in front of us and divided up the area with the missionaries, asking if they would send runners to every village in the area assigned to them.

And the next night, 24 hours later, we could tell exactly where smallpox was.

But you don't want to waste the vaccine when you don't have enough on people who will not be exposed this week or this month or this year or ever.

So we decided to use the vaccine only in those villages with smallpox.

And we used the remainder of the vaccine where we thought it might spread.

The strategy at that time from WHO was mass vaccination followed by going after outbreaks.

All we did was eliminate that first strategy and went directly to the second strategy.

When I was a forest firefighter, we were drilled over and over, "You can't have a fire without fuel," and therefore your job is to remove the fuel.

And that's why you dig a fire line around a fire so that it can't jump over.

The same thing happens with smallpox.

By and large, that virus cannot go very far.

And so if you have a fire line 6 feet out from a person with smallpox, you're going to stop almost all spread.

This had worked so well in Eastern Nigeria.

Then we tried it in other countries in Africa.

Some places were very creative.

In Togo, they actually trained 12 people on motorcycles who would be the smallpox group, and they would go out to smallpox outbreaks.

By early July 1967, we had only one outbreak left in Eastern Nigeria.

This was a program that was supposed to take five years.

And at six months, we were down to the last outbreak.

And pretty soon, it worked in all of West Africa, where country by country, the same procedure was followed.

Smallpox disappeared so fast because they trusted us.

And it was enough to convince us it was possible to try this in India.

We went to India in October of 1973.

After six days of searching in Uttar Pradesh and Bihar, the searchers found 10,000 new cases of smallpox that no one knew existed.

We were overwhelmed.

And some people said, "This is just making us look foolish."

But we said, "No, we have to do it and we have to keep doing it."

The coalition for smallpox eradication in India was unbelievable.

When you think of smallpox eradication, you're really talking about hundreds of thousands of people that were involved in this.

And for each one, it was a contribution that you can't put a price on.

It took us about three months to perfect the surveillance system.

We found we needed to be much more specific.

So we tried a house-by-house search.

We had people putting marks on the door to show they'd been there.

Then we found we needed secondary surveillance, and so we set up surveillance systems in marketplaces, going around with a smallpox picture.

"Have you seen a person like this?"

And that would help us to find villages that had not been reported.

Then we needed tertiary systems.

That is go to places where we were finding smallpox, but it was difficult.

This would include bigger communities where people didn't often go.

It would include the people who were making bricks for roads and so forth because they were always moving.

And we got to a point where surveillance was so good that after three or four months, I said to myself, "You know, it can't get better than this."

Containment was much more difficult.

With 10,000 cases, what do you do?

And so we asked people, "Just go to that village, "vaccinate the people in the house and the houses around that house, and then move on to the next village."

Soon we realized we had to put watch guards at the house, not to keep people from escaping, but to keep people from going in to visit the sick people and then coming out with smallpox.

And because you can give a vaccination on the day of exposure and prevent the disease, all we did was vaccinate those people, but we didn't interfere with the culture.

Those people could still visit a person with smallpox.

It required hiring more and more people.

I mean, it was really an army of people doing this without smartphones, no computers in the field.

I was so comfortable at this point, I could almost see the end of the program.

In my mind, there was no way of failure.

There is a feeling in global health circles that people parachute in to do something, and oftentimes they talk local people into doing what they don't want to do because there's money involved.

And that is a feeling that I don't like to be part of.

We don't believe in any kind of discriminatory treatment.

With everything India had gone through with smallpox and all the criticism that they'd received along the way, how can you be a modern nation and continue to have smallpox?

I thought it was important for India to get the credit.

They're the ones that put in 99-plus percent of their people, the resources.

We were a fringe on the edge of that.

They deserve the credit.

The eradication of smallpox was finally completed in the mid-'70s.

When you look at that story, it really leaves me with this feeling that we just have the wrong set of heroes in society.

You think about two events that happened more or less in the same time... one is the Apollo program, sending a man to the moon for the first time.

And the second is the eradication of smallpox.

Ask your average, you know, ten-year-old, do they know anything about the lunar missions?

Of course they do.

Tranquility Base here.

The "Eagle" has landed.

That stuff is seared into our collective memory.

That's one small step for man.

But how many of us are familiar with the smallpox eradicators?

They took this virus that was probably the single most deadly killer in human history and they eliminated it from the face of the Earth.

And yet, think of all the movies that have been made about astronauts.

What mattered more?

You know, we would have a lot less vaccine hesitancy in the world if we taught smallpox eradication as one of the seminal achievements of the last century.

I've probably spoken to about 2,000 to 3,000 vaccine-hesitant people during this pandemic alone.

I think the most basic takeaway that I've learned from this is to-- and it sounds very simple, but it's really to have empathy, that individuals that do have concerns about vaccines, that is a real concern for them.

And I think the reason why they do have those concerns is because they haven't been able to speak to someone that has been empathetic and compassionate towards that concern.

The larger structural issue that we're facing is really the distrust in government.

People see the vaccines as a product of that government that they distrust.

And there have been a number of studies that have looked at the correlation between trust in government and vaccine acceptance, and it does correlate.

But I think the onus is upon us to understand why that might lead to individuals saying, "You know what?

I don't want anything that the government is providing to me."

COVID arrived in the U.S. sort of as a spark on dry grass.

Anti-science, anti-truth, too much income inequality, too much disadvantage that's enshrined by structural racism, too few people with confident access to health care, all of these things were what drove a real prairie fire of COVID-19.

And it was predictable.

It was predictable.

A standard feature of U.S. medical education is that teaching hospitals are located in poor neighborhoods.

When it came time for me to pick a residency program, I decided to train at Harlem Hospital.

The sickest patients I ever had were the patients on the ward there.

Just everything about their lives had broken them down.

And I'm not just talking about drug use, which is what people often think.

I'm talking about everything that left people with heart disease, cancer, the common killers.

None of this is in our genes.

All of this is related to what it means to be classified as a person of color.

At the beginning of the 1900s, WEB Du Bois said, "Do not locate the problems of health "in the bodies of Black people.

Understand the social context in which they live."

In the city of New York, your life expectancy fundamentally depends on where you live.

The life expectancy of the richest neighborhoods in New York can be as much as 11 years greater than the life expectancy of those who are in the poorest neighborhoods of New York.

We live in a society that is highly segregated.

And as a result, the notion that where you live has a great deal to do with the quality of your health up to and including how long you will live.

if there's a better expression of structural inequality, I have to admit, I don't know what it might be.

So often when we talk about inequities or we talk about disease outcomes, we talk about it through a lens of race.

But it's important to be clear that it is racism that is the issue here and not race.

It was in 2019 that we marked 400 years since the first person was brought against their will from Africa to the North American colony of Jamestown.

And the fact that enslaved labor was what catapulted the U.S. into the ranks of wealthy nations is not one that people are taught or even want to think about.

I think a lot of our understanding of public health benefits from an understanding of history, and so does our understanding of what we are now calling structural racism.

Starting with 1641, Massachusetts became the first colony to legalize slavery.

The politicians worked with the business interests to develop, implement, and enforce these laws.

Connecticut, New York, and other colonies then followed suit.

And as if that were not enough, these policymakers worked on developing policies that explicitly prohibited Black and Indigenous groups from raising their own food, from earning their own money, from learning to read and write.

They were prohibited by law from going within a certain radius off the plantation.

They limited their movements.

You can see the effects of these policies on health even today.

There's this notion that, well, you know, why aren't you exercising personal responsibility?

You should be eating correctly.

You need to exercise.

But we know that those "behavioral health determinants" play a small role in our overall health.

You know, the overarching determinant are these social determinants of health.

Choices people make are determined by the choices that they have.

If you live in a community where there isn't a grocery store anywhere near but there are fast food restaurants, trying to make the healthy choice is a difficult choice.

When we talk about the social determinants of health, we're talking about everything outside of the 15 to 20 minutes you may spend with a health care provider on occasion.

That's everything from education to transportation to your access to food to housing to your employment status.

These systems allow for inequities to not only begin to fester, but they perpetuate them.

Black infants are highly vulnerable in the first year of life.

We know infant mortality rates are two times higher among Black infants than they are among white infants.

This is not something that occurs only among poor women.

We see the racial disparities in infant mortality even among Black women who have high levels of education and income.

So this suggests that it's about more than access to care and that it's really more about things that we have a hard time measuring, which might be the exposure to discrimination and racism in the society.

An African American child is more likely to develop obesity by the time they're two years old.

So that tells you that there's something going on very early in life or in the intrauterine environment that causes that.

We know that there are biological changes within a woman's body whereby if she's experiencing stress, it can be transmitted to that infant.

And so it's not surprising, as devastating as it is, that infants of color die at higher rates than white infants in this country.

For every social determinant was a preceding law, policy, regulation, executive order, ordinance, you name it, that created the structural conditions that these folks find themselves in and that play a disproportionate impact or role in their lives.

In the early 1900s, the Home Owners' Loan Corporation Act was developed by Congress, signed into law by President Franklin D. Roosevelt.

That law authorized property appraisers in over 200 cities in America to go out into the neighborhoods of these cities and to grade them from a scale of A, B, C, or D, and align them with a color code.

The A communities were aligned with the green color.

These were your affluent, white communities.

The D communities were your, quote-unquote, "hazardous communities."

And these were your primarily or predominantly African American communities.

And this is where we get redlining from.

It determined where to give VA loans, then FHA home mortgage loans.

And in so doing, they essentially starved these Black and brown communities of the resources that they need to survive and thrive.

You might have noticed a major highway cutting right through these communities, or you may have seen a railroad track splitting the neighborhood in half.

Major parking lots, right?

Factories, toxic waste sites right there abutting these communities.

And so we have been able to understand why there are higher rates of asthma in these Black and brown communities.

We've been able to tie it to the smog coming from these highways.

They cut these communities and split them in half.

We can see the impact that those policies from 400, 300, 200, 100, 50, ten years ago and all the way up until today are having on our health and well-being.

Many of the problems we had with COVID-19 weren't just a function of the virus itself.

It was the conditions that the virus was able to exploit: hypertension, diabetes, cardiovascular disease, certain forms of cancer.

But COVID-19 was something that could even hit the most powerful members of human society.

The prime minister of England, the president of the United States gets infected with this virus.

If you thought about it carefully, the best way to make sure that folk in rich communities were protected from the ravages of this virus would be to make sure that their neighbors in poor communities of color didn't have conditions that created the risk that they themselves would face.

The pandemic has just highlighted so many inequities that underscored what we always knew.

Yet the work, in many ways, has derailed.

All the work we've done for the whole time I've been here--active living, healthy eating, you know, chronic disease prevention, that all got sidelined.

And I was like, "No, we need to bring it back."

This is why you need public health.

It became very clear to me.

I mean, literally, because of the pandemic, I wasn't riding the bus to work anymore.

I was riding my bike more.

And I was riding down the Eastside, go to my produce store, and I'd get south of city limits.

All of a sudden, the housing quality goes down.

And it clicked.

It's like, "Oh, no wonder, right?"

-Who lives on the Eastside?

-Mm-hmm.

You've got Black communities, you've got Pacific Islander communities, got Latino communities, you got, you know, -Eastern European communities.

-Yeah.

COVID basically was just-- it was pulling the scab off.

These are the same communities with high rates of chronic disease.

Right now, just as the rest of the country, the areas with the highest case rates are the areas that have the lowest vaccination rates, where people are refusing to get vaccinated, or sitting on the fence and not getting vaccinated, right?

So we've got to work with them.

We cannot ignore them because they will affect the health of everyone else.

Well, that's true because you cannot end a global pandemic until you address the pandemic globally.

And that applies not just to the rest of the world, it also applies right here in the state of Washington.

We're all at risk at some point if any one of us, any one part of our communities, wherever those communities are, are not protected.

The idea that we're in this together is still a lesson that I think people have a hard time learning.

If it is clear that this virus thrives, changes, and evolves in places where there is a reservoir of infection that has not been treated, where there haven't been enough vaccinations, that means that many parts of the world will continue to be a source that will create variants of the virus that we will struggle, almost forever, to try and confront.

The fate of my community may be very closely tied to the fate and health of your community.

My interest in health, I think, started from childhood in the early 1970s, strolling in the streets of Asmara, Eritrea, which was part of Ethiopia at that time.

I saw posters about smallpox eradication.

That's when I was introduced to World Health Organization.

Global public health actually cannot exist without local public health.

We're intertwined.

The world is smaller.

The world is more globalized.

Viruses can move faster.

The threats are common.

Anything that happens in the poor countries can reach the rich countries within no time, so we need to help each other.

It's a shared problem, then we need to have shared response if we believe that we are one humanity.

It's important to remember that eradicating smallpox led us to stop routine smallpox vaccination in this country.

It's always been a surprise to me that a virus with no brain, no central nervous system can somehow outsmart us.

And yet that's what happens all the time.

But evolution is slow for the virus, even with the coronavirus.

It takes weeks or months to come up with a new variant.

We've got to constantly improve our tactics so that we can stay ahead of it.

-Hey.

-Pastor Christopher.

Dr. Chen.

Good to see you.

There's no doubt in my mind that the majority of Shiloh is not going to be some of the first to take that COVID vaccine.

I remember one of the things you said to me was that you personally had some concerns.

Mm-hmm.

I did.

Right?

Because there was a lot of distrust.

There are a lot of things that public health cares about that people don't realize we care about.

-Right.

-Well, you know this, right?

It's like someone's health isn't just their medical health, it's whether they got a home, whether they got a job, you know, their mental health and all that, so.

People want to know that others know what's really going on... Mm-hmm.

And they're not afraid to say it.

Mm-hmm.

But I never thought of having that conversation with the Pierce County Health Department.

This pandemic has led to a lot of uncertainty.

I think for many, the vaccine represents more uncertainty.

The vaccine is the mark of the beast.

They figured out-- During times of uncertainty, people are more likely to listen to and believe conspiracy theories.

The number one concern individuals had with regards to why they did not want to get the vaccine that I've spoken to, and these were particularly individuals of color, is because they were convinced that there was a microchip in the vaccine.

When they brought that concern to their doctors, their doctors dismissed them.

I think that's the exact wrong thing to do.

How do we improve this communication so people don't feel as though they're being dismissed or they're being ridiculed?

I spend time explaining how the vaccine was developed, how scientists are community members just like you and me, and how the data that came out with regards to safety and efficacy was really looked at by individuals that care about the health of our communities.

This comes up again when you talk about vaccines and do people trust the government administration behind the vaccine.

I would never distribute a vaccine that didn't work and that wasn't safe.

The community that I travel in, you know, always had great respect for you.

So, you know, I think that this, you know, really have appreciated the opportunity to work with you.

Same here, Dr. Chen, same here.

With the sound of my voice right now, Lord, just continue to bless those that's on their way right now, Lord.

Churches are extremely good at supporting the members in their congregation.

We're just giving them the messages to deliver, the medical content to deliver, and they ran with it.

Amen.

We do want to continue to ask everyone to please continue to wear your masks.

If you are infected with COVID-19, it can do more damage to you than you believe that it can do to you.

And so we just want to encourage all of us to get vaccinated.

They are still saying that African Americans are falling behind in getting their shots.

Taking that vaccine, for me, would be a demonstration of my Christianity, that I love Frank.

And I wouldn't want to be so selfish as not to take it and expose Frank to the COVID.

And those that are struggling of taking the vaccine, I hope that you get to the place to where you are OK with taking it.

Tomorrow, the Shiloh Church to be the host church of 300 persons that will come in to be vaccinated.

You know, we only got one shot at this.

We're now in this process of reevaluating what public health is, things beyond the laboratory, and are now considering the social world we built.

We have to deal with inequality as a root cause of illness.

And illness is a kind of emblem of our--of our society.

We need more individuals that are working hand-in-hand with communities that are struggling.

We need more individuals that also are, I think, more open and are more willing to talk about some of that historical trauma, as well as racism and discrimination.

A lot of things we do is abstract, you know, like community engagement.

We go talk to the community.

We listen to them.

We do what they ask us to do, right?

That's all abstract.

It's just amazing when you see it come together.

Thank you so much.

Have a nice day.

You, too.

Take care.

Congratulations.

We feel that government officials, they should serve us and they should allow us to have a voice.

And Dr. Chen did that.

-Pastor Christopher.

-Dr. Chen.

Good to see you.

This was a community effort.

Some of the youth went out knocking on doors, trying to find senior citizens that didn't have internet.

There are persons that are frustrated, basically giving up because they don't have a computer.

They can't catch the bus to Walgreens to get vaccinated.

And so that's where the church community comes in at.

Amen.

You guys know how to organize this better than we do.

I mean, normally, you guys have so much, you know, stuff you're doing for families and for your congregation.

So, you know, this might be a good time for us to start talking more about other issues, right?

Mm-hmm.

When you have earned the trust, you're going to be able to work on other things.

Alcohol sales are up.

Marijuana sales are up.

Drug overdoses are up.

All the surveys on stress and anxiety are showing people are more stressed and anxious.

What can we do?

Public health is not just a machine that will run indefinitely.

Even before COVID, average life expectancies started going backwards.

For the first time, we had three years of declines.

That is a bad sign for our society.

We're going to lose a generation to overdose.

The number of people who die from opioids a year is much higher than HIV deaths at the peak of the HIV epidemic.

If we treat what we're dealing with now as if it's totally new, all the lessons that we're in a position to learn will be lost.

Just today, we've heard that the CDC is facing $1.5 billion in budget cuts.

This is a workforce that has been beaten and abused.

You did not listen to we, the people!

She needs to be fired.

It's like Public Health Vietnam.

We need a new playbook.