Biden COVID Equity Advisor Faces Dilemma as His Employer Drops Vaccine Mandate

Dr. Cameron Webb

Marianne O’Hare : Welcome to Conversations on Health Care. This week we welcome Dr.
Cameron Webb, Senior Policy Advisor for Equity on the White House
COVID Response Team on the Biden administration's quest to address
health disparities and inequities .

Dr . C ameron Webb: People who have access who have privilege, they're going to get
access to the resources. I think it's about tailoring and designing
interventions to folks who have those barriers, those challenges with
access.

Marianne O’Hare : Now, here are yo ur host s Mark Masselli and Margaret Flinter on
Conversations on Health Care.

Mark Masselli: Our guest is a dynamic physician and public health leader whose
service in the White House extended from the Obama to the Trump
administration. Now after a run for political office, he's a key part of
the Biden administration's effort to ensure equity in fighting this
pandemic.

Margaret Flinter: Dr. Cameron Webb is the Senior Policy Advisor for COVID Equity on
the White House COVID - 19 Response Team . Dr. Webb is helpi ng to
shape the national discourse and the management of the pandemic.

Mark Masselli: Well, Dr. Webb w elcome to Conversations on Health Care and thank
you and congratulations, you've been serving patients all during the
pandemic. And we really honor our fr ontline providers. I wonder if
you could help us define how you and the administration see equity
as different from equality .

Dr. Cameron Webb: Well, first, thanks so much for having me today. And I think, you
know, the question that you're hitting on was actually my first
question when I was deciding when and if to join the administration , I
asked, w hat do you mean by COVID - 19 Equity. And it's really
important to make that distinction because in this pandemic we've
seen that there's no one size fits all so lution, there's no single
intervention that's going to serve all communities the same way. So
by equity, how we've defined in our team is, is simply that it's our goal
of ensuring that all communities at all times have the resources that
they need to not j ust survive, but thrive through this pandemic. And I
think it piggybacks off of the existing definitions about equity. It's just
that notion that we have to make sure that we're delivering to
communities, the tools, resources, and opportunities that they n eed
to navigate the unique circumstances that are driving the direction,
the impact of the pandemic on them and on their families and their
communities. So I think that's what the work has looked like. And you
can imagine, that becomes, you know, pretty, p retty large, it allows us
to take a pretty big vantage point on the pandemic.

Margaret Flinter: Well, Dr. Webb, the recent study found that Native Americans,

Dr. Cameron Webb

Latinos , and black people were two to three times more likely than
whites to die of COVID - 19 when the pandemic first hit and actually I
think we started seeing that information almost as soon as the
pandemic took off and it never lit up. But we're in another phase of
the pandemic, we still have a long ways to go, we have some
treatments available. What more can all of us do to close this gap now
in the COVID pandemic and hopefully, it will give us some lessons for
the future as well. But what can we do to close the gap now?

Dr. Cameron Webb: Well, you know, I appreciate that you raise some of those stat s early
on and at the time I was both running for Congress but also I was in
the midst of helping serving my community. I'm an internal medicine
doctor so working on the COVID unit, working to take care of patients .
The reality is we actually didn't have a ll those data. We knew that in, I
remember it was in Milwaukee 70% of the deaths were in the black
community, in Louisiana they saw similar high numbers, and the
question became how widespread is this dynamic. And the first thing
we had asked for was data. And months later, in January of 2021,
when I joined the Biden - Harris administration, the data that we had
on the vaccin ation effort across the country, only 52% of vaccinations
administered, did we have race, ethnicity, out of every two, we would
only hav e one of them where we knew the race and ethnicity.

Now, in the most recent weeks, we are up to about 80%, you know,
and overall, we're nearly 75%. And the way that we did that was by
emphasizing the data. And so I raised that because, you know, in
medici ne, we say all the time, you can't treat what you can't see, it's
really hard to know, where the inequities lie if we're not collecting
data that allow us to know that and to drive the differences. But I hit
on it a second ago, vaccinations have been an ab solute huge and
game changing intervention in communities of color in changing that
trajectory of the differential mortality . What vaccines have done is
they've really reduced that rate of mortality. And it's helped to level
the playing field, if you will, because while we can't change all those
upstream factors that put people at increased risk for severe
outcomes, what we can do is make sure that they have immunologic
protection to prevent some of those worse outcomes. When you
complement that, with some of the therapeutic options like
monoclonal antibodies and oral antivirals, what we're able to do is
really put together the pieces downstream to prevent folks from
dying disproportionately. But that does not absolve us of the need to
continue to work upstr eam to terraform communities to make it
easier for communities that have historically been hard hit to navigate
this and future pandemics.

Mark Masselli: Well, I really love the idea that data is driving the sort of policymaking.
And this year's theme for Black History Month is Black Health and
Wellness . And the theme focuses on how the American healthcare

Dr. Cameron Webb

system has ofte n underserved the black African - American community.
Why is it important for everyone to understand this?

Dr. Cameron Webb: It's important because it informs the very nature of what we mean
when we say health care in certain communities, and particularly in
the black community . Again, we can go back to what was called the
Slave Health Deficit , the dynamic between folks who came over in the
At lantic slave trade and ultimately we're here into forced servitude.
Those individuals, the idea of appearing sick became a real risk to
their life. And so that was a huge challenge. You move forward, and
we continue to see that W . E . B Du Bois, the Philade lphia Negro, this is
the late 1800s , and there's a chapter on social determinants of health
that on health inequities, you know, Martin Luther King said, of all the
forms of inequality, injustice in health care is the most shocking and
inhumane. In 1985, S ecretary of HHS Margaret Heckler commissioned
this taskforce on black and minority health that found that there were
these huge differences, these gaps in health outcomes, it's the first
time F ederally, we recognize d that and you can keep going .

This has been a legacy. We've told this story over and over again. But
the fact of the matter is, we haven't changed it, we haven't changed
those dramatic dynamics that lead to increased morbidity and
mortality in communities of color . The way that we do it is we h ave to
again, get far upstream of it . There are, you know, health doesn't
happen in hospitals and clinics, it happens in the places where we are
born, grow, live, learn, eat, play, and pray. And so if you intervene
there, you're giving communities a chance to stay healthy. And then
you can put the healthcare system, you can kind of align incenti ves in
terms of quality, access, and cost to make it easier for folks to
na vigate there. But it takes both, it takes interventions and
healthcare. And it takes the i nterventions in the social determinants.
And then I think truth and reconciliation , that reality of the harm
that's been done to black communities through the healthcare
system, that's not a remote history for a lot of people.

Even in my own hospital, the University of Virginia, its one generation
back that people were born in a basement in the West complex
building. And so their parents remember that. There are people who
say, I would rather die at home tha n go to that hospital because of
what happened to my grandmother , so that we have to contend with .
In America we talk about race, we talk about health care, it's not
something that's easily done , it takes work, and we have to be equal
to that task.

Margaret Flinter: Well, let's talk about an issue that l ooms large and that is mental
health. W e know even before the pandemic, our minority populations
were less likely to receive mental health support. And certainly the
pandemic has only aggravated and accentuated those needs. Tell us a

Dr. Cameron Webb

little bit about how t his factors into the discussions and the thoughts
and planning of the administration as you work to reach all Americans
but to specifically address the mental health issues.

Dr. Cameron Webb: Yeah, it’s impossibl e to divorce the health impacts, the economi c
impacts and the mental health impacts of this pandemic, in
particularly, the burden that's placed on communities of color. And so
I think that from our perspective, a lot of that work, we are able to
execute through SAM H SA, which has done really tremendo us work in
terms of grant making for mental health services and supports for
folks facing issues with substance abuse. All of these are challenges
that we've seen exacerbated by the pandemic. So by making
resources available for community level organizatio ns and entities,
that's really where those interventi ons are getting most effective.

But the other thing is just kind of what you're raising, we have to
continue to name that problem. We have to continue to sound that
alarm of the disproportionate harm. A nd nowhere is that more, you
know, salient, more critical than among our youngest folks . There's a
crisis of suicidality in young teens of color. There's a crisis of just the
tremendous mental health impact of this pandemic because of
increased orphanhood, folks who've lost caregivers. When you think
about the cases and the deaths in the black community, we're talking
about young people who are losing the trusted adults who were
taking care of them throughout their lives. And that's going to
resonate throug hout their lives. We have to make sure that we' re
there to support and engage. So I think it's really taking a truly holistic
approach to what this pandemic is doing. We've got great leadership
at SAM H SA with Dr. Miriam Del phin - Rittmon and I think taking t hat
mentality to the whole person is going to be the key.

Mark Masselli: I know you've got a lot of jobs, including you're still on the faculty at
the University of Virginia and your school has recently rolled back
requirements for students to get vaccinat ed based on an opinion from
the S tate A ttorney G eneral . What do you do in this type of situation?
Are there additional precautions that you're going to take or
recommend to people find themselves in situations like that?

Dr. Cameron Webb: Well, I think you 're hitting on a really critical moment that we're in .
There's a lot of, I'll say eagerness to see the pandemic end. Often I
hear people talk about transitioning from pandemic to endemic . I
think there's a misunderstanding of what endemic means. And for a
lot of people, they just see those first three letters. And they think it's
kind of a mash up of end - pandemic. The truth of the m atter is t hat's
not what it means. What we're seeing is there's this rush to roll back a
lot of the strategies that have gotten us to a point where we're seeing
less death from COVID - 19. So there are people who just assume that
we got here, by accident, or by good fortune. We got here because of

Dr. Cameron Webb

vaccination effort. We got here because of layered mitigation
strategies, because of m asks because of testing and because of
vaccinations. So because of all that, I think it's a matter of taking a
step back and ensuring that the decision makers at the school level
know, the decision makers at an individual level, the students
themselves kno w that your best way to protec t yourself based on the
science, based on the evidence is this. And even though this pandemic
has been politicized to a point, it's indistinguishable from the rest of
our political rhetoric .

You need t o protect yourself, your family, and your community at all
costs. And you do that by following science, not by following political
rhetoric , o ftentimes meant to motivate a voter base and so I think
that's where have to really double down . I think the university is a
public instit ution, there are some unique dynamics to navigate , and I
think that we're going to do that. But one thing I do love about the
University of Virginia is that there's an emphasis on taking care of
those students. And so I know that we'll continu e to find way s to do
just that.

Margaret Flinter: Well, I t hink about where we are at this moment of time. And I think
we can say that we have all been treated to a two - year intense
graduate course. And now we're getting very close to FDA approval of
the vaccine for ki ds under five. Hopefully everything we've learned
will help us to ensure equity in vaccination, outreach and delivery .
What are your thoughts about the steps that we're taking nationally
or the administration to make sure we really just knock this one out of
the park in terms of reaching the very young children?

Dr. Cameron Webb: It's funny because as an internist I recognize there is a joke that we
internists often think that children are a little adults. But that's not the
case. And we know that here with these youngest kids under the age
of five, this is a very different vaccination paradigm. So there are
some great lessons to learn. But you remember the earliest days of
the vaccination effort, mass vaccination sites were critical for
throughput to get as many people vaccinated as soon as possible.
There's no such thing as mass vaccination sites for three and four year
olds . If you've ever taken that three or four year old to get a shot, you
know, you don't want them out in public. And so, you know, I thin k
what we have to do is, we have to change our focus at each step. And
so one thing that's encouraging about this is that that population
under five, this is the population in this country who's the most
familiar with getting shots even though again, they do it kicking and
screaming, and some adults do too. This is a demographic where
they're used to getting shots . They know where they go to get all their
other vaccinations, especially those are heading into school.

And so our job our responsibility is pig gybacking off of that

Dr. Cameron Webb

established network, think about the vaccines for children's program,
what that's done for equity in vaccination efforts across the board, by
race and ethnicity over the last 30 years. We say we've got a model
here, but some of the mo st salient lessons we have learned are about
how to build vaccine confidence and how to not undermine that
confidence w ith the rollout itself. We say we're following the science
that means FDA leads on this, that means we don't tell parents go get
your kid vaccinated if they're three, four years old, before FDA tells us
that that's what they should do or before CDC tells us that's what they
should do b ecause we don't want that to appear like a rubber stamp.
We want people to know, we're going to be nimble, we're going to
follow what they direct us to do , but politics isn't going to drive
whether or not there are shots authorized for kids under five, it's
going to be science. And we're going to be ready to i mplement no
matter what.

I think there's good news that the Pfizer M o derna vaccines have been
fully approved by the FDA for adults. I think that's given a little bit
more confidence . And you know, we're not going to expect 90% of
parents of kids under five to get vaccinated on day one. We know it's
going t o take a series of conversations, Medicaid, reimbursing
providers to have those conversations, that's a big deal. We didn't
have that in place before the 5 to 11 rollout. So we've learned along
the way how to make sure that those pieces are in place that w e can
leverage schools, we can leverage providers to be those trusted
messengers locally. But ultimately, I think we put all those things into
place and then we just continue to stay at it.

Mark Masselli: You know, I really like that you laid out a roadmap for parents that it's
not just going to snap of the fingers and have your child immunized
that the FDA and CDC has looked at this, they want to make sure it's
safe for children and that's, that's so important in our own
experience. We ran the Connecticut' s only four mass vaccination sites
and vaccinated half a million Connecticut residents, but we know it's a
different strategy right, for these younger children. So there's a lot to
think about. I was struck by one of your earlier answers you were
talking a bout the need, people are thinking a bout how do I protect
my family, and I really want to go into the issue of undocumented
adults and children who aren't legally present in the United States . It’s
just an enormous challenge for them. And it's a challenge for the
entire United States Health System, right . Just tell our listeners how
they fit into the administration's equity focus.

Dr. Cameron Webb: It's such an important part of it. So I'll start off by saying we rolled out
the adult vaccination effort . We heard really quickly that even having
mass vaccination sites wasn't going to be an effective way to reach
folks, because of the chilling effect of the previous four years of
undocumented individuals accessing F ederal services that concern

Dr. Cameron Webb

that this could b e that type of interaction that could lead to their
displacement from home and from family. And so we had to send a
strong signal we worked with DHS, with FEMA, we really worked with
ICS , and we said there's going to be no ICS enforcement at any of
these s paces, we need to make that really clear. And that's something
that really helped. And after a couple of months of that effort, we saw
the uptake really jump up . I think that what's critical is you can't
design with them as an afterthought with undocumente d individuals
as an afterthought, especially with a disease like this, where every
single human body in this country is a part of the equation . You have
to make it as easy as possible for people to access. And you do that by
d esigning it with folks in mind .

And so I think that's what we've learned along the way. I think I'm
always reminded from a policy perspective that for so many of these
individuals, they're only undocumented because of harmful policies in
past years th at have kept them in that state, t hat have made it
impossible for them to have a pathway to citizenship. And that's
something the President has talked a lot about, how do we change
that , how do we reverse that , how do we create opportunity , so some
of it is just a matter of political circu mstance . And then no matter
what I think our value of human life is to make sure that everybody
has access to the tools and resources they need to serve people . So I
think it begins with centering that community. It begins with
centering all communities th at have historically been marginalized or
forgotten about and designing from that pers pective, people who
have access, who have privilege, who have power, they're going to get
access to the resources, no matter what . We tailor too many
interventions toward that population. I think it's about tailoring and
designing interventions to folks who have historically and
contemporaneously have those barriers, those challenges with access.
That's where we need to focus.

Margaret Flinter: Well, along those lines, I w onder if I could ask you to comment as
well, if there are any thoughts or planning around best strategies to
reach our rural populations. That's a group that has suffered some
adverse health impact as well. And certainly people often think of our
minority populations living in urban areas, but certainly, they are in
our rural areas as well. Is there anything targeted or thoughtful in
terms of innovation about reaching our rural populations at this
point ?

Dr. Cameron Webb: You know, I'm from a rural county i n Virginia, my wife's from a rural
county in Virginia . She said she grew up with three stoplights and one
blinking light. So I mean, we know what rural means. I think the way
that I think about this, is that in rural communities, you ha ve several
overlappi ng dynamics. Here we know there's a dynamic of
politicization of the pandemic. But we also know that rural hospitals

Dr. Cameron Webb

and rural health care settings have been decimated in the last 20
years, just in terms of the lack of access that we've seen in rural
commu nities far outstrips that that we have in some other parts of
the country. So it's a matter of making sure that we're showing up in
those spaces with those tools with mobile resources, but also directly
connecting with those providers. Because what we know from rural
communities is that those local trusted messengers, the public health
and the health care professionals, the folks who took care of you your
whole life, took care of your mom and took care your daddy, those
are the folks who are going to be cri tical to you or making a decision
on what you're going to do with your health, whether it's
vaccinations, or whether it's about wearing masks in public spaces,
how you protect your health and well being . Yes , you're hearing a lot
of messaging from various spaces , but if you're hearing from your
doctor how to take care of yourself from the nurse practitioner who
you trust or another public health professional makes a huge
difference.

And, you know, we've also talked about how we can partner
effectively in r ural spaces. We are always dreaming up this great
partnership with Dollar General because we know that there are great
opp ortunities and spaces like that. It's not meeting people where they
are making sure that messaging is spot on a t the end of the day
ma king sure you center rural health because so much of our country
is rural. America I think is so much driven by the rural experience, we
have to make sure that what we often see is this big spike in urban
spaces first, and then we say oh, we're out of the woods, things are
getting better. And that's when it's hitting rural communities the
hardest. So we've actually developed occasions where we really focus
in on rural communities earlier on, and we've seen from an equity
standpoint, you look at Alabama, you look at Mississippi and some
instances we have higher vaccination rates in communities of color in
rural spaces than we have in the white community. There a lot of
reasons for that, but I think it speaks to the effectiveness of that
outreach .

Mark Massell i: Well , from a rural county in Virginia to the White House, helping
advise the President --- the President's about to give a State of the
Union address, but what can we expect to hear from him about the
portfolio you focus in on and I think the $64 million question or
whatever is d o you think there is going to be additional funding for
health equity issues?

Dr. Cameron Webb: Well, you know, one of the things that really endeared this position to
me was the idea that President Biden was saying, equity has to be at
the center of our response . Vice President Harris was saying equity
has to be at the center of our response. And if you look, you know,
day one of the administration over a year ago, there was an executive

Dr. Cameron Webb

order on racial equity . Day two there was an executive order on
ensuring equity in the pandemic response that became a consistent
and ongoing theme was how do we make sure that that equity is at
the center of our work as an administration . And so I think the
President is going to continue to drive t hat home. I know ev ery time
we engage, every time we brief and talk with the President, which is
regularly, his questions about equity are coming from a place of
authenticity. And I think his expectation is that we deliver on that ,
understanding the histor ical dynamics, understanding the challenge
that exists there, we use the full resources of the F ederal government
to deliver on equity , and I think that's something that, that there's
really encouraging to me, as somebody who's been an advocate in
this spa ce for a long time .

I think the President's going to continue to drive that message home, I
think he's going to name the successes that we've had, but he's also
going to name the work that we still need to do. And when it comes
to funding, you know, again , a lot of that question goes back to
Congress, a lot of that question goes back to our legislators ’ spaces
and if they're going to continue to invest in this space, because in a
crisis, oftentimes people pay attention. But as we think about next
phases, f uture states, are we going to continue to invest in equity and
in the dynamics that drive equity. And the hope is that they will, I
think the hope is that we learn this lesson from this pandemic, that
we are all tied to mutual, you know, single garment of destiny. And
that is what's critical to our nation's success.

Margaret Flinter: Dr. Webb, we want to thank you for all that you have done for all that
you are doing, and for sharing your insights with us today. And thanks
to our audience for joining this i mportant talk. And remember, you
can learn more about Conversations on Health Care and sign up to
make sure you get notification of our shows at www.chcradio.com .
Dr. Webb, thank you so much again .

Dr. Cameron Webb: Thanks for having me.

[ Music ]

Mark Masselli: At Conversations on Health Care we want our audience to be truly in
the know when it comes to the facts about healthcare reform and
policy. Lori Robertson is an award winning journalist and Managing
Editor of Fa ctCheck.org, a nonpartisan, nonprofit consumer advocate
for voters that aim to reduce the level of deception in U.S. Politics.
Lori, what have you got for us this week?

Lori Robertson: COVID - 19 has killed more than 800,000 people in the United States
a ccor ding to the Centers for Disease Control and Prevention. Yet a
viral video on social media suggests the disea se is the same as a
common cold. COVID - 19 is in the same family of some cold viruses,

Dr. Cameron Webb

but its potential for severe outcome, including death is much higher
than for the common cold. COVID - 19 was the third leading cause of
death in the United States in 2020 a ccording to the CDC . Heart
disease and cancer ar e in the first and second spots. An analysis of
CDC data from the Kaiser Family Foundation and the Peterson Center
on Health shows that the same ranking is expected for 2021. Despite
those facts, a TikTok video suggesting that the disease is the same as a
common cold has racked up more than 4 million views. The video
merely shows that a medical encyclop edia published in 1989 lists the
common cold as being ca used by the Coronavirus family.

As we've explained Coronaviruses are a family of viruses, there are
hundreds of Coronaviruses most of them circulating among animals.
There are seven Coronavirus es kno wn to infect humans according to
the CDC, four of them cause upper respiratory tract illnesses often
referred to as a cold. Three of them cause more serious illnesses,
including Severe Acute Respiratory Syndrome, M iddle East
Respiratory Syndrome, and COVID - 19. Common colds can be caused
by a variety of viruses , Rhinoviruses , not Coronaviruses are actually
the most common. Some cases of COVID - 19 can be mild, but the
potential for a severe outcome is much higher than for the common
col d, especially for older people.

And t hat's my fact check for this week. I'm Lori Robertson, Managing
Editor of FactCheck.org.

[ Music ]

Margaret Flinter: FactCheck.org is committed to factual accuracy from the country's
major political players and is a project of the Annenberg Pub lic Policy
Center at the University of Pennsylvania. If you have a fact that you'd
like checked, e - mail us at www.chcradio.com , we'll have
FactCheck.org's Lori Robertson check it out for you here on
Conversations on Health Care.

[ Music ]

Mark Masselli: Each week Conversations highlights a bright idea about how to make
wellness a part of our communities and everyday lives. One in five
Americans will suffer a diagnosable mental health condition in a given
year and most often don't seek treatment. For those with serious
mental health conditions the consequences can be devastating.
Seeing a rise in mobile A pps aimed at behavioral health entering the
marketplace, the University of Washington researcher Dror Ben - Zeev
thought a comparative effective analysis study would be a good idea.

Dror Ben - Zeev : My team and I conducted a three - year comparative ef fectiveness trial
having a head - to - head comparison between a mobile health
intervention for people with serious mental illness c alled FOCUS and

Dr. Cameron Webb

more traditional clinic based group intervention called W RAP or
Wellness Recovery Action Planning. So the study really gets at some
of the core differences between mobile health and clinic based care ---
is there something about the mobile he alth approach that would
make it more a ccessible or less accessible?

Mark Masselli: More than90% of the mobile A pp group engaged in the online
program, which was a series of text messages offering coping
strategies and self monitoring of s ymptoms, along wi th weekly call - ins
with a behavioral health clinician .

Dror Ben - Zeev: The second thing we wanted to see is after people complete care,
what are their subjective ratings of their experience in treatment , are
they satisfied with both interventions , are there differences, and
probably the most important piece of the study are the clinical
outcomes. So we measure to see whether involvement in both
interventions for a 12 - week period, would that create some sort of
difference in psychiatric symptom severity, and 90% of the individuals
who were randomized into the mobile health arm actually went on to
meet a mobile health specialist to describe the A pp to them and train
them how to use it and use the intervention A pp that's assigned to
them at least once. Whereas i n the clinic based arm, we saw that only
58% of the participants assigned to that clinic based intervention ever
made it in for a single session .

Mark Masselli: Both groups of patients saw roughly equal results from their
completed treatment, but the mobil e group was more likely to
engage in therapy. Ben - Zeev says this suggests that mobile therapies
may provide a useful tool for clinicians having trouble getting those
with serious mental health issues to engage with the clinical
interventions .

Dror Ben - Zeev : The group dynamics, the fact that there's a sense of shared
experience, and perhaps even normalization of so me of the
experience, that on its own is quite potent for people. But for others,
the interaction is anxiety provoking, just making it to the clin ic to
engage in that interaction is logistically complex. In both intervention
arms people improved both in terms of reduction in their symptoms
and the distress associated with symptoms and improvements in their
recovery .

Mark Masselli: A targeted mobile A pp aimed at facilitating access to clinical care for
those experiencing serious mental illness symptoms, proving equally
effective in managing the condition improving access to intervention ,
now that's a bright idea.

[ Music ]

Mark Masselli: You've been lis tening to Conversations on Health Care. I'm Mark

Dr. Cameron Webb
Masselli.
Margaret Flinter: And I'm Margaret Flinter.
Mark Masselli: Peace and Health
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Marianne O’Hare : Conversations on Health Care is recorded at WESU at Wesleyan
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