Nashville Family Doctor Takes Prescription for Eliminating Health Disparities to Washington

Dr. James E.K. Hildreth, Meharry Medical College president

By Sandra Long Weaver
Tribune Editorial  Director

NASHVILLE, TN — Finding solutions to the disparities in how people of color receive health care regarding COVID-19 is the challenge facing Dr. James Hildreth and members of the national task force to which he was recently appointed.

The work of the COVID-19 Health Equity Task Force will be “making sure the needs of the most vulnerable populations are met and looking at the disparities,” said Hildreth who is the president of Meharry Medical College. The task force has already met to go over procedures and will meet this week with its chair. 

He said the group will also “look for ways or recommendations to eliminate the disparities that resulted in the disproportionate burden of the disease in the first place.”

“The disparities in health pre-existed the pandemic by decades. It’s mostly heart disease, hypertension, chronic lung conditions, diabetes. As I understand it, we are supposed to make recommendations that would eliminate some of the differences in health status between populations.”

Hildreth said he hopes “the pandemic is behind us by Fall but the problems that it shed light on will not be done by then. So I suspect that the work will be extended beyond that.”

While his team will focus on disparities related to COVID, there are others in the Administration who will focus on overall health equity.  “I’m excited there is a President who is coming in recognizing that we should make eliminating health disparities a priority.”

He said he does have concerns that politics may enter into the work the task force needs to do. There has already been a case in Dallas, Texas, he said, where the local health departments decided to target people in the most vulnerable zip codes in that state. “Those areas turned out to have large populations of Black and brown people and there was pushback at the state level. They were told they could not do that,” he said. 

Hildreth said he will avoid framing conversations around health disparities through the lens of racial politics. “We have to find a way to eliminate race from the conversations because whenever it comes up, it makes for challenges,” he said.

“So I like the idea of using the vulnerability index,” he continued. “You account for the economic status, health status, access to health care and a number of other social parameters. By doing that you don’t have to mention race because in a lot of places, that would mean African Americans would already be at the front of the line. Taking the vulnerability approach might be a way to avoid that. That will be my approach.”

Hildreth said he sees a top priority for the task force as having a coordinated plan at the national level for the continued rollout of the vaccine. 

He said a recent report by the prestigious medical journal The Lancet, said “if the country had a plan at the national level, 40 percent of the people who have died would still be alive today. Even if we had targeted nursing homes, assisted living facilities which account for large percentage of deaths” that would still be a high number because there was no national plan.

“I was pushing for that almost a year ago but I wasn’t sitting at anyone’s table,” he said. “The reason for a national plan is the virus does not respect borders of any kind.  We have 50 governors all doing something different and as soon as restrictions are lifted, we have surges.”

He said the task force can make recommendations to develop a strategy that’s coordinated but at end of the day, it will be up to governors to accept or not.”

Hildreth also noted that getting people vaccinated has been difficult but he said there will be more supplies available in the next few weeks. “The supply has has been the problem for getting more people vaccinated. The companies are looking for a way to reduce the production time,” he said.

And with plans to ship vaccines directly to pharmacies and clinics, it will be easier to get appointments. He also pointed out that there are challenges because the raw materials to make the vaccines are not unlimited and that can affect production as well.

While there are many people who want to receive the vaccine, there is still some hesitation from others, especially among people of color for various reasons.

“I find it very encouraging that there are more people wanting the vaccine than we have vaccine available. For a long time, there was  a concern the interest in getting the vaccines wouldn’t be as strong as it needed to be but clearly this is something that could save your life and save the life of someone you love.”

Some worry about the side effects from the vaccine. “I try to explain to people the second injection may give you more challenges than the first,” Hildreth said. 

“The reactions that people are witnessing are manifestations of our immune system doing what our immune system is supposed to do. The whole purpose of a vaccine is to educate your immune system to recognize the spike protein of the COVID virus.”

When the immune system is activated some people may “have fever, have chills, lymph nodes under arm where injection occurred can swell and there may be muscle aches. “There are little chemical messages that go throughout our body when the immune system gets turned on,” he said. 

The virus that causes COVID-19 had not come contact with humans before December 2019, Hildreth added. “The first time the vaccine comes into contact with your immune system, you may have not a strong response,” he said.  “It may make some antibodies but not a lot of them. But the second time it comes into contact with your system, you make a secondary response and that’s when the magic happens.” 

He said a lot of people get a much stronger reaction with secondary doses because the immune system response is stronger. 

There are also concerns about allergic reactions. But Hildreth said studies show there usually only 2 bad reactions out of 1 million, which can be easily treated. 

Others have said they don’t want to be guinea pigs. But at this point over 100 million people worldwide have received the vaccine and no one has died, he said. 

Still others have pointed out vaccines take a long time to develop so they question how can these vaccines be safe because they were developed in 10 months.

Hildreth said there are three reasons they are safe. The technology we have now allows companies to move faster. The virus and what causes it is identified and the information is used to find a vaccine candidate. 

Secondly, resources allowed the development to move along parallel lines and not just completing one step before moving to the next one. A third reason is the infrastructure built around finding a vaccine for HIV created a starting point for a COVID-19 vaccine.

Hildreth, who also serves on the Nashville coronavirus task force, said one of his recommendations is that “we be guided by science. We have to make sure people understand why we are making the decisions we are making and what the science actually means.”

 “When the mayor first asked me to speak, as an infectious disease specialist, I would try to explain the science. It is easier to accept and adhere to some of things we’re asked to do when we understand the science.”

Hildreth also serves on the FDA committee which reviews the efficacy of vaccines. It will meet on Feb. 26 to consider the Johnson and Johnson vaccine. If approved, the recommendation goes to the CDC and that vaccine could become available in early March.

However, there are still 130 countries that do not have any vaccine. “The whole world needs to be vaccinated or else we will be dealing with this for a long time,” Hildreth said. “Unless we are going to shut down our borders and not let anyone in or out, we won’t be safe until the whole world is safe.”

“As soon as we reach the level where the United States is taken care of, we should purchase vaccines and make them available to Africa and other poorer countries because I’m concerned they might not get the vaccine for another year or two. That is unconscionable and we can’t let that be the case.” 

Hildreth added that “Canada, Britain, Germany and other European countries should all get together and make sure they get them because it’s in our own best interest.” He said he also worries that “even if 7.5 billion of us are vaccinated, there is another whole swarm of viruses in bats that could get in an animal we interact with and this could happen all over again.” 

He said “as a global community, we should set up a task force of scientists and other experts whose job is to monitor for pandemic potential viruses and make sure they don’t spread beyond where they arise.”

“That requires a global effort and collaboration between countries. There are 39 viruses out there. We know we can make a vaccine in a short period of time. The bad news is that the virus next time might have a higher fatality rate.”