Governance and Education Committee 2/9/21

maybe eight minutes max worth of public comment, assuming no one else signs up, um, once we convene.

So, um, after that, we'll go ahead and dig into the first panel, which is the community perspective panel.

And then we'll hear from our, um, government partners in the second, um, second panel, um, conversation.

So, um, And then that'll round us out for this, the vaccine equity conversation.

And and then at that point, all of you who are here for those 2 panels are welcome to.

Say goodbye for those of you who are on the community panel who need to go after the 1st panel, you're welcome to log off.

No obligation to stay on.

So.

Thank you all in advance for being here.

And thanks to all of the council members who are not members of this committee for joining us today too.

So without further ado, if folks are ready and don't have any questions, we can get started.

Any questions?

All right, we're solid.

We're ready to go.

Let's get the meeting started.

Thank you Seattle Channel.

Good afternoon everyone.

Welcome to today's meeting.

The February 9th 2020 Governance and Education Committee meeting will now come to order.

I'm Lorena Gonzalez chair of the committee.

Will the clerk please call the roll.

Herbold.

Councilor Herbold.

Council Member Morales.

I'm here.

Thank you.

Council Member Mosqueda.

Present.

Council Member Strauss.

Present.

Council President Gonzales.

Present.

Seven present.

Thank you so much.

We really quickly chairs report colleagues and distinguished guests.

I want to thank everyone for joining me today in this important discussion about vaccine equity.

Today, we will hear from regional partners, community health experts, and impacted community members on the issue of COVID-19 vaccine equity and distribution and apportionment issues.

Because of the important conversation we are about to have in this committee meeting, I have, utilizing the council rules, invited all of my colleagues on the city council who are not members of the Governance and Education Committee to join us today in order to engage in this important conversation that impacts every individual in the city of Seattle.

So a huge thank you and hearty welcome to each of you for joining us today in this really important conversation.

Today we have three items for discussion.

Agenda items one and two are about COVID-19 vaccines.

First, we will hear from a panel of community health experts and impacted community members on vaccine equity.

They are here to share their perspectives on the initial rollout and ongoing challenges that affect vulnerable communities, our communities in particular.

Following the community panel, we will have a roundtable of representatives from federal, state, and local government to respond to equity concerns and share how they have been working on collaborative action and solutions for equitable vaccine distribution and access.

Our last agenda item, although unrelated to vaccine equity, is related to our pandemic relief response for our immigrant and refugee neighbors.

Director Koo Vu from our Office of Immigrant and Refugee Affairs will be joining us with a few members of her team to provide an overview of the Office of Immigrant and Refugee Affairs' hard work in ensuring our immigrant and refugee community members are not left behind in receiving crucial information to stay healthy and safe in the pandemic, nor be shut out of the city's efforts in disaster relief.

I know Council Member Mosqueda is with us today, but a special thanks to her for making sure to include this as part of funding in the Jump Start Seattle payroll tax ordinance.

And this will be an opportunity for us to sort of hear at first blush from OIRA the good work they've been able to do with that additional revenue.

Well, today's conversation will focus heavily on the experiences, barriers and disparities that black indigenous and people of color are experiencing with vaccine rollout.

I want to acknowledge that one of the key factors fueling the perspectives we're about to hear is the unpredictable and scarce supply of vaccines.

We heard about the scarcity in supply this morning during Council Member Herbold's Public Safety and Human Services Committee, and I want to acknowledge that accessing the vaccine is a challenge for every community, but by focusing on those with the most barriers to access vaccinations, it will ensure that we have a more equitable distribution system.

Our Seattle Fire Department have been key players, along with many others, including those of you in this meeting today, in helping us meet the needs of our community during this pandemic.

The Seattle Fire Department, for example, provides a daily snapshot of COVID-19 statistics.

And as of Friday, February 5th, we know that there are 78,062 confirmed cases of COVID in King County.

We have 1,277 confirmed deaths in King County.

We have 303,961 confirmed cases in Washington State, and 4,449 lost lives in Washington State to this virus.

In terms of vaccine administration through our Seattle Fire Department mobile vaccination team, we've been able to since January 14th vaccinate 2547 people in our community.

Those are really heavy numbers because we know they're not just numbers on a chart.

These are people's mothers, fathers, sons, daughters, aunties and uncles and cousins.

These are real human lives lost to this pandemic.

While we wait for the federal administration to ramp up vaccine supplies to our state, it is incredibly important to look at the challenges and concerns we are hearing right now, to learn from it, and to use this time as an opportunity to tweak our vaccine distribution and access system so that when states and communities are receiving a reliable supply of vaccines, we do not have to repeat the hunger games of the last few weeks and get people protected against this deadly disease, particularly those communities that are at most risk of exposure and death.

As a complement to this discussion and to memorialize what we have learned in these past few weeks, We will be discussing in today's committee a draft resolution that outlines our shared principles to achieving more equitable outcomes in vaccine distribution here in Seattle.

You should have received a draft of that resolution from Jeff Sims earlier today, or it might have been last night.

This resolution was drafted with input from many of your offices, the mayor's office, Seattle King County Board of Health, and Washington State Department of Health.

I'm looking forward to today's conversation to further inform the final version of this resolution, which I hope to introduce and have the full council consider next Tuesday, February 16th.

During our full council meeting at 2 o'clock PM.

So, with that, I'm going to.

close out my president's report.

I'm going to move into public comment.

Again, at this point, we have about four individuals signed up for public comment, so we'll go ahead and open up the remote public comment period.

While it does remain our strong intent to have public comment regularly included on future meeting agendas, the city council does reserve the right to end or eliminate these public comment periods at any point if we deem that the system is being abused or is no longer suitable for efficiently conducting our business.

I'll moderate the public comment period in the following manner.

The public comment period for this meeting is up to 20 minutes and each speaker will have two minutes to address the council.

I will call on three speakers at a time and in the order in which they registered on the council's website.

If folks are watching and listening and would like to speak but haven't registered, there's still time to do that, but you must do it before I close out public comment.

You can go to City Council's web page at Seattle.gov forward slash council or you can click on the link listed on today's agenda.

Once I call your name staff will unmute your microphone and you will hear a prompt if you have been unmuted.

That will be your cue to press star six and then begin speaking.

I'd ask that you please start speaking by stating your name, the item that you are addressing, and as a reminder, your public comment should relate to an item on today's agenda.

During your public comment, you'll hear a chime.

That chime is notice that you have 10 seconds left of the two minutes that you have been provided.

Please listen for that chime, and I'd ask that you wrap up your comments once you hear the chime so that we can go ahead and move to the next person.

Once you've completed your public comment, we ask that you please disconnect from the line.

If you plan to continue following this meeting, you can do so on Seattle Channel or one of the listening options listed on the agenda.

So the public comment period is now open.

We'll begin with the first speaker on the list.

Again, please remember to press star six after you hear the prompt of you have been unmuted.

First up is Janice DiGucci followed by Joe Kunzler.

Janice, welcome.

Thank you.

Hi, I'm Janice Taguchi, Executive Director of Neighborhood Health.

Thank you so much, Council President Gonzalez and council members.

Neighborhood Health serves 2,500 immigrant and refugee elders in 14 different languages, living in public housing throughout Seattle and King County.

So far, we've assisted over 350 people access vaccinations.

The city has a robust infrastructure to serve BIPOC elders through the Human Services Department Aging Disability Services Division, which also serves as our county's area agency on aging.

We are one of over dozens of partners serving Seattle's low-income seniors.

What's been challenging is knowing where to access the vaccine.

We lack real-time information on who still has the vaccine, and when we do hear about vaccine availability, our staff hit the phones and contact elders on their caseload.

And even when we know about the availability, access has been extremely challenging.

One of our case managers called the Swedish clinic 67 times to get through only one time.

What's working, though, has been our partnership with King County Public Health and the Area Agency on Aging.

We were given early online access to the mass vaccination sites in Kent and Auburn, and in three days, we signed up 250 elders for appointments, arranging transportation and allaying vaccine fares.

We believe this is a valuable and effective strategy so long as community partners that serve BIPOC elders have early access to level the playing field.

Community health clinics play a vital role in disseminating accurate information and also providing care and vaccines.

One of our case managers contacted 80 people on her caseload and only three agreed to set up a vaccine appointment.

Our clients say that they would prefer accessing their vaccine information through a primary healthcare provider or community health clinic where they have a trusting relationship.

However, you'll probably hear from the panelists that the supplies have been inconsistent.

We're eager to partner with the city and community health clinics and Seattle Health Authority and others to stand up pop-up vaccine clinics in the community.

And we view that as another way to specifically target BIPOC communities.

I urge you to act swiftly to work with ADS partners and other community partners to set up a system targeting BIPOC elders and facilitate access before the next stage of the vaccine availability opens up.

Thank you.

Thank you, Janice, for calling in today.

Next up is Joe Kunstler, followed by Lee Nguyen.

Hello.

Can everyone hear me?

We can hear you.

Okay, good.

I heard the comments asking me to stick to the agenda and not matters in the committee's work plan.

this endorsing legislation, so I'm going to be incredibly brief.

Knowing that this mayor-elect for all practical purposes is very logical and will make an excellent mayor of Seattle, that I endorse you for mayor and that I ask that you look into Washington State House Bill 1329, As to keep remote testimony after the pandemic, I've been asked to keep my comments to the agenda, so I want to hand over the mic to another person to speak on the agenda.

Thanks for all you do, Council President.

You'll make a great mayor.

Thanks, Joe, for calling in.

Next up is Lee Nguyen, followed by Megan Perry.

Hi.

Good afternoon, council members and community members.

My name is Lee Huynh.

I'm commenting today about vaccine equity as a social work intern at a local community health clinic that serves the mainly API population, Asian Pacific Islander, and as a second generation Vietnamese American.

At the clinic I'm at, I see a lot of older patients who speak languages other than English and have low digital literacy skills.

Even before the pandemic, these elders faced isolation.

Now many of them can't see their families at all.

This means no one to help with groceries or to book that very rare vaccine appointment.

I've heard countless stories of fear leaving the house because elders are scared of getting sick or getting attacked.

New York City recently saw a 1900% increase in anti-Asian hate crimes just in the last year, which is undeniably linked to the racist rhetoric around COVID.

Now that there's a flu vaccine, why are we leaving these elders behind?

My worry doesn't end when I step foot out of the clinic and my 93-year-old grandmother haven't been able to secure a vaccine appointment either.

My grandmother laughed about how it's been almost a year since she left the house to go to church or the grocery store and that she might not live to do either of those things again.

She has a kind of dark sense of humor.

I ask that our city and our state do better to ensure our elders, especially Black, Indigenous, and elders of color get vaccinated, not just those with the fastest Wi-Fi connections.

Thank you so much for having this conversation today and having community members input as well.

Thank you for inviting me.

Thank you, Leah, for calling in today.

Next up is Megan Perry.

And Megan, if you're with us, you'll need to hit star six so we can hear you.

IT, do we still have Megan or did we lose her?

She's still there.

Megan, if you want to try one more time, pressing star six.

Sometimes folks hit pound six by accident, but we're looking for that star.

So star six.

Okay, looks like we're having some issues connecting and Megan is my last speaker assignment for public comment.

I'm going to give Megan one more chance here, star six, so we can hear you.

Okay.

Megan, I'm sorry we're not able to make this work out.

You are welcome to send me and the full council your public comment via email and we'll make sure that it's part of the record.

So we're gonna go ahead and close out the period of public comment and begin items of business on our agenda.

So first up, I'm gonna ask the clerk, Vinwin, to please read item one into the record.

Agenda item number one, vaccine equity, a community perspective for briefing and discussion.

Thank you, V, so much for that.

Okay, so we have several presenters with us.

I'm really excited about both of these panels, and I'm gonna go ahead and hand it over to you all to introduce yourselves.

And if you could popcorn amongst each other, that would be helpful.

So we can go ahead and get folks introduced, and then we will begin the process of making presentations.

Who wants to go first?

Should we start with Gigi?

You want to go first?

Sure.

Hi, everyone, council members.

My name is Gigi Giale.

I am from the Marshallese community, Marshallese Women's Association, and thank you for having me here.

Great.

Thank you.

Trang, you want to go next?

Sure.

Thank you, Council President.

My name is Trang Tu.

Hi, everyone.

And I'll be speaking today as a community member.

Teresita.

Hi.

Teresita Bataola, International Community Health Services.

And I'm one of the panelists.

Esther?

I kind of figured you were going to go anti on me, Teresita.

Hi, everybody.

My name is Esther Lucero.

I am Diné and Latina, and I am now the president and CEO for the Seattle Indian Health Board.

You're going to see a shift in our titles for a very specific reason, since our organization has doubled in size since I actually started with the organization.

So with that, I will pass it on to my partner in crime, Abigail Echo.

Good afternoon, everyone.

I'm Abigail Echo-Hawk, a citizen of the Pawnee Nation of Oklahoma, on my father's side, and from the upper Ahtna Athabaskan people on my mother's side of Mentasa Lake, Alaska.

And I'm the Executive Vice President of the Seattle Indian Health Board, where I direct our research, evaluation, data collection, and public health efforts, along with our National Tribal Epidemiology Center.

Excited to be here with you today.

Thanks, Abigail.

And how about Dr. Danielson?

Good afternoon.

I'm Ben Danielson.

I'm a pediatrician who has worked in the central area in Seattle for most of my career.

And I'm honored to be here with this incredible panel and with this council.

So thank you for this invitation.

Thank you for being here.

And then last but not least, I think we have Jesus Sanchez.

Oh, and Jesus, you're on mute.

Okay, still technically challenged.

Sorry about that.

It's bound to happen.

I'm Chris Lucentis and I'm here representing CMR Community Health Centers.

CMR, I'm here as a Senior Vice President for CMR and thank you, Madam Chair and members of the Council and partners in the healthcare community.

Good afternoon.

Thank you, Jesus.

Thank you all for being with us.

I think that did cover everybody on the community panel side.

So as members of the viewing public and colleagues, you can see we have a very powerful panel of experts, as well as community impacted community members who are with us in this panel today.

I know that each of you have a lot to share with us, but in an effort to try to stay organized, we'll start with each presenter sharing sharing their perspectives and concerns regarding vaccine distribution.

And if we can keep it to somewhere between, you know, three to five minutes, that'd be super great.

But, you know, we have we have some flexibility there.

So I think she who is our master MC behind the scenes here, I'm just sort of saying the words, came up with an order of speakers.

So we're going to start with Teresita, and then we'll head over to Esther and Abigail, and then we'll hear from Jesus, then Dr. Danielson, then Gigi, and Trang will bring us home.

So without further ado, I'm going to hand it over to Teresita.

Thank you so much, Council Member Gonzalez.

And thank you for the invitation for us to be able to share more publicly our experiences.

And I would never claim to be an expert, but definitely we have the experiences of the community and what it's like to try and battle for very scarce supplies of vaccines.

So brief overview on ICHS.

I think there you go.

47 years of care, service, and advocacy.

So we've been around that long.

Next slide, please.

We started back in the late 1960s when community leaders and student activists were angered over living conditions for the elderly in single room occupancy hotels in dilapidated Chinatown International District neighborhood.

And our clinic started off as the ID Health Clinic in 1973 as part of the civil rights movement with the Asian community demanding equal rights and access to services.

But I will also definitely acknowledge the other communities that enabled us to be able to get started, specifically the Black and Latino communities who were very present in a partnership with us and also the Native American community where we have a lot of shared familiar relationships.

So the arrival of Vietnam War refugees in the 1970s very quickly shifted our services to accommodate not just the elderly but all ages and also more languages than the languages we were serving.

So today we are a full service primary care provider with 11 sites serving 50 different languages a year.

And those languages are Asian, Pacific Islander, East African, Eastern European, and of course, Spanish also.

We established a foundation in 501c3 in 2007 because when you have primarily low income patients, it's very hard to do any kind of fundraising.

And so we needed to basically have a mechanism for general community support.

Next, please.

Our 2020 data is still in the process of being done.

But in 2019, we served close to 33,000 patients.

139,637 were health center visits.

So this means basically that we are taking care of people who have multiple conditions.

So they need to have multiple visits.

Plus, because we also provide not just medical but dental, behavioral health, nutrition, pharmacy services, they are able to get the benefit of all of those services without having to run from building to building, provider to provider, hospital to clinic, et cetera.

We had over 460,000 health encounters, meaning we were also out in the community, that we were doing work beyond the walls of our exam rooms, doing health education, doing health fairs, doing vaccinations, and other health-related activities.

7 out of 10 of our patients are low income, 4 out of 5 patients are persons of color, 1 out of 5 patients are 65 years old and over, and 1 out of 10 patients are homeless.

Our patient coverage tends to be Medicaid, Medicare.

The privately insured patients that you see here are basically usually patients who have gotten their coverage through the Washington State Health Exchange Authority, which means that these are subsidized plans.

And about 7% are uninsured.

Now, the uninsured has fluctuated quite a bit, especially in the last four years under the previous administration, just because a lot of fear and intimidation was instilled in our communities.

especially because we serve primarily immigrant and refugee populations.

We did over a million dollars worth in uncompensated care.

Over half of our patients needed interpretation in the 50 languages.

About half live in Seattle and we have 11 sites in King County.

Moving on to COVID-19, definitely it's been, next slide please, persistence in a time of pandemic.

Next slide.

Just to kind of refresh everyone's memory, it was a little over a year ago when we had the first COVID-19 case confirmed in the country, but also in our state.

And very soon after, our Bellevue Clinic got impacted when the first patient with respiratory conditions presented herself, but no recent travel.

So at that time, everybody thought there was some kind of travel associated with Wuhan that brought COVID-19 here.

But this patient had no travel associated.

Patient was tested and confirmed to be COVID-19 positive.

positive, and that patient was associated with Life Care Center, which remained the eye of the storm, if you will, for several months where we had so many elderly die.

By February 29, we already experienced our first death in King County when public health announced that death.

And again, that death was related to Life Care Center.

March 23, we began drive-through testing, and it's starting with Chinatown International District and Shoreline Clinics.

We instituted temperature and symptom checks at all sites.

Dental access became limited to emergency services only, so we lost 90% of our dental services because of that limitation.

We started to do pop-up testing, initiated for communities with severe barriers to access.

including testing Pacific Islander populations in South King County because Pacific Islanders are disproportionately affected in our community.

And we also began a mass testing site at Bellevue College, which hit a high of 1,200 tests a day.

Now it's averaging between 700 and 800. So we are in this situation, We also did community flu vaccinations, which is very important because we did not want to have layers of diseases and illness in our community.

So we did a very aggressive flu clinic efforts out in the general community.

So next slide, please.

So, so far we participated in vaccinating 1A qualified people beyond ICHS staff to include other 1A from nonprofits and also vaccinating the seniors associated with Legacy House.

Now we are in 1B, those over 65 and 50 years old and up in multi-generation households, and this is where the problem started for us.

Since the expansion in January 18, we received zero allocations for each of the three weeks that 1B became qualified.

So it was very alarming and it led to me basically banging on doors, rattling windows, and endless emails, texts, and calls to different levels of government, state, local, and also the county.

And our race concerns eventually led to Public Health Seattle-King County transferring some doses to us during the weeks of February of January 25 and February 1. But I will say that those doses were very limited.

When you think about the fact that we have about 7,000 patients, just our patients alone, who qualify as being 65 years or older, 500 does not get you much in terms of the ability to take care of that.

Additionally, we are vaccinating not just our patients, but the community around us.

And right now we are helping vaccinate Chinatown International District because many of the people who live there, the elders who live in low-income housing, do not have any kind of access to vaccines otherwise.

From January 25 to February 5, we have only received 1,300 doses, not from our orders, but from transfers, not just from public health, but also we received some from Swedish.

Of this total, approximately 150 doses went to community events.

Of all of our clinics, only Chinatown and last week Holly Park also received some prime doses for vaccinations.

Bellevue and Shoreline clinics continue to await.

Next slide, please.

When you think about underlying conditions in terms of what our communities have to deal with, definitely we're hit hard with racism, with age, and with poverty issues.

Disproportionate impact on COVID-19 on seniors, blacks, indigenous people and people of color, immigrants, refugees, we are such high risk for spread, for hospitalizations and death.

Definitely from our point of view, there is a severe absence of vaccine equity.

The barriers are high and wide.

The digital divide is very, very real.

You have to be adept at using face finder then scour sites if you q any available appointment as soon as you have the r have the right finger tha refresh, refresh, refresh Language and culture presents a big barrier.

We find that there's misinformation and confusion.

There is so much information out there that counteract different pieces of information.

And with our population, we find that they get information from other sources beyond or aside from the official sources.

And then there's access availability challenges for those who are working or who have to care for members of their family.

Actions needed, next slide please.

We are in an ultra race against COVID-19 and it's aggressive variants for the most vulnerable.

We have to walk the talk.

Government has to walk the talk.

All levels of government I talk to hold equity as a fundamental value, and yet the vaccine allocation does not mirror the value.

It is so frustrating for me to have to do these calls, texts, and emails week after week to get the right thing to happen.

Orders by community health centers must be filled.

I do not know of a single community health center that tries to hoard or tries to over order beyond what we reasonably feel we can really push out as fast as possible to not just our patients, but our communities.

But the last point I have is that because we are in an ultra race and because our populations have been disproportionately affected, I do believe that we need to have all providers engaged.

everybody needs to address equity.

It cannot be just us who are already focused on the equity issues.

Everybody, all the hospitals, all the providers, even the mass vaccination sites, they have to have a plan for equity.

So thank you very much for the opportunity to present.

I will say Council Member Gonzalez that you talked about the Seattle Fire Department.

I also want to give kudos to them because they have been vaccinating some of the big buildings in our communities to reach the elders so that they don't have to come out and take the risk of being in line for a vaccine.

So we thank that partnership, but we need so much more to happen.

Thank you, Teresita, for that presentation and for the acknowledgement of SFD's work.

And I think the mobile team model is one that is showing promise.

So I definitely am interested in continuing to engage with you all to make sure that it continues to show promise in terms of a potential equity model.

But of course, we need much, much, much more here in this space.

Colleagues, we will have an opportunity to ask questions at the end of the presentation, but for those of you who might be having burning questions now for as panelists conclude their sections, feel free to let me know.

You can either send me a text message or use the raise the hand feature or go old school and just raise your hand in the video here.

And I'll make sure to call on folks as you have questions, OK?

OK, so we're going to transition now over.

I think next up in the slide deck is Esther and Abigail.

OK, fantastic.

Abigail, I'm going to have you start, since we're starting with kind of health disparities and things like that, and then I'll go into a little bit more in-depth how this has played out within the Seattle Indian Health Board.

Thank you so much, Esther, and thank you so much, Teresita, for that incredible presentation.

You really laid the groundwork for what equity isn't looking like in our state and in our county and in this country right now, so I really appreciate your work and your words and Esther for letting me kind of jump into this right now.

I'm really appreciating Esther and I's new partnership to be able to support each other as we do this very difficult and draining and traumatic work serving our community.

We know right now that the health inequities that exist around COVID-19 aren't new.

What we are seeing is a system that has been built to marginalize and for indigenous people to eliminate us.

And what we are seeing with COVID-19 and this virus is that these systems are working.

This is what institutional structural racism looks like in its outcome.

And I think some people are surprised to see it for the very first time.

My answer to them is that I never had an opportunity to not see it.

The leadership of the Seattle Indian Health Board never had the opportunity to not know this is what was going to happen.

As a result of that, our organization really concentrated on fulfilling the gaps that we couldn't expect to get from the federal government, from the states and for the counties, particularly as we look at the data.

When we look at the information right now that's coming out around COVID-19, we know that American Indians and Alaska Natives nationally are 3.5 times more likely to be infected and 1.8 times more likely to die.

This was published in the CDC's MMWR.

I was a co-author on both of those papers.

However, while I was glad to put that information out, the thing that I was most concerned about was the fact that we were only able to look at a limited number of states.

For the 3.5s more likely to be infected, We could only look at 23 states in the nation simply because only 23 states were reporting at least 70% of race and ethnicity.

So that means most of the other states, including Washington State, have such gaps in their data and as a result of the non-investment in the public health infrastructure, people are getting away with not capturing race and ethnicity.

And as a result of that, these health disparities are effectively being hidden.

So if we look at Washington State right now, at the percent of missing race and ethnicity for Washington State, we are at 51% is missing in Washington State data.

And if we look at the COVID-19 cases in county, 45% is missing.

How can policymakers make any kind of informed decisions based on data that doesn't exist?

And the data that doesn't exist is very often that of American Indians, Alaska Natives, African Americans, Hispanic, Latinx, people of color.

As a result of that, when these equity, fundamental equity is built into these governments, as is often said, in actuality, we've never seen that.

And that is resulting in the death of our community members.

I'm feeling really fiery right now.

That's because I had a recent death two days ago, a friend, my cousin two weeks ago, another relative three weeks prior to that.

That is the experience of the native community where our people are dying, and they are often dying in silence.

So when it comes to equity around the COVID vaccine, it has become integral for us to recognize that we're not going to get the information that we need from the county nor from the state in the way that we need to get it to serve our communities well, and we have to do it ourselves.

The Urban Indian Health Institute, the research arm of the Seattle Indian Health Board, recently released the very first, the very first, coming out of Seattle, for the nation, data on perceptions and hesitancies and possible uptake in the American Indian Alaska Native community.

I wrote that survey late nights over the course of a week while the rest of my staff was dealing with other things, juggling scarce resources, barely seeing my family as Esther and I'm sure all the other folks working in community health centers are doing the same.

Because nationally, there has not been enough information on the hesitancies around the COVID vaccine for American Indians and Alaska Natives.

Instead, we saw folks guessing.

We saw them using information from the flu vaccine and others.

This is not the time to guess.

This is the time to gather information to direct resources to those who know how to do it.

So we were able to juggle some funding, put out this report.

And what we found in this region, that Native people were 77% of them were willing to get vaccinated.

But willing to get vaccinated and hesitancies are not mutually exclusive.

All of those folks also had hesitancies.

And so they told us what they needed to know.

They needed to know what the clinical trials looked like, how many Native people were included in them.

They wanted to know where their other Native leaders.

And the number one place they wanted to get information from was urban Indian health programs, tribal programs, and trusted community leaders.

That is who they trusted.

You want to know who was at the bottom?

Governments.

Policymakers not associated with our community.

At that time we did the survey, the Trump administration.

We are the trusted community messengers and we took that information seriously.

When I looked at the great information that was coming out of King County Public Health, the health materials did not meet the needs of our community.

It's not something I would put in our clinic.

So we created our own using this information that really pulled towards what native people were looking to see and understand.

Our information seats on Moderna vaccine, which we have here, includes information about the clinical trials.

And it also includes one of the key findings from our study, that again, I had to write late at night over the course of a week and struggle to find money to launch and then do the analysis of.

And what we found is that 74% of all native people were making the decision to get vaccinated based on their responsibility to their community, their tribe, and to their family.

When the same question was asked of African Americans, only 36% said that was their decision-making process, and 53% of Latinx, and it was much lower for non-Hispanic whites.

The Native community has a very distinct reason for getting vaccinated, thus making every other health materials that kind of grouped people of color together meaningless to us.

And it really showed how you need to look into each individual community to be able to properly communicate why getting vaccinated is imperative.

So at the Seattle Indian Health Board, We just don't gather information to put it out in the public.

We implemented it the moment we got it, as it was coming in.

It's the way that we rolled out our vaccination clinic, leaning on our tribal sovereignty to be able to make decisions on where those vaccines were going.

One of the things that I keep hearing constantly, before I pass it on to Esther, is from my public health colleagues, locally and nationally, around health literacy.

Oh, make sure we meet the health literacy of the community.

And my answer to them is, public health is the one lacking the literacy.

It's not the community, it's public health.

We have not implemented or practiced what many public health entities and governments have said about equity.

It has become just discourse we sit around tables and talk about rather than actual implementation.

And now that places like the Seattle Indian Health Board have actually implemented that, when we do look at the data that is available on vaccine uptake in King County, we see about 15% of American Indians and Alaska Natives have been vaccinated.

We're hearing other people take the credit for that, and not even mentioning the Seattle Indian Health Board the work we're doing with our community partners and engaging them and making sure they have the materials they need to communicate to their people, regardless of where they're getting vaccinated.

So not only is the equity work being done in our communities and then the credit for it is being taken in other places.

When that happens, that means the places that get the credit that isn't us, it's not about the credit, it's then about the resources that come with that.

That is the perpetuation of a system built on structural racism that doesn't trust the community's organizations who are the trusted messengers of those communities.

So we have taken all of this information that we have gathered about our community and gathering their voices.

We honored it and we implemented it in the way that our vaccine distribution has happened at the Seattle Indian Health Board.

I'll pass it to Esther.

Thank you, Abigail.

You know, I'm sitting here listening to my auntie Teresita, and my heart is breaking for her, right?

And I want to remind folks that this is the very first time urban Indian health programs were included in any sort of vaccine distribution, outside of the flu shots, of course.

And the reason that's significant is because we set ourselves up well.

At the Seattle Indian Health Board, we are really blessed to have a government affairs team, a policy team who is dedicated to maybe informing the language that goes into legislation, right?

We are so blessed to have tribal partners who believe in us as part of the continuity of care, who continuously leverage their tribal sovereignty to support our distribution.

And I'm just like, I'm floored by that because I'm looking at Teresita who doesn't have that.

The other thing we have is we have our Urban Indian Health Institute and we're well versed in public health information.

So one of the things the city of Seattle should really look at is what it means to empower communities, right?

I think the Seattle Indian Health Board is a good model of that.

What happens instead is there's this very intrinsic intertwined relationship that the city of Seattle has with Public Health King County who continues to try to be public health for all entities and not listening to community voices and certainly not empowering communities to implement their own strategies.

So when you actually empower communities to be responsive for themselves, right?

then you get to do it like we have.

Number one, we have been consistently receiving replenishment in our vaccines.

And there are a couple of reasons for that.

One is that the state of Washington actually set aside about 5% of the vaccines for tribal communities.

And because the tribes included us into that, we've had access to that distribution list.

Additionally, because we've been able to keep good inventory records, and as Teresita said, we're only asking for the vaccines that we can actually distribute, both in first doses and in second doses.

And for that, we are grateful to our pharmacy director, Patrick Henry.

And what pharmacists have that other clinical providers don't typically have is they know how to manage inventory and they know how to manage it well.

And so we've been able to manage that inventory to be able to effectively distribute it to our communities.

Additionally, we received the authority to have more autonomy in our distribution, right?

Meaning when the CDC actually rolled out, you know, elders to be vaccinated and they had to be 70 and above, we were able to roll out 55 and above.

Number one, we don't have a lot of our community members who are living, you know, that long time periods.

That's number one.

Number two, we also knew that we had elders in our elders program who are struggling with homelessness.

We wanted to make sure that we vaccinated all of our elders.

Additionally, we were able to vaccinate all of our staff members, right?

We've been working through this pandemic, both on the public health side and the community health side.

And we also recognize that there were other community-based organizations who provide much needed services to our community members.

And we wanted to maintain that continuity of care and get those services up and running as soon as possible.

So we were able to vaccinate Our staff members from Chief Seattle Club, a community partner, the United Indians of All Tribes, community partner, right?

Mother Nation, community partner, very instrumental in providing resources that we need.

And also UNEA, right?

Because they're serving our youth and families.

All of these folks have been putting themselves at risk, still providing services for our communities.

But we recognize that we are nothing without our community as a whole.

And back to Abigail's point, our community is getting vaccinated so that we can support community, for our independent gain, right?

So it's interesting as we move through our rollout, and we started off like a very controlled and only serving American Indians, Alaska native people.

And when the state of Washington decided to open up access to the vaccines for individuals who are in multi-generational households, right?

They said, anybody 50 and up, if you're in a multi-generational household, we're going to vaccinate you.

And for us, we said, wow, most of the people we serve actually that live in multi-generational households, be very difficult for our staff to kind of sort through who is eligible or not.

So we opened it up to everybody.

And I will tell you, we have never seen folks from Mercer Island in our clinic until that day, right?

Right up front and center, bullying their way to the front of the line saying, why is it that that native elder is getting a vaccine before me?

Fortunately, we were smart enough to preserve 65% of our vaccines for our American Indian and Alaska Native populations.

And I'll tell you, we're booked through the end of March for those non-Native slots, if you will.

So when I think about that experience, and it took three days, three days to have that happen, and I think about these pop-up mobile clinics that are showing promise, what is King County doing to ensure that those vaccines are still getting to the communities who live in those zip codes and not the Mercer Island folks who are traveling all over to get in the front of the line?

And when I say bully, I mean bully.

I have to commend my staff for maintaining their composure and their kindness and their respect and love in those moments where we were experiencing that level of entitlement and quite frankly, privilege.

So I'm here to say to you, when you empower communities to serve their people, serve them well, you wouldn't have Teresita sitting here saying, I can't get our elders vaccinated, right?

You wouldn't have these experiences where entitled folks infiltrate the systems that are designed to support us.

And I'm asking us to do better.

I'm also asking us to think about capacity building for other communities of color so that you can follow the model of the Seattle Indian Health Board.

And when you have access to the public health support when you have access to the resources in policy and advocacy and those types of things you're going to be more successful.

It's about a transfer of resources power and authority.

And that's where we need to live if you want to make a difference.

I just want to follow up on one thing related to what Esther was talking about.

I'm very fortunate to do a lot of national work and will actually be offering congressional testimony similar to this in the upcoming weeks around the COVID vaccine, specifically around the Biden administration and every state and county in the nation trying to get as many shots in arms as possible.

That is not equity.

And so when we send out Sean our nurse and our other folks to spend time with the brilliant people at the Chief Seattle Club directed by my sister Colleen Echo Hawk who's formed a partnership with us to ensure that that Sean and team get vaccinations to 15 people.

Instead of let's say 100, that's equity.

It's not about the numbers.

It's about the people that you reach.

And right now in this vaccine distribution, we are concentrating too much on the numbers.

There's a reason we are a small population in this county and it's genocide.

And the only way we're going to stop that ongoing elimination of our people is to truly implement equity.

So when you say the city or the county is doing a set aside a vaccine, then you actually need to set it aside, maintain accountability and measurable outcomes for making sure that that vaccine gets to the right people and capture the race and ethnicity so you don't effectively hide whether or not you're reaching equity.

Equity, I learned this from my dear friend, Ben Danielson, who's on the call.

Equity is uncomfortable, and it is disruptive, and it is absolutely not voluntary, but it is the community we want to see and the community we want to build, and that is who we are at the Seattle Indian Health Board.

Yeah, that's great.

Just one last thing also.

I learned this morning, so I'm on the board of the Northwest Primary Care Association, that the Biden administration is actually going to distribute one million doses of the vaccine directly to community health centers.

directly to FQHCs.

But that is an example of the inequities presented when you go through state and county systems.

Thank you Esther and Abigail for that really important real time, real life case study.

You know, a lot of us are learning as we are going right now.

And it's just so important to make sure that we are creating space to learn from people who are seeing some great success and really taking action on these equity goals.

So I appreciate that.

I know I have two people in the queue with questions.

Before we transition over to Jesus, I'm going to call on Councilmember Mosqueda first and then Councilmember Morales.

And then if there are any other questions, we'll take those.

And if not, then we will hand it over to Jesus after these questions.

Councilmember Mosqueda, please.

Thank you very much, Council President.

It's really good to see so many of you.

I know you have been working day and night and weekends, mornings and evenings.

So thank you very much for sharing your story with us.

Thank you for doing everything you are doing.

Where do we need to be leaning in to get more of the vaccines to FQHCs?

Obviously, there's many layers there.

Our partnership with public health, state government as well.

But Esther, if you could just share a little bit more about that last note that you made in terms of when the Biden administration will be sending those directly to the FQHCs.

and do you need any advocacy from us in order to help make sure, as Abigail said, that those are truly allocated, set aside, and that the equity analysis and requirements go along with those.

I'd love to hear more about that, because that's great news.

Absolutely.

Thank you, Council Member Mosqueda.

Yes, we just learned that information today.

I can forward the article to you directly.

I just know that it's a million doses.

They didn't give a timeline.

to FQHCs specifically, but you asked what you can do to help.

I think that given our experience, right, FQHCs are contracted to serve anybody regardless of their ability to pay.

And I think about, like, my Auntie Teresita there, and how is she going to make sure that those elders, you know, stay prioritized without breaching contractual obligations?

We are blessed as an urban Indian health program because we allocated 65% to American Indians and Alaska Natives because that aligns with our contractual obligations.

And so I think you as a city council and as leaders in this environment can really set us up to make sure that the people who are in most need are prioritized.

Thank you for that.

Council Member Morales.

Thank you.

I think I think I might have the same question, although I might ask to I have a little deeper.

I'm really happy that you're all here.

This is an important conversation for us to be having and.

And as I said at our council briefing on Monday, like this is not a new problem.

We've known, we're a year into this pandemic and we knew that racial equity and equitable access was gonna be a challenge.

We've had a year since the testing, you know, outreach for testing began.

So we've known about the technology problems.

We've known about the language barriers.

It's frustrating to me that we seem to like relearn that there is a racial equity issue every time something happens.

So Esther, you made a point that we need to make sure that people aren't bullying their way into the front of the line.

We've already seen that happen.

And so my question is, what proactive steps can we take to ensure equity, setting aside, allowing for the set aside for a certain, percentage of people, a certain population.

I'm wondering if you have specific, like how specific should those kinds of requirements be?

Is it showing an ID with a zip code or your age or, you know, how do we, how do we put in place the checks on this?

Because right now it is really just an honor system and we've seen how that works.

Yeah, I think we need to empower community health centers to decide, right?

And we can put out our own messaging.

I think that our federally qualified health centers have been really worried about putting out that messaging, right?

If Teresita was able to say, look, we only have enough vaccines to vaccinate all of our elders, and that's what we're gonna do first, don't come or call because you won't get an appointment.

That's great, and you as a city council can put your authority behind that.

Right.

Or for us, like if we are trying to preserve our language keepers, our culture keepers, right, being able to do that.

I think that that's what we need to do.

We just need to let communities come up with their own distribution strategies.

And that is how you're going to reach the people you want to serve.

We serve them every day.

We serve them every day.

So I would like to weigh in since my name keeps coming up.

So our strategy is different.

When we opened up the schedule publicly, we quickly found out, no, we have to shut it down.

So it's very labor intensive for us.

So for our patients, we're calling them directly so that we could answer their questions up front and be able to bring them in.

But in the community setting, what we're doing is partnering with other nonprofits.

So for instance, in Chinatown International District, we've been partnering with Skip the Seattle Chinatown International District Preservation and Development Authority because they manage many of the buildings with the elders in them.

And they are the ones who do the upfront outreach.

They do the initial collection of registration information.

They help accompany the elders to a special site that's out in the community instead of making them walk all the way to 8th and Dearborn for the vaccination.

We're also coordinating with Chinese Information Service Center which has been working with Seattle Fire Department so that we know which buildings are going to get covered, which elders will not get left behind.

So very, very labor intensive for us, because that's what's needed at this point.

I'm really fearful of when the qualified faces now hit essential workers, because we have so many in our community, not just in Chinatown International District, South Seattle, we have not done any community events in South Seattle, just because we haven't had the supply but we have community nonprofit partners who are waiting who are eager who are contacting us saying, when are you coming out to serve us in South Seattle.

And, you know, supply is always a big barrier, and I have to be really grateful that you know the intensity of work has enabled us to deepen our partnerships with the other nonprofits.

I'd love for a CRS to be in play.

I'd love for you know the Vietnamese refugee.

Association to be in play.

I'd love for all of these other community nonprofits who are the trusted, we're trusted, but they're trusted at an even gut level and granular level.

And so that's what it takes in our community.

It's not the mass vaccination sites, but it works differently in other places.

And I'm sure Jesus will be very proudly sharing their experience because it's also very different from our community.

And I just wanted to add one thing, and it's a very often asked this kind of a question.

And then we talk about how we as a center are going to be accountable to ensuring equity and and advocating for that.

But my question always back is, is how is the city going to be accountable?

How are you going to be accountable to ensure that those who are administering the dollars, those who are allocating vaccine are accountable to ensuring that equity is achieved could start as easily as with mandating and having consequences for non-collection of race and ethnicity.

There are a lot of places in which you can do that, but the responsibility also has to fall on the city government to make substantive change to break down these systems of structural racism that are not serving our communities well.

So the formula and numbers work against us.

The State Department of Health is the one in charge of actually allocating the vaccines.

You know, public health can give input and advice recommendations that I know they've been supportive of ICHS in particular, but I already told you about the 000 results.

Um, the allocation formula supposedly has had community health centers in it since a week ago, two weeks now.

But it's lumped in with all these other providers.

So it's not a set aside the way my colleagues have talked about.

It's just, here's another mini line for us to get into, to get an allocation.

So that is a problem in and of itself.

And I would echo what Abigail Eco-Hawk is saying in terms of not collecting information on race and ethnicity.

We're supposed to be reporting to the, immunization registry, it's optional information.

You know, those of us who are very zealous, very much on fire about this issue, we do it, but not everybody does it.

And both Department of Health and Public Health issue wonderful dashboards that look as if we're collecting the data.

And then there are these tiny disclaimers down at the bottom that says, oh, you can't really rely on this data because it doesn't really have everybody reporting or words to that effect.

Something else has to happen.

If equity is really the principle, really the value that we're driving for, then all the other actions have to flow from that equity instead of continuing to just say it.

You know, I don't need supporters soothing my feelings.

I need action.

Thank you, Teresita.

I think Naomi Ishizaki's article headline this morning was very aptly put, that there's a lot of lip service to equity right now, but not a lot of action.

So I'm glad we're having this conversation because we are going to have a conversation about a resolution to sort of cement what our equity principles and goals and actions are.

So I think it'll be a good opportunity for us to integrate what we're hearing here and what we're learning here into that resolution.

Council Member Juarez, please.

Thank you, Council President, Council President, you just actually perfect way to to move forward.

I was just going to talk about briefly your resolution and thank you for doing that.

And we think we we are working with your office and trying to infuse language from.

Abigail and what Esther are sharing today, but I'm going to be very quick because I know we want to hear from the other folks.

I think what we're hearing and what we've been hearing our whole lives, those of us who are indigenous is, and Esther kind of pointed right to it, as did Abigail, is that we need to infuse indigenous ways of thinking, models, values into non-native governments.

So the resolution that you're proposing and some of the language that we are suggesting Um, is, um, it's factual and it can't just be in the recitals.

It's got to be in the resolve portion.

So an example, and we've seen them all along and council president, you heard me talk about this last Monday, but when I first talked about the report that came out and some of the values in Indian country and how, and Abigail put this more aptly in her report is how we value wealth is through generosity about what we give away.

and that we don't hoard and that we lead to leave.

And those are principles that are important to us.

And we're trying to bring some of these leadership principles of who we are and what we were taught into our roles, into non-Native organizations.

And so I'm hoping with your leadership, Council President, that we can actually put ink to paper and visualize and write and put them in there so we do, as Abigail would say, decolonize the data for Native people by Indigenous people and continue marching forward in that direction.

So, thank you.

Absolutely, Council Member Juarez.

It's part of the reason why I wanted to just circulate a draft pre-introduction, because I thought it would be good to have sort of a baseline language resolution.

And then that gives us all an opportunity to layer on top of that base, other interests and important perspectives into the language.

So looking forward to seeing your proposed edits on that and welcome them from you as well as from others.

Okay, so let's quickly transition over.

I know we have a few more presenters on our community panel, and it's about 3.10 now, so I wanna make sure that folks get an opportunity to share their perspectives with us.

So I'm gonna go ahead and hand it over to Jesus Sanchez from CIMAR.

Okay, all right, got it.

Buenas tardes, good afternoon, everyone.

Thank you very much for this opportunity to give a sense of testimony of our experiences here at CMR Community Health Centers.

So I want to start off by reading a few things here for you that I think is very pertinent to what's been happening recently.

In 1978, CMR Community Health Centers began on the premise that Latino communities were neglected in the environment of health care.

Since that time, many communities of color and poor white communities have been afforded healthcare through CMART care centers on that very premise, health equity.

The irony though, the unfortunate is 40 years later, we find ourselves at the same juncture, still finding that very issue of health equity.

The COVID-19 pandemic has simply just brought it into the spotlight, but it's been with us for 40 years.

While the recent state and county approaches to mass vaccinations, while effective, delivering vaccines in large quantities has done little to help communities of color.

CMR communities and our partners in the healthcare organizations with our boots on the ground approach is capable of having tremendous impact reaching communities of color.

Health centers are fully equipped to do this quickly and efficiently.

For example, 13 of CMR's community health clinics have received vaccines out of the 36 that we have.

If we were able to have 100 vaccines for each one of our clinics to give on a daily basis, we would have nearly 3,600 vaccinations a day, 16,000 vaccinations a week.

That's just on a five-day work week.

At our health, with our, at that, our healthcare organizations, our partners out there, we can do more than double our capacity in King County.

In essence, community health centers are mass vaccination sites if you allow us to do that work.

We're not just a mass vaccination site in a parking lot.

We're a mass vaccination site in our communities, and we're capable of delivering that capacity.

We're able to reach these populations, both who are most at highest risk.

The very same communities of color today we're serving are the people who are dying and being hospitalized at an alarming rate.

And I share this also that as Latinos, African-Americans, Native peoples, and many other communities of color, are affected daily by this.

And imagine the impact, however, of vaccinating our communities with a commitment for health equity and commitment for community vaccinations in the poorest communities and communities of color.

When combining all of our health organization partners, how much more effective we can be engaging equitably through the community health centers.

Community health centers play a vital role reaching out to communities, providing health care, not only at our clinics, but we also go to their homes through our home health programs.

We get there through mobile home, our mobile clinics to our farm working communities.

Mass vaccination sites do not accomplish this.

So as I look at mass vaccination sites in our fight against this pandemic, let's make no mistake about this.

This is not a silver bullet for our communities.

Community health centers need to be included in this fight, reaching out to patients that have traditionally been left out of the major culture care system.

With support financially from federal, state, and local governments, we can hire more staff and increase our vaccine allocations.

We are capable and willing to support seven-day-a-week vaccinations.

COVID-19 doesn't take weekends off any more than we should.

We need to be doing this seven days a week.

Our patients, our individuals are coming from community to get the vaccines.

We represent well the vulnerable populations we serve.

We believe our current approach to the issue of equity in the vaccine distribution is necessary.

However, I strongly believe that we can do better.

We can receive a bigger allocation of our weekly supply.

We believe strongly that community health centers like ICHS, Santa Elena Health Board, CMAR, Neighborhood Health, and other community health organizations should be the preferred primary way to execute an effective vaccination plan to ensure addressing the issue of equity.

The final issue that we find is trust.

That is probably the most critical piece for us in our community with respect to trust and access.

When we look at migrant farm workers and immigrant communities, migrant farm workers and immigrant communities in King County are not being served by mass vaccination sites.

Rather, mass vaccination sites serve as a reminder of broken trust left by the residue.

Oh.

Jesus, you accidentally muted.

Sorry.

There we go.

We got you back.

I was saying farm working families and immigrant families go where trust and confidence is located in our health care communities.

And that's been a critical staple in their lives, which community health organizations such as CMR and our local community health partners provide.

I can say with some degree of confidence that you would be hard pressed to find a farm worker in one of these mass vaccination sites.

I sincerely doubt that.

it takes established trust and confidence in our community health network to be able to reach out to these communities delivering health care and vaccinations.

And we must take a serious and critical aspect of federal and state local strategies designed to reach out to these populations.

You know, we here at CMR, as we see it every day, last weekend, for example, we did a mass vaccination, mini, I guess I'm going to call it a mini, Because we were lucky enough to find, last minute, 200 vaccines that were made available to us by one of the local hospitals because they couldn't reach out and call us just days ahead, two days before, and ask if we can reach out to our communities.

And we put it out on the radio on Saturday.

And we quickly reached out to 200 individuals that came back.

Actually, we had 400. But we had 200 vaccines, and we were able to reach 98% of those people that came through for those vaccinations were all Latinos.

They came in off the farm fields.

They came in from Yakima, from nurseries as well.

I mean, they came from everywhere as quickly as they could, and we were able to reach out to 200. We just got word today we might get another 200 possibly this week, and we'll do it again.

We have many more issues like this that happen, but the idea is where and how are we going to be part of the strategic thinking?

You know, when I look at the asks that our partners and with Teresita Batayola and Abigail Echo Hawk and others, you know, we are looking to be able to be at that table for strategic thinking and distributing of our vaccination.

We have to be at the table for distribution.

We can't be just a recipient, but we have to be at the table.

The second thing that has to happen is part of the asks that they're looking for is that I'm looking for as well in our communities is an audit, you know, audit of equitable distribution.

that has to happen on a weekly basis, not on a monthly or annual basis.

That's too late.

We need to know what's happening from an audit perspective, calling for this information from state agency.

Hold on just a minute.

Sounds like somebody is not muted.

So if technology could mute that person, that'd be great.

Sorry about that.

That's OK.

But I think it's important that we're able to self audit and or audit the agencies in the distribution plan to see how we're doing on a weekly basis so that we can self correct on a weekly basis, not give us a report six months later or three months later or a quarter later to determine how well or how bad we did.

We need to know how we're doing on a weekly basis so that we can self correct weekly.

and get that equity issue involved at the level, at the strategic level, so that we are part of that process of self-correcting and correcting, helping the state to do improvements in that area of distribution.

Our partners here today, I'm just, I find myself in the same category.

We have the same experiences.

We're dealing with the same issues.

And the sadness about it is we have a committee today that you, thank you for bringing to our attention.

But, you know, I think we, This is just an indicator from 40 years ago that we're here today, that nothing has really improved much.

My mother, as a short story, my mother was 62 when she finally got preventive health care, because we didn't go to health care unless we were at death's doorstep, because we didn't have insurance or care.

We were lucky and happy that she broke her leg picking apples, believe it or not, because that's the only way we can get her away from working in the fields anymore.

But when she broke her leg in 62, when she was 62, she went to Yakima Valley Farm Workers Clinic.

She had access to health care by that very moment.

41 years later, she died at 103. You know, we were able to take care of her.

But the importance is, is that we have this amazing capacity, amazing passion, amazing ability that we can achieve so much because we have a moral in a sense of obligation to want to help our communities, something that the majority culture does not have.

It's embedded in us.

It's in our hearts.

It's our desire to improve and better our communities.

That's why we believe community health centers are the core answer to equitable distribution of vaccines and equitable to health care.

We need that and we need the communities and leadership of the City of Seattle to really hold accountable government and how it does this level of distribution.

And audits, I believe, calling for what's happening on a weekly basis and so that we also are at the same table dealing with the strategic development is going to be important.

Thank you.

Thank you, Jesus, for for that presentation.

Really appreciate it.

And I know this theme is already developing.

I suspect we're going to hear more of it from the rest of the panel about how important community health centers are to to the strategies around equitable vaccination and someone who.

is a product of the Yakima Valley farm workers.

I can attest to the fact of how important those community health centers are, not just to accessing healthcare on the preventative side and also just on the treatment side.

It's also places where people in our community go to to get information about things unrelated to direct healthcare provision.

And so I'm certainly, I know I'm in good company on this perspective, but I'm certainly a huge believer in the power of community health centers and how they are the infrastructure in our communities to deliver these services and to be trusted messengers around why getting the vaccine is important.

and in centering strategies of how to effectively prioritize the hardest hit communities.

So thank you, Jesus, for your work and for being with us today and sharing those experiences.

Okay, we're gonna shift really quickly over to Dr. Danielson.

And then after Dr. Danielson, we're gonna hear from Gigi Ann Trang.

Dr. Danielson, welcome.

Thank you.

And I feel a sense of wanting to make sure that all voices have a chance to be heard in this.

And I think that there's just a sensitivity to time.

So I'll just try to build on ideas that might be worth mentioning, but not repeat too many of the things that have been said.

I caution about that because I don't want you to lose the sense of the emphasis that have been in some of these most important messages, however.

I want to say that in the ways that we hear messages from black African American and African immigrant communities in this area, the issue of trust takes on different layers and different levels.

And I have to look at all of this from a broader holistic historic perspective.

If we are not taking into account the history of Tuskegee, Henrietta Lacks, and the other experiences that have made for the reason that trust is so not present in Black communities, then we're just going to sit in moments trying to solve crisis problems without actually creating solutions.

And this is what we're seeing, right?

The same issues that have come up around testing and PPE distribution and other approaches are just being repeated and repeated, Justice Councilmember.

Morales, I believe, mentioned.

The conversation has to step up and above this current crisis of issue around vaccination or else all of us are going to get tired coming back and talking about this over and over again in the same way.

I wonder how we can change conversations because I'm also disappointed by watching public health and other entities think that in the black community, there is a need to educate us about why the vaccinations are important.

Rather than acknowledging that what has happened is that the health system, my health system, has not earned the trust of the community that it's supposed to be serving.

That our health care system is unworthy of being trusted, and that is a fact, and it is well grounded.

So rather than being uninformed, our communities are highly informed.

highly historically informed, highly informed by the present, highly informed by the experiences that are so relevant to this situation, we cannot We cannot try to pretend that some health education process is important in the area of trust.

Trust is significant in so many parts of the Black community for just a good reason.

You see partial data show you things like 35% of African-Americans in this country are pretty wary of vaccination.

You see the results from the CDC study through January that was, again, not full information, but showed that African Americans, Blacks, are three times less likely to have been in this first round of vaccinations up through the 12 million that were given in January.

These are undeniable issues about trustworthiness, not about information.

The process that we need to think about, I hope, is around how to really tap into broader areas of trustworthy spaces.

And I guess my question to this council having not seen the proposed language, is how can we start to be very clear about what power we are transferring to communities?

How can we create language in our resolutions, in our legislative processes that say very clearly how power is transferred and whether that is adequate?

I hear statements about Wanting to be at tables, I'm so sick of being at tables where the game is already set and you're just there representationally.

We talk about having a voice in processes.

That is not equity.

True, bold equity is actually us naming the processes ourselves.

When do we start actually making that the intention rather than the begged for exception or the possible occasion?

What I really feel like we need to start practicing is a bolder kind of true equity that is really accountable.

And I really appreciate.

language of everyone, Esther, Abigail, Teresita, my soul sisters in really promoting this kind of talk.

I beg you once again, name the power that you are shifting to communities most impacted when you make any decisions that impact the communities that are most at risk for the worst outcomes from illnesses like this.

I think that there are many ways for communities to name their own path and course in this.

The community clinics like Odessa Brown Children's Clinic in the central area, Carolyn Downs Clinic that have served Black communities for five decades are important resources.

I also think that we need to tap into the community health boards from the Somali health board to the African American health board and the other health boards that have direct relevance to the families and communities most impacted.

We have to start thinking about this in a very, very different way.

What we learn In our experiences working, especially in the Northwest, is that these days the appearance of equity has been the biggest barrier to equity actually happening in our systems, especially in healthcare.

No more representational equity.

No more statements about equity.

Name the ways in which you are shifting power and show us and be accountable to us for those shifts.

Thank you, Dr. Danielson.

Council Member Morales, I see your hand is raised.

Go ahead.

Yeah, thank you.

This is a fantastic question, Dr. Janssen.

What is the power we're shifting?

So I can speak for myself.

In some other work that we're doing as a council, we're shifting budgeting power, right?

We have this process that we're set up.

We have set up, we are setting up, to give community decision-making power about how we're going to spend some money as it relates to community safety.

In this context, what kind of power sharing or shift do we need to be thinking about to make sure that community is able to not just be sitting at a table, but actually being part of naming the power that they need and want and facilitating, how do we facilitate that transfer of power?

Who wants to take that one?

Esther, you wanna, you have thoughts about that?

Go for it.

I do.

I don't want to jump ahead of Ben, though.

It looks like he's frozen.

Oh, yeah.

OK.

I was wondering.

I was like, he's sitting very still.

So I don't know if he was being pensive or he actually froze on us.

Dr. Danielson, are you still with us?

We may have temporarily lost him.

So hopefully he'll sign back in.

And while that technological glitch is being worked through, happy to hear from you, Esther.

Yeah, thank you.

So I agree.

Dr. Danielson said, you know, we're so tired of being at these tables, but nothing actually happens.

I can't even tell you how many task forces and committees I'm on saying the same thing over and over with the same like lack of outcomes.

But in order to transfer power, you have to transfer resources.

You know, Council Member Morales, I think about what would have happened if community health centers would have had equitable distribution of the vaccines, would have received low temperature freezers instead of depending upon hospital systems because they're already equipped with that, right?

And would have received some funds to be able to man the call centers, would have received some funds to add staffing, right, to increase capacity.

And then your access to community is already built into what we do.

That is a good example related to COVID that we could have done differently, right?

And then each of us be able to implement our distribution plans that are most meaningful and most important to our communities.

That's a transfer power.

And it means that you can't have a county system duplicating efforts trying to reach our people and how do we do it better?

You have to give the resources over, you have to.

Thanks for that.

Okay.

I'm not seeing Dr. Danielson come back online yet.

Still very much frozen on the screen that I can see.

So any other thoughts on the question posed by Council Member Morales that any of our other panelists would like to share?

All right, I'm not seeing anything else.

Thank you for that.

Really appreciate it.

Let's go ahead and hear now from Gigi.

Hello, thank you.

My name is Gigi Jolly.

I'm a Marshallese from the Marshallese Women's Association.

I am very thankful that I'm in this space to be sharing and talking about distribution of the vaccine to our community.

Although we appreciate the efforts of the, you know, the mass vaccination for our community hasn't been successful as we hoped.

The process is lengthy and there's a lot of confusion.

I have been here maybe 20 plus years, 30, and I still have a hard time trying to click here, click there.

and all that kind of stuff.

You know, we have is for our older people, our seniors, and they don't understand, you know, these technology, you know, they don't understand it.

They don't understand the language.

And so as community people, not an expert in all of that, but we try to break it down, you know, and then send it out there, you know, for our folks and say, go here.

But by that time, um, there's no more vaccination left.

It's full.

You know, so those are just, you know, a few things of it, but as the Pacific Islander, you know, the PICA, they had a, you know, a vaccination that they were, you know, they got donated, which was, we had 150 people that were vaccinated in the PICA organization, Marshallese Women, PICA, you know, they were all, gathering for Pacific Islanders to get our people go get vaccinated.

Let me tell you, our people, I have to say, you know, even though we were calling them and explaining, come over here, give me your name and your number and all that, and PICO was, you know, registering them.

So simple, you know, as doing that.

But there was, you know, folks that were, wait a minute, where is this at?

Are you guys going to be there?

Because our people have some mistrust with the U.S. government, I have to say, just like everybody else.

But our older folks, they don't really go out there in the community.

They stick with their own people, if you may say.

Families all the time, churches with their own culture.

So to understand this, if one of their family members are not you know, registering for them, they got lost in this system.

But the way that PICA, the Pacific Island community, put it together, it was great.

We were so happy that, you know, there was numbers of the 150 people that, the Pacific Islanders that got vaccinated.

You know, up to the day that there's people canceling at the last moment, You know, because like I said, there's trust and all that, but after the day we had people calling in to say, when is the next one?

I mean, for, I think for our community is very important.

It's very like, okay, we can, you know, you want to get tested?

Yes.

We want to get tested.

I mean, vaccinated, but you know, how can we do it?

You know, this mass vaccination places, It's really difficult to navigate through.

With our people, like I said, there's a lot of trust with vaccination.

With our people in 1996, when they kind of like forgot or something that they did not bring back healthcare, to our people.

And we've been navigating for decades trying to get, you know, medical.

For our people, you know, when the 67 bombs was tested on our islands, you know, okay, America says come to America and you can be qualified for all these, you know, stuff, but you cannot vote.

But as people are starting to come because they have cancer, they have all the underlying issues, underlying health issues, you know, they're turned away or they're, oh, you know, you cannot, you're not eligible.

So a lot of our folks have passed away because, you know, all this stuff that has happened in the history.

But, you know, as they're trying to navigate the health system, they don't trust the health system because, oh, They said we're this, they'd say we're qualified or not qualified.

Different states, you know, we're lucky that Washington State has passed the COFA medical insurance, you know, since 19, I'm not sure, 19, 2018, I think, yeah, and the dental.

And wow, we can get, we were, a lot of our folks were, wow, we can get medical finally, have some preventative care finally.

You know, but as our people are coming in, they're going to places like Harborview for their charity because they're sick.

And so all these healthcare stuff is like a question, big question mark for our folks.

And when our folks were getting the high numbers and everything, you know, multi, multi-generational people that live together and not understanding the language and, you know, language barrier and everything.

I mean, as myself and organization, we're looking at how our people were, you know, struggling when this pandemic hit.

But we were grateful that we became an organization to address, you know, directly to our people, to let others know about what we go through of, you know, anything that's happening with our community.

Um, I think, um, I think, um, should distribute the vaccination vaccines to, um, you know, like community centers or something that we recognize, you know, we're familiar with faces familiar.

I had Marshallese folks call me to make sure that I was there at the vaccine space to help them and I helped interpret for, you know, some, but even with a Pacific Island thing that was there, there's still, you know, reserve, they still cancel at the last moment, you know, and all that.

But I'm just kind of glad.

I'm glad because there was some that were able to get vaccine, the vaccines.

And how do we keep building that trust with our community so they can get vaccine?

And with all these click here, click there, link there, link there, it's confusing.

I myself am confused.

And just imagine the language in there is not there for certain communities and for our people.

And so we help them, try to help them.

But like I said, there's issue with this vaccination distribution.

I agree with everybody else that You know, how can we really address our communities?

You know, how can we help them understand it?

You know, and all these spaces that I come into, I try to advocate for our people, you know, to let you know what is really going on with our community.

You know, so as a person that is in an organization trying to advocate for our community.

I'm in spaces more, you know, and I am, you know, there's language coming out, you know, as a cultural navigator with public health.

You know, I appreciate that because I'm in there and I get to get words or whatever I can get to address our community's issues.

But it just took a pandemic for the help that, you know, we're getting now.

It's kind of sad, like I said, you know, and it's the trust with our people, with their history that has all these barriers.

And so as residents of Washington, I think, you know, with the health care and with the medical, and now finally they passed the COFA medical for Medicaid to all you know, all the COFA people after all these years, but, you know, we're finally there, but, you know, I just wanted to share that exactly what is, you know, with our folks, there's the trust, you know, and knowing people that are there, they would go all these mass vaccination place, you know, at the PICA, when they were doing it, they had you know, people lined up, they had wheelchairs, the people that were sitting in their cars, you know, and restrooms open.

And, you know, those are the things that it just comforts our community, you know, of where we, we know what our, we know what we need to do with our community and respect our elders and how we take care of our elders, you know?

So I am thankful to be in this, space.

I have my mother, I have to say this, that is going to be 80 in May and she lives in another state.

She has not taken her first vaccine.

She can't get it anywhere.

She's been trying to, you know, get it with my siblings, but she hasn't gotten her first one, you know, trying to register and everything.

So, you know, I don't know what can be done or how can It could be better but I'm worried.

Should I bring her here to Washington to try to see if I can put her in anywhere here because she hasn't gotten any anything you know to be vaccine the first one.

So I just want to share that and I want to thank you again for having me in this space.

Thank you, Gigi, for sharing and for being with us today.

Our last panelist on this first panel is Trang.

And I do see that Council Member Juarez has her hand up, but I'm going to let Trang go first and then we'll take.

I don't got my hand up.

Oh, it's in the Zoom feature.

Sorry.

OK, sorry.

It's a holdover, girl.

No worries.

No worries.

Trang, go for it.

Thank you, Council President.

Thanks for the opportunity to speak as a community member today.

My name is Chang Tu, and I am the sole and primary caregiver for my elderly mother.

who lives with me and has advanced dementia requiring 24-hour care.

While I've often felt it couldn't get more challenging, COVID has made it more so.

So to keep her safe, I've strict quarantined us from the start, halted outside help, including from other family, and I've given up most of my work.

Above all, knowing that if she were infected, we would likely lose her has terrified me.

So I've known that the end game for her and the path to finding some relief would be in the vaccine.

But that path has come with many challenges, which many community members have had to mobilize and fight for.

From raising awareness that BIPOC and refugee and immigrant families are more likely to care for our elders at home in multigenerational households, with the added risks and burdens that that entails, to now, facing barriers and inequities in actually accessing vaccine.

To be clear, we know that supply is constrained everywhere.

The problem is that the impact of that hasn't been equal.

Those with technology, English fluency, time, transportation, and other resources have more easily accessed vaccines, while those without are often shut out, made worse by incidents of vaccine favoritism that we have seen.

For my mother and me, this has been challenging and we actually have some resources.

She has me and I speak English, have internet and a car, but I think about others, our friends and community members who don't.

I appreciate what our public leaders have done to advance equity, including the state prioritizing elders in home care and our county and city leaders doing targeted work to increase access, but so much more is needed.

Right now, the focus on speed and scale in delivery comes at the cost of sacrificing equity and fairness if there is not intentionality about hanging on to equity values.

Recognizing the role of the city council and other government partners here today, I would urge you to take the following actions to ensure that equity policies are actually reflected in practice.

So one, right now, level the playing field for those with the greatest barriers to access, including upgrading DOH's provider list to be a vaccine finder tool that has real-time updates, creating a centralized wait list of BIPOC individuals seeking vaccines, and urge or even mandate providers, especially the large healthcare systems, to use it, to prioritize it.

Clarify phase finder, either simplifying the language, as King County has done, or perhaps better, removing it and making this clear to the public.

Provide BIPOC serving organizations early access to signups at mass vaccination sites.

Partner with, fund, supply, and empower community-led vaccination work, as we have heard from other panelists today.

Collect race and ethnicity data of people who are vaccinated and use it to ensure equitable access throughout the rollout.

And then second, a little bit longer term, harvest the lessons and improve the system for next time.

Be proactive during planning.

Think through the specifics of how equity will be operationalized at every step and then institutionalize this so that when the next crisis comes, It's not this mad reactive scramble to build the equity plane and try to fly it at the same time.

And related to that, be thoughtful about community engagement as Dr. Danielson spoke to.

community members are asked to give input all the time, and it gets exhausting.

It's important that that input be used in service to system change, not to enable chronic system failure to execute on equity.

My hope is that equity will become so ingrained in the DNA of the work that there will be no trade-off between speed and fairness, that they're simply part and parcel of everyone being served equitably.

Thank you.

Thank you, Trang, for that testimony.

Really, really powerful, really important points that you've made there.

Okay, colleagues, any other questions or comments for our panelists here?

Council Member Mosqueda, please.

Thank you again to everybody who has presented today.

And I'm struck by sort of the historic legacy of underfunding and under-resourced inequities that we've seen in our communities for centuries and decades that people have mentioned today.

I think that it also I feel like we should also sort of talk about how public health as a entity has also been sort of under resourced historically as well.

And I'm wondering if there's some like legacy work that we maybe should do in that respect, you know, public health, our healthy water systems, and making sure that we have access to clean air and healthy food, all of these sort of things that you don't see on a daily basis.

They've just been underfunded decade after decade.

And working in public health, you all have sort of stepped into a role that has been largely like decentralized and created more and more of a skeleton of what should be the backbone to what creates healthy communities.

And I'm just wondering if there's also some parallels that we should also be lifting up about how we invest in public health and demand more equity and accountability in doing so.

but recognizing that our country has also stepped away from traditional public health and how that's compounding the crisis that we see now.

And as Dr. Danielson talked about, and many of you also talked about, the institutional racism that we see within our own health systems is only compounded by a lack of investment in our frontline community health centers, those who are providing services directly in our communities, and the fact that public health has been sort of dismantled over time, I feel like it was intentional as well.

in some regards.

So I'm just wondering if folks have had a chance to think about that and any thoughts you have about that as we think about how to demand more resources and getting that to the ground would be helpful.

Abigail, I see you take yourself off of video, so I'm sure you have some eloquent thoughts about this, but I'm struggling with that, you know, historic disinvestment, prioritization and decentralization of public health as well in all of this.

Yeah, thank you.

It's a beautiful question and a necessary one, and especially understanding that the reason we weren't prepared for a pandemic was because of the chronic underfunding of the public health systems.

And as a result of that, even though folks like myself have been doing this for more than 20 years, and I see some folks on the calls who've been doing the same, we've been saying something's going to happen if you don't fund us correctly.

and it happened.

We're really fortunate in Washington State because unlike many other states, very recently there was an investment in foundational public health dollars at the Washington State level.

As a result of that, and part of that going to the urban Indian programs, tribal epidemiology centers, my team and I have been providing support to seven urban Indian programs, including four in King County and several others in Spokane County, where they get updates on at least a bi-weekly if not monthly update on COVID-19 in their communities, looking at the most recent data and information for them to inform both their programs.

and their policies and their advocacy.

And so what if that existed for all the other community health centers that we're talking to?

They probably don't have the same access because I'm only serving the urban Indian programs.

And that's not a lot of money.

It was $250,000 that I'm getting from the state of Washington.

So even though we passed and saw that investment pass at the state level, it still wasn't nearly enough.

And until we allocate the proper resources to revamp, to restore, and to build out public health systems that, like Council Member Juarez said, mirror indigenous communities, I feel, then we're not going to see success.

And in the next pandemic, we're going to experience the same thing.

And we have to recognize there will be another one.

This isn't a one and done kind of thing.

There will be other instances like that.

And when I say like indigenous communities is that when we say public health, it often comes from a Western concept of, you know, Western civilization created public health.

No.

The reason 74% of native people are making the decision to get vaccinated based on the responsibilities of family, community and tribe is because that is what public health is about seeing your individual responsibilities contribute to the whole of a community.

That's what I wish every other community was doing because in Indian country, which we call the United States, native people are more likely to wear masks, to get vaccinated, to social distance, to self-quarantine.

Tribes, including in Washington state, were the very first to implement public health measures like that.

And so when we rebuild that value system and recognizing that it didn't start with Western public health, but started with the first peoples of this land and restore this idea of community, which has to have the investment of resources.

And so Washington state, was a little bit ahead, but we need much, much more if we're truly going to address all of these inequities.

Thank you.

OK.

Council Member Strauss, please.

Thank you, Council President, for bringing this panel together.

I don't want to take up too much time just to say thank you to everyone for presenting today.

I've been taking notes as you've been speaking.

And you've got some great leaders here.

I would like to say thank you to all of the councilmembers who put this panel together.

If there is anything I can do to help support you, please don't hesitate to reach out to me.

Okay, friends, I think we are wrapping up with this portion of the agenda.

I do want to express my sincere gratitude to you, not just for being here, but for actually doing all the work that you continue to do in community.

So important, not just not just in and during a pandemic, but beyond that.

And as Council Member Mosqueda has astutely observed, the historic failures to adequately invest in the health and well-being of our community is coming to roost right now.

in the loss of lives for many of us to this pandemic as a result of that intentional failure to invest in healthcare systems that are designed by us and for us.

And I appreciate all of the work that you all are doing to continue to give voice to people whose voices aren't historically heard in these powerful systems.

and I know that there is much, much, much more work for us to do.

I'm excited to be able to not only receive additional feedback from council members on the resolution, but with your all's permission, would love an opportunity to share it with you all and have you take a look at what improvements and action items we can put in the resolution that will help us as a city make sure that we continue to be accountable to these equity goals and would love an opportunity to continue to engage with all of you offline to make sure that we have the most robust version of the resolution that we can possibly have for council's consideration next week.

Okay, folks, thank you so much for being with us.

You are, you're welcome to stay and listen to the next panel, but you're also, I know we've, we've had you here for a long time and I know you have important work to do outside of this call.

So you're welcome to, you're welcome to disconnect as well.

We're going to go ahead and transition to our second panel.

V, can you go ahead and read item two into the record?

Agenda item number two, vaccine distribution, government round table for briefing and discussion.

Thank you so much.

I know we are starting to lose some panelists here.

I am going to, instead of doing the round robin, I'm just going to sort of call on folks and have you introduce yourselves and then make your remarks.

I got a note that Matias from the Seattle King County Public Health is going to have to leave here shortly.

So hoping to get him in under the wire here.

Matias, if that's OK with you, would you mind making some comments at the top here.

Thank you.

Go ahead and introduce yourself and take it away.

All right.

Thank you, Council President Gonzalez.

I'm Matias Valenzuela.

I'm the Director of Community Partnerships and Equity for Public Health, Salekin County.

And as I listen, I just need to, before I say my comments, just acknowledge the power and the truth and the community voices that were just stated.

I just think those voices plus data, the disaggregated data should really be driving our public health approach around this, plus the learnings.

I think I heard a lot about things happening all over again, and I also just will ditto that, that I think when we learn things, and even already we've learned things from testing, we need to be able to not replicate those same missteps that had happened earlier in the pandemic.

So in King County's approach to vaccination, these are some things that we control and are running, or other times it's the partners or the healthcare systems.

There is work happening, of course, to the healthcare system, pharmacies, employer-based.

Our efforts are more mass vaccination sites and then pop-up sites and mobile vaccinations, which meet people where they're at.

I think it's been really critical, and we've been hearing the same thing through our channels, about the pop-up and mobile vaccinations.

And meeting people even in their home is where it's gonna actually be the most powerful, especially when you have systems that have created distrust among populations, asking them to go to places.

And right now for the 65 or 75 and over populations with the challenges with transportation and those kinds of things, people wanna go where they're gonna feel welcomed.

And we don't necessarily wanna be re-traumatizing folks.

In COVID-19, the area I've been leading is around community mitigation and recovery.

It's really around the non-pharmaceutical interventions, everything to providing guidance for businesses and others around physical distancing and mask wearing and those kinds of things.

Now, our main focus of work is vaccination.

We have multiple teams and we're working with schools and childcare and small businesses, older adults, immigrant communities, CBOs, faith-based organizations, And we are regularly sharing through our large networks information, guidance, webinars, conferences.

This last week, we had an interfaith conference with about 100 participants focused on vaccines in which we really listened to community and also provided answers and addressed some of the concerns that existed.

We also continue to translate into up to 33 languages.

Really for now as we move into vaccine and distribution and the efforts, we really are trying to provide information so people at the end make the decision that they feel is best.

We have a group focusing on BIPOC communities where we have developed work groups.

We know that you can't have a one size fits all approach.

So for example, we have a group focusing on the black community and there have been listening sessions.

We actually use the flu vaccination as an opportunity to learn and build on some of those activities.

These are led by some of our black employees and community partners as well.

And now we are working around potential pop-up clinics as more vaccine becomes available.

We also have a pandemic and racism community advisory group.

It's about four organizations from different sectors, including business, but half of those are from community We've had the pleasure of also having Esther be part of that group.

And that's really a group that guides our decisions and our policies, even as we roll things out or talk about our priorities or how things should look.

We work with that group to provide input to us.

We also started, this is something we didn't have.

I know the city of Seattle has their community liaisons.

We built a community navigator program with about 30 community navigators working across communities, those most impacted.

Working, for example, very closely with GG on this call and the Pacific Islander Health Board and with different groups.

There we've been granting funds to community as well and to leaders.

The last part of this was 46 grants for $10,000 to fund community organizations, knowing that they're the ones that really are trusted and are going to be the ones to be the messengers and the listeners and really be able to work with community.

The one slide that I have here is just on the guiding principles around equity and vaccine delivery.

We have already started our own two mass vaccination sites, but one of the key things in South King County, one of the key things that we are doing too is actually creating public private partnerships.

And I know folks are very aware of some of the situations in which it's happening, which some providers, for example, offered preferential treatment to some groups and some populations and some other clients.

So as we go into these, we wanna make sure that the principles that we are following and our commitment to racism as a public health crisis is not just a public health commitment, but also by the healthcare sector and hospitals And some of the big businesses we've been approached, I think, like others like the state and the city of Seattle by some big businesses that want to work with us.

But we all we want to do that.

And we want to have those public private partnerships that we need them to also be on board with us around these principles that we have here, especially beginning by acknowledging the disproportionate impacts that we've seen by race here in our region and nationally.

And it's around things like removing barriers that deter access, as you see there.

I think importantly, and I think it was Dr. Danielson that talked about this, is really how do we frame this so it's not around blaming the individual and actually addressing the distrust that has been created by the past practices.

The number two there is around creating an inclusive process.

So really working and also importantly resourcing community early, continuously and meaningfully.

Our commitment to BIPOC communities and anti-racist work.

And part of this too is the data and how do we continue to use the data to drive our decisions and where we have our pop-up clinics and where we put our efforts.

And continuously showing this.

We now have a dashboard which we show how we are doing by age, by geography, and importantly by race and continuing to kind of highlight and using that to send to really guide how we're doing this.

In terms of the principles and actions, these are just very concrete steps, best practices, things that we know that work.

So, for example, working with communities on some of the pop-up clinics or mass vaccination, one of the things that we have been able to do here, too, is we've given, for example, our community navigators advance notice, and they have had an ability to pre-register folks.

So, opening something up so everybody registers at the same time, we know that's a challenge.

Or how do we actually, when we do it, open it to particular zip codes where we know there have been challenges.

or higher impacts in terms of COVID-19.

So continuing to work with community, that's that second bullet there, and supporting the work that we continue to do with our community navigators or pandemic advisory group.

I think registration is a big issue right now.

We are working to a model in which you actually have a phone center that can provide complete service.

I mean, for, and we just heard, for example, Gigi talking about the challenges of getting an elderly individuals signed up and then getting the transportation and all those kinds of things.

So we need to address the digital wide issues for people with disabilities and all those challenges.

And we know, for example, having a full service phone center, which we're trying to work on now to set that up, is going to be as we open it up to more individuals, we need to reduce those barriers.

Also making it accessible when people needed and when they're available, so evenings and weekends, addressing transportation mobility issues, and continuing to do the language access and translation and interpretation at the sites as well.

So that's it for me, and thanks for inviting me to this, and I really enjoyed the conversation, and I think there is a true commitment in terms of listening to what the groups here have been saying and continue to work with everybody.

So, because we know this is the most significant, I think, public health challenge that we've had in the last century.

And we can't continue to perpetuate the outcomes that we've been seeing.

So thank you.

Thank you for being with us and for that presentation.

I know you are running a little late to another commitment that you had at four o'clock.

So I appreciate you hanging in to to to walk us through this information.

Colleagues, if it's okay, Matias, if there's one or two questions from my colleagues and you have just a few minutes to take those, I'd appreciate it.

Great.

Colleagues, any questions or comments for Matias?

I'm not seeing any hands raised.

Okay, well, Matias, thank you so much.

Really appreciate you being with us.

Really appreciate you, your continuing willingness to sit here with open mind on listening to some of these community voices.

There was some, I would say, criticism of how our community partners on the line here today are feeling like the relationship is going with public, health right now and would be very much interested in continuing to have conversations as a partner in this area to try to make sure that we are resolving through action some of those concerns that we heard expressed here in this committee hearing today and that I know they've been expressing in other venues as well.

So look forward to those ongoing conversations.

So do I.

Thank you very much.

Council Member Mosqueda, did you want to say something now?

That's okay.

I feel like you can read my mind through the Zoom.

Thank you for calling.

I spend enough time.

Thank you, Council President.

You know, I did want to just say thanks to Matias and the team at Public Health.

We have had a chance to talk recently, and I know that the folks from our Seattle delegation who worked on census outreach are also listening into this presentation today.

Knowing that many of the organizations that have presented this morning are also part of our communities that we're trying to do everything they could to get information out to folks about census.

We have these built in networks and as the folks from ICHS and CMAR.

And others have said that the FQHCs are our built-in public health safety net, and wanting to make sure that we honor both the trust that they have already built in community and the ask that many of us in government have put out to them in the past to be part of our ambassadors and to carry messages to community.

I think that one of the things that really resonated with me today was that this is not about educating people as to why the vaccines are important.

This is recognizing why folks are hesitant of public health or, you know, and government generally.

and really trying to meet them there.

I know you put out some important information listening to what Abigail said about the work that she has done and others have done to translate the information to make it into like what really resonates with folks.

I think was a really salient point from this morning's conversation.

So I just wanted to lift that piece up because I know you spent a lot of time working on materials and really how we pull folks together going forward.

I just, again, don't want to interrupt any of the conversations you all are having about vaccine distribution, because I think that's the most important thing folks lifted up today.

But as we deal with the lack of vaccines, recognizing outreach and education and engagement and meeting folks where they're at with the knowledge and expertise that these folks have already in community and trying to pull that in more was a helpful reorientation for us to hear this morning, at least it was for me.

So I just look forward to having future conversations with you about that outreach and engagement lane and really pulling in what was discussed this morning.

And thanks again for your work on that on behalf of King County and looking forward to doing more with you all at the city level as well.

Thank you so much.

I did too.

Great, thank you so much.

Again, Matias, I know you have to run, so thank you for being with us a little bit longer.

Really appreciate it.

We're going to move over now to Stephanie King, who is with us from Congresswoman Pramila Jayapal's.

office, and we're going to hear from Stephanie here really quickly around the federal perspective, and then after Stephanie, we'll hear from Paj, Katie, and Blair, and then we'll round out our conversation with Ku and Joaquin.

We have, because we've gone a little bit long, I do think it was important to create as much space as possible for the community voice aspects of the agenda today, so I do apologize in advance to our friends over at OIRA on the last agenda item three, excuse me, last agenda item on today's agenda.

We're not gonna be able to get to the report out of OIRA, but we promise to have you back and hear that really important conversation.

So for now, let's hear from Stephanie and then we will shift over to the Department of Health and we will conclude with Director Vu and Joaquin.

Stephanie, welcome.

Hi, everyone.

Thanks for convening this.

I was talking with Vy last night and I told her that I could tell that a lot of intentionality was put into who you brought to this conversation and the perspectives.

And so I really appreciate it.

It's just such a critical conversation to have right now.

And I think, you know, we're seeing headline after headline around vaccine equity.

But I think what's been made really clear today is, you know, we're tired of rhetoric.

What really can be done right now and what also do we need to reckon with for the future?

So, hi, everyone.

I'm Stephanie Kang.

I am the health policy director for Congresswoman Pramila Jayapal of Washington 7th.

I have my doctorate in public health as well as my master's in global health.

And so really coming from this public health lens and policy lens of when it comes to vaccine distribution.

And just wanted to give a little bit of updates from what's happening specifically within our office.

And then just share a little bit of a commentary to what our approach and thought process has been specifically around the vaccine distribution.

And so, first, I just wanted to flag that this week we'll be sending out a letter to HHS in conjunction with Congresswoman DelBene.

And this is really around, you know, those egregious stories we have seen happening in hospitals in the Puget Sound area around hospitals allowing special access, you know, special invitations to board members, donors to access the vaccine early.

And, you know, we just I know that the Department of Health already put out, you know, some guidelines and an explicit ban on special access, but this doesn't exist on the federal level.

And so this letter will be to the HHS, to the Health and Human Services to direct the CDC to put an explicit ban on special access on their provider requirements, as well as it being incorporated into the provider agreement.

And so really, you know, it was very sad, but not actually terribly surprising that, you know, when we were doing this letter, we were curious, you know, how common was this story?

How often is it happening?

And with a very quick Google search found, you know, incidents very similar than what happened in Washington State and New Jersey.

in other states across the country.

And so we'll be putting this letter out on Friday and hopefully we'll be having, I would expect a lot of support from across the Washington delegation and as well as the Democratic Party around really making it clear that these types of practices are just simply not acceptable, that they absolutely interfere with the already poor results we're achieving in terms of equity and vaccine distribution.

And really just making it clear that the HHS and CDC need to provide more accountability mechanisms for how are they monitoring and tracking these types of distribution mechanisms and what are they doing to ensure that these uh, incidents don't happen again.

Um, and what will they do also to remediate what happened, right?

So we can't just say, fine, it happened.

No.

Now we need to also have some more accountability for that.

And so just wanted to flag that letter.

Um, but you know, in terms of just really thinking through a vaccine distribution, um, as a whole, You know, as so many people have already commented, it's a complicated topic.

It requires the collaboration and intentionality across the entire public health system, healthcare system.

And as we know, in the US, our health system is incredibly fragmented.

It's incredibly disjointed in terms of both financing, in terms of delivery, in terms of administration.

And so, I think for our office, we've been thinking a lot of, well, if you're trying to build out a public health response, let alone a vaccine system in conjunction or in parallel to a system that is already so fragmented and inequitable, Can you really expect then that the vaccine delivery itself will be equitable?

I'm sure as many of you know, the Congresswoman is the lead sponsor of Medicare for All in the House.

And just to be very, very clear, no one in our office or anyone thinks that Medicare for all would have solved all of the issues in terms of inequity that we've seen both in terms of COVID testing and treatment that we're already seeing disproportionately impacting our black and brown communities.

But we absolutely believe that it's a foundational aspect and a huge contributor as to also why we're seeing this huge inequity arise.

And so just thinking through, I mean, In the past, we've seen, for example, for the flu vaccine, if you have an insured population, you're gonna have significantly more people.

In 2018, 40% of vaccine people, people, sorry, 40% of insured people got the flu vaccine, while only 16% of uninsured adults did.

And so those inequities existed previously, and now what we're seeing in COVID is so much higher.

where 12% of the population is Black and 18.5% are Latinx, and yet only 5.4% of vaccines have gone to Black individuals and 11.5% to Latinx individuals, even though these demographics are being hit especially hard throughout the pandemic.

And as we know, uninsured adults have a greater exposure to COVID-19 than people who are insured because they tend to work in jobs that have a greater exposure.

They are essential workers.

And so, you know, we've really just been thinking about this from a coverage standpoint because, sadly, what we realized was that, you know, of course, the U.S. does not have a national program.

to cover vaccination costs for uninsured individuals.

And again, I just want to make it really clear.

I'm only talking from a coverage perspective.

There are so many other aspects that impact someone's ability.

And people have talked about this, whether it's community mistrust, whether it's communications, whether it's geographical distance, et cetera.

But from a coverage and financing perspective, there's really the only The only safety net that the uninsured population have right now that is federally funded is through the Provider Relief Fund.

So this is something that was funded throughout the CARES Act and basically providers are able to be reimbursed on COVID-19?

And I'll also note, because this is the only program that reimburses doctors, in order to incentivize doctors to take on patients who are not insured, they're allowed to charge a small administrative fee.

And, you know, study after study will tell you even if the fee is small, that will absolutely reduce uptake of the vaccine amongst populations that are already, you know, more exposed to the infection.

And so, you know, if providers are only ability to, only incentive to provide the vaccine to the uninsured population is through this very limited program that reimburses them, I mean, right there is just a huge inequity issue in terms of coverage.

And so, I mean, we're doing as much as we can.

You guys may know that right now the House is pushing through the COVID-19 package.

It's very closely aligned with what President Biden had put out for his American Rescue Plan.

It's a $1.9 trillion package.

There is some expansion of coverage for the uninsured.

There is some other key stimulus pieces that the Congresswoman has led on, specifically on $15 minimum wage and also making sure that we're not hiring the threshold for stimulus checks.

But all this to say is we're still far, far from what is needed.

And I think what we hope is if we're really going to be talking about equity in Congress, do we mean it?

Are we actually going to upheld those principles and the way that we approach vaccine financing and distribution?

Or are we just going to continue with Band-Aid solutions and just filling in the gaps where we can and just leaving the most marginalized, you know, basically with with not a lot of help?

And so, you know, the congresswoman, I hope you all know, is it just a very is a very active and strong champion right now.

on all of these issues and is fighting as much as she can to ensure that these issues are being addressed.

And so I think that's mostly what I'd like to say.

I think I just also wanted to comment on what Dr. Ben Danielson said, you know, about really around being past just bringing people to the table.

We're in close communications with Jeffrey Zients, who is the coordinator for President Biden in terms of the COVID response.

We're trying to make this extremely clear to everyone who will listen that just any vaccine strategy plan needs to absolutely rise to the occasion for now.

We understand that it's going to take a lot to provide coverage for people immediately at this minute.

So there are gaps that we need to fill in this moment, and there are immediate actions to take.

But there really is this deep reckoning, and it's been discussed in this call, this deep reckoning that has to happen with how did we end up here in the first place?

How did this gap become so wide?

And how do we make sure it doesn't happen in the future?

And so, yeah, that's it.

Thank you, Stephanie.

Thank you for being with us and for sharing that perspective from Congressman Jayapal's office.

Really excited to hear about this letter.

And if there's anything that we can do as a council to be supportive of her efforts in the Seattle Delegations efforts around these issues, we certainly would be happy to talk to our own federal lobbyists around making sure that we are weighing in as a city on some of these issues.

I see that Council Member Mosqueda has a comment or question, please.

Thank you so much.

I hope you can hear me okay.

There's some background noise out there.

It is so great to see you.

Thank you, everything.

Please pass on our appreciation to the Congresswoman, obviously a huge champion for equity, health, justice, and health care for all.

Appreciate that.

One thing that we have been hearing on the budget side of things is that many cities are being potentially penalized for sort of acting early and acting with, I think, the urgency and integrity that we needed to respond to COVID.

Now it sounds like some of the interpretation from some of the federal administration officials is that federal dollars, FEMA, some CARES Act dollars, if we're using it towards some of our COVID relief now that we've already paid for in our budgets, it will be seen as supplantation.

So couldn't miss this opportunity to put a note out there to our delegation that I've talked to the Office of Intergovernmental Relations, our AWC, Association of Washington Cities Partners, and NLC, National League of Cities folks.

I know many cities are probably in the same position.

It would have been irresponsible for us not to have acted.

And so any sort of digging that you can help with to make sure that on the health-related front where we've stepped in and provided this critical assistance, we are not sort of penalized or dinged for now being asked to use federal dollars, and obviously there's not enough money to go around for the type of needs that we have, but would love to work with you on that, especially as it relates to the incredible work our firefighters and public health folks have done in partnership to get COVID testing out the door and some of our initial vaccination efforts.

So I look forward to working with you.

I just wanted to raise my concerns about that, wearing a budget role.

Yeah, thank you so much.

And just to quickly comment on that, the congressman actually had a roundtable with, I believe, the seven city mayors that are in her district.

And they, I think, touched on this issue exactly what you had said, both from a many city perspective and also the medium-sized cities are just both being sort of left out and not being considered when it comes to these calculations.

And so I don't know if you're already in touch with our outreach coordinator, but Lavanya, she'll absolutely take on those comments, and we should continue this conversation.

Yeah.

Great.

Good flag, Council Member Mosqueda, on that.

Glad we were able to Get that on the table.

Okay, colleagues, any other questions for Stephanie?

Otherwise, we're gonna move over to our Department of Health partners here.

All right, looks like we're ready to hear from our folks over at Department of Health.

So I'll hand it over to you.

I think, Paj, I see you come off mute.

So maybe you're gonna lead us here first, but I'll leave it to you all to walk us through.

Thank you, Council President Gonzalez and Council Members.

It's nice to see many of you.

I think our paths have crossed in the past before, and I'm really grateful to be part of this conversation today.

I also want to acknowledge our community leaders that I personally have relationships with, that I respect, admire, and have learned a lot from.

So it's really nice to have such stellar powerful community leaders really teach us being the state and county governments on how to actually lead with equity instead of just paying lip service to it.

So I want to first acknowledge that.

And second, it's just Blair Hainwall and I today.

Katie had to go to another meeting.

But we will quickly go through some slides around allocation and just some of our process for allocation, and I'll quickly end with our commitment to equity and engagement and what we're actually doing.

So we're really talking about the action side of the house and not just about what is it that we've been preaching.

Great, thanks.

Claire Hanawalt, thank you.

I'm just going to quickly echo Pajan's saying, really appreciate you all engaging us in this conversation.

It's super important and is so valuable to hear the perspectives of all our community leaders.

And there is no doubt we have been learning from you all and trying to apply some of your best practices, as I hope you'll hear.

So thank you for the work that you all are doing.

You all asked us to just walk through a little bit of current state of allocation and distribution challenges and current strategies.

So that's what I will try to tackle and do slides.

I don't know who owns the slides.

Next slide.

V, my office is running the slides, so if you want her to switch, just say next slide, and she'll pull it up for you.

Thank you.

And just to say, obviously, equity has been infused throughout many parts of the Department of Health's COVID response with vaccines.

Through our guidance work, through allocation, distribution, information, education, communication, and more, and so will continue to be.

And I'm just going to focus on allocation right now.

This is what I've listed here are the factors that we use for allocation of vaccine and just to help sort of problem solve around how to get past this gnarly problem that we have.

So when we're looking at how to allocate vaccines, consider a number of different factors.

And what's not also on this list, which is we start with consultations with our local health jurisdictions in terms of understanding what they're seeing on the ground and what they're saying.

Are there priorities based upon complications with their own community, priority efforts that they're pursuing, et cetera?

And in addition, when we think about these other factors in terms of population and allocating proportional size based upon eligible populations that phase that year, we also take into consideration equity.

So we look at social vulnerability index as a combination of factors, socioeconomic, um language access issues and apply those when it comes to allocating both the counties as well as to providers themselves in terms of where they're located.

And then we have to think about distribution channels and we have to think about what are the best modalities or channels in order to reach the eligible populations.

So there's a lot of folks right now in the eligible group are homebound individuals.

We have to think about how do we actually allocate vaccine to outreach efforts that can reach those homebound individuals.

You already heard about Matthias talking about pop-up sites.

So again, other strategies that are necessary, depending upon the group that we're trying to meet.

I'll come back to this.

And there's an issue around implementation.

So Moderna and Pfizer, two different vaccines.

You have to have certain cold chain requirements to be able to manage Pfizer in particular.

And we try to minimize the brand changes for providers.

It's difficult if you're constantly getting two different vaccines.

In addition, we think about inventory, and you heard from, like, she's a great example of a group who asked what they need and they drew their vaccines and within the week, and that's a high inventory turnover, and we're looking for the providers who are actually pursuing that consistently.

And then we think about second doses.

The second doses automatically sent three or four weeks, depending upon the brand from the federal government.

What we're seeing, which is, sometimes individuals are actually seeking their second dose somewhere else and that then changes kind of the inventory requirements for different providers.

So that's requiring us to actually be operating a little bit more on the fly in terms of trying to allocate our second doses.

There's other considerations that we'd love to consider but they're really not actually pertinent at this point in terms of only allocating those who are reliably reporting to the IAS.

If we did that, we're afraid that we'd actually lose some very valuable community-based players.

And so instead, we have sort of a grace period that we're allowing them until they're able to have that functionality, just as an example.

And I'll leave it up there.

So key challenges, you've all heard the key one, which is around scarcity of vaccine.

And just to bring that to life, Last week we got from 600 providers requests of about 358,000 first doses.

And we only got from the federal government 107,000 first doses.

So we could only actually try to actually fulfill a third of those requests.

You know, so Jesus talked about It's a perfect example of a provider who could do more if they had more vaccine, and we sadly just do not have enough.

The other challenge, which is not all the same vaccine.

So Pfizer comes in orders of 975 doses per order, whereas Moderna comes in 100. So Pfizer and Pfizer requires this cold chain requirement.

So we can only send Pfizer two sites that have adequate capacity to manage those cold chain requirements and get through those volumes in time.

If we had more providers to be able to kind of split those or manage those in different ways, and I think that's something that is creative problem-solving and why you see sometimes public health in King County able to send things to other players, is people are managing those inventories of those two different products in different ways.

requiring us to get creative about that.

The other challenge, which is information, and it was cited by Abigail and others, we don't have all the information we would love in terms of transfers, first and second administration, as well as inventory.

We don't have it from all the providers sometimes to be able to actually respond as effectively as we would like.

So strategies we're pursuing.

We're really looking at where some of those high social vulnerability index areas we may not have as many providers that we would like.

And we're being more proactive in trying to actually prioritize getting some of them enrolled so that we have them ready to go when we do have more vaccine.

And in addition, we're prioritizing supporting some of these providers that are reaching out to high vulnerable groups in terms of information support and reporting support.

so that they can be providing us the necessary information and perhaps using a platform like PrepMod, which actually makes it easier in terms of data entry.

So those are some examples.

And next slide.

This slide is just trying to introduce the idea that we're in moments of time with this COVID response.

So with each phase of group, There's a new strategy that we have to think about in terms of distribution.

So we're living in a world right now of this Phase 1B, Tier 1. When we were in Phase 1A, our distribution looked very different.

We allocated to different providers and partners.

In 1B, Tier 1, now we have a different set of partners that we're trying to engage and rebalance.

And this is going to continue in each one of the phases.

And I think, and I think it was trying, you said, you know, let's be intentional, let's think ahead.

So one of the things that we're trying to do, which is to think about what's next here of, um, ad workers, grocery, retail, childcare workers, what are going to be the best strategies to reach them?

And how do we start to look ahead and engage the right partners in terms of designing distribution strategies, outreach onsite, be they giving vouchers to child care workers or grocery retailers who then have a pre-booked scheduled appointment to certain places.

How can we think creatively about the new strategies to make sure that individuals actually get access to those individual sites?

Because I think, as, you know, President Jesus, everybody has mentioned, you know, it's not just about getting the supply.

It's also about how do you design the program in the most effective way to actually intentionally enable access pathways to the BIPOC community.

Over to you, Raj.

Thank you, Blair.

Next slide, please.

So I think I wanted to just end our conversation, at least from the state perspective, around some of our equity and engagement strategies that we have identified.

And in fact, this list continues to grow.

What I would like to do is actually introduce two new strategies that we've identified very recently as we've dived deeper into this work, specifically around our allocation and how do we integrate a pro-equity approach into vaccine allocation and distribution.

I heard a lot of comments earlier from our community leaders, and I think we are sort of moving into this phase where We really want to have some minimum requirements around race, ethnicity, data reporting, looking at language access services and ADA accessibility, making sure that we reserve appointments that can be filled directly by community partners and or via COVID-19 hotline, which will have language interpretation services available, partnering with trusted community organizations and leaders.

And then intentional and culturally responsive outreach to disproportionately impacted communities and also high social vulnerability index areas.

So an example of this would be people, we know that people are facing language, technology, and disability barriers to getting online appointments.

So what we're trying to do is with our MaxVax sites that are now online, we're starting to reserve appointments that are specifically for phone-based scheduling.

And for example, right now in Clark County, 20% of all appointments are now phone-based.

Similarly, we're also wanting to see how can we prioritize allocation to providers who effectively serve disproportionately impacted communities, and many of those providers were on the call today, and really applying that COVID-19 social vulnerability index mapping tool to align vaccine allocation and coverage with high SDI areas.

And we can identify providers in high SBI areas and prioritize them for enrollment through PrEP mod support and also sustained allocation.

I think it's really encouraging to hear that the Biden administration is going to allocate 1 million doses to community health centers or FQHCs across the nation.

And my hope is that that is a sustained effort as well because we know that it can just be that one once in a moment sort of an approach.

For some of the other strategies that are listed on the slide in front of you, the two that I just shared are newer strategies.

The first one, engaging communities to inform vaccine prioritization and planning.

We intentionally led a community engagement process in October to solicit feedback from over 18,000 individuals across the state of Washington.

And that actually helped inform our phases 1A and 1B.

In fact, BIPOC communities strongly shared the need to prioritize older adults and elders who cared for them at home.

So this feedback directly informed our inclusion of older adults in multigenerational households in phases 1B and Tier 1, just like Trang Tu mentioned earlier.

When we talk about investing in trusted community leaders, messengers and organizations like Gigi and Marshallese Women's Association, they have been a prior contractor of ours.

We want to continue to contract and subcontract directly with community-rooted and community-led organizations.

We also want to support community-led COVID-19 vaccine outreach, including via trusted community messengers and leaders.

And as an example, right now the Black Lens in Spokane is organizing a radio show to address vaccine hesitancy with the Black community.

And many of my team members who are from the African American community will be joining those conversations to help sort of dispel some of the myths and partner with community to actually answer some of their questions.

These are just smaller examples, but Nonetheless this is what needs to happen at every community and we do this in partnership with our local health departments and other community based organizations.

We also want to ensure that all our communications education and outreach efforts are culturally and linguistically appropriate and accessible.

We have multilingual campaigns educational materials and outreach in 36 languages.

But as I think Trang mentioned earlier, we were building the system or the plane as we were flying it.

We did not, the system was not ready for this pandemic due to the inherent inequities and racism that's built into governmental structures.

So we actually had to create a language access plan for COVID-19 to make sure that vital information was being translated in the top languages that community really needs.

We need to leverage social media and influencers, especially culturally appropriate influencers through trusted community leaders, and do in-language audience testing for all campaign messaging.

And we've been doing that, and we need to continue to do that even more.

I agree with Abigail and others.

We need to strengthen the public health system's ability, not only during this pandemic, but beyond.

But for now, we need to center communities in vaccine outreach and access.

So my team has been working to develop community specific engagement plans for 10 priority communities.

And of course no surprise to any of you on this in this forum today.

Black African-American community members Latinx native Hawaiian other Pacific Islanders Asian-Americans immigrant refugees agricultural workers people in jails and prisons who are incarcerated people experiencing homelessness and individuals with disabilities.

And these are specific plans that we want to connect with our partners on so that we can get real-time feedback on how appropriate will these plans be and how we can resource community-based partners then in actually implementing a lot of the work because we know the work is happening at that neighborhood, at that locality level, at that community level.

We're also organizing meetings with our local health partners to discuss effective strategies to engage, let's say, Latinx community and the farmworker community, knowing what we have learned from our testing strategy, especially in Central and Eastern Washington, and working with organizations that serve farmworkers directly.

And then the other thing I want to quickly mention is fostering opportunities for collaboration.

We just recently launched the COVID-19 vaccine implementation collaborative, which intentionally centers community voice Dr. Ben Danielson is part of that collaborative and I know he's plugged into many other forums and committees that the government has set up.

But we're really grateful that we have leaders like Dr. Ben and others who are going to be joining the collaborative and giving voice to a lot of their concerns.

that often leaders in decision making spaces don't really have the luxury to listen to.

So we have 20 percent of our collaborative members are BIPOC or represent other disproportionately impacted communities and 30 percent are representatives from organizations business businesses or unions that serve disproportionately impacted communities.

And then finally, we want to support a trauma-informed approach to vaccine conversations for all the reasons that Gigi and many others mentioned, including Abigail and Esther.

We know that the historical legacy of distrust and intentional violent harm on communities of color has has created that level of distrust that we're now seeing and creating that BIPOC paradox where we need to get our most disenfranchised community members vaccinated, but then also completely understanding the reluctancy or the hesitancy around getting vaccinated.

So as an example, we have BIPOC community partners have asked DOH to provide training and resources to provide, to support vaccine hesitancy conversations with historically marginalized groups.

And how do we, again, use the community resources that we know that are trusted to really help us do that?

So again, I'll pause here.

These are just, I know we're way over time, but I wanted to take this opportunity to provide a slice of what we're working on from the state perspective.

Thank you, Paj and Blair.

And I appreciate you hanging in there.

I know we're running pretty late today.

I appreciate it.

Colleagues, any questions or comments for Paj or Blair?

Looking for hands.

I'm not seeing any.

You know, the one question that I have is.

You know, I think there's there's from the state level a.

You know, sort of lean towards towards hospitals and and and sort of partnering with hospitals as as a as a point for vaccination.

You know, in hospitals in a lot of ways are set up.

a little bit better because they have more resources, et cetera, et cetera.

But but how do we how do how is the state evaluating that with the reality that many of our community health clinics are the ones that are most trusted by by communities of color and are the trusted messengers.

Right.

So how do we how do how is the state looking to or are is the state looking to reconciling and sort of pairing up those skill sets to be a better delivery model for communities of color?

Yeah, really good question.

And Blair, if you're still on, you can chime in as well.

We are shifting allocation right now pretty consistently towards moving away from larger health care systems, even though they will still be a strong component, but into federally qualified health centers and CHCs.

I know Teresita and I have had many conversations about this.

and other health system partners as well.

The other thing that I may not have been clear on is that including when we talk about integrating a pro equity approach into vaccine allocation and distribution, that includes requirements for health care systems like hospitals and pharmacies.

So how do we make sure that they are also collecting the information that we need?

And so that if we see that there's lack of compliance, or our health care systems who actually adopt the pro equity approaches might receive preference for sustained vaccine allocation.

So those are the types of conversations that we're having internally.

And then how do we make sure that they reserve appointments to be filled directly by community partners.

So I think that's the kind of conversations that we're having internally.

We wanna make sure we're also having conversations with many of our CHC partners, including Teresita.

So always willing to listen to more ideas that would make most sense to support them.

Thank you for that.

I would also...

I think, you know, I think that some of the systems and V, if you could go back a couple of slides or maybe just one slide, no, one more.

So some of these issues that are flagged around, you know, we heard our community voices talking about the fact that it's, that race and ethnicity isn't being captured.

If it is being captured, it tends to be inconsistent or sporadic.

And I am not understanding why the state can't just require this data collection.

I mean, these systems are run by the Department of Health, and it seems to me that some of these issues that are being flagged are issues that are directly within the control of the Department of Health in terms of flipping a switch one way or the other.

So help us understand why these challenges continue to be challenges and why it hasn't yet been required to consistently and systemically collect race and ethnicity data so that we have a better sense of how vaccine allocation and distribution is playing out throughout our state.

So the IAS is a federal national system, right, that people use for reporting on their immunization practices and not just COVID, right, for other vaccinations as well.

And those categories are requirements from the federal government as well as the state in terms of completing them.

What we're finding, which is There is some added complexity of reporting for COVID and specifically into IIS.

And a number of providers, quite honestly, are having some challenges in terms of getting that information in.

And so it requires sometimes our calling and actually getting the information via phone in terms of where they are in the administration or inventory or other factors.

So some of it is just complexity.

of actually entering in the data.

Some of it's the staffing capacity of, um, or actually being trained to do it.

Sometimes you just find, like, commas get put in places, and then that actually offsets numbers or responses.

And it's just, honestly, it's human in terms of some of the errors, and then some of it is where actually supporting some of these providers to put in the information most effectively and efficiently and have the capacity to do it, back to the points around public health capacity and sort of the under-resourcing of a number of these partners.

So we've often seen sort of a lag of new partners in terms of it takes a couple of weeks before they can kind of get all the information accurately put into the system.

But we are absolutely focused on making it happen.

And as we've noticed, we're actually really trying to provide support to some of the smaller facilities and being able to do that most effectively.

Does that help answer your question?

Yeah.

Yeah.

Yeah.

Frustrating reality, but you did technically answer my question.

I appreciate that.

Colleagues, any other questions for these panelists?

Okay, I'm sure we're gonna keep being in communication with you all.

I certainly will make sure to follow up with any additional questions that I might have and really do appreciate your time.

I know we're running pretty late here, but I appreciate you sticking it out with us and appreciate your willingness to be with us for this really important conversation.

Thank you so much.

Thank you so much.

Thanks for having us.

Of course, of course.

Okay, so we are going to conclude this panel with hearing from our Office of Immigrant and Refugee Affairs.

So I think we still got Kou.

There's Kou, and I think Joaquin might still be with us.

Hi, all.

Last but certainly not least, let's hear from Kou and Joaquin.

Take it away.

Thank you, Council President.

And I guess we can say good evening now.

I'm going to keep my remarks brief because I my children are home from school and I have to shift to parenting.

But the person that you want to hear from is Joaquin Lee, who's been participating in the mayor's office team on a daily basis.

So our office is all in.

I would just offer that, you know, we've It was very impactful to hear from our community panel.

And what we're hearing, obviously, is that there's a gap between our stated commitment to equity and how we're operationalizing the very hard work of what that means.

And so our Seattle Office of Immigrant and Refugee Affairs is poised to do as much as we can to address that problem.

So Joaquin, and I apologize, I'll reconnect with Joaquin, and you know where to find me.

Thank you.

No need to apologize, Q.

This is the reality of having our offices be in our living rooms or our other rooms.

I myself just said hello to my toddler, so I can totally empathize.

My five-year-old has a penchant for video bombing, so it's probably a good idea for me to sign off before she does that.

Thank you.

We are in good hands with Joaquin.

Take it away, Joaquin.

I just wanted to mention that one of the great joys of working for the Office of Immigrant and Refugee Affairs is when the little kiddos come and Zoom bomb.

It's the best kind of interruption that we could have.

Thank you, Council President, committee members, and my aunties who spoke earlier.

I do have a slideshow and it's really short.

I can just go through it pretty quickly.

I don't know if we're going to put it up or if I should just keep it informal.

There you go.

So I'm not going to belabor this.

A lot of this has already been talked about.

Significant obstacles that we've seen.

Supply is extremely limited.

A lot of that dates back to the lack of a plan from the federal government and, of course, a lack of centralized information.

Who has the vaccine and when you start.

refreshing and seeing if there's appointments.

Sometimes there are appointments, sometimes there's not.

Again, this is something that the federal government could have easily done.

They have the resources to enact and roll out a more centralized form of tracking this, but that is not currently in existence.

And because of the lack of centralized appointment signups and knowing who has what, We have to deal with the, and I know that this analogy has been talked about a lot, so I'll say it again, a Hunger Gamesian type of situation where people are going to 25 different vaccine providers and 25 different websites trying to figure out, mostly in English, how to sign up for appointments or which numbers to call for when.

Next slide, please.

So given all that, the city is trying to do what we can with what we have.

It is or has been rare for city entities to be vaccine providers.

Obviously, the hospitals, the clinics, the medical providers, they were some of the first vaccine providers out there because of their staff and who they care for.

That makes sense.

But for us, we got into it just four weeks ago.

We became a vaccine provider and we are getting only a thousand vaccines per week.

And even that is not certain.

Sometimes we're finding out the last minute that we're able to get the vaccines and we're able to move forward with the clinics that we've committed ourselves to.

And so as someone who works for the Office of Immigrant and Refugee Affairs, one of the things that we always do is before we move forward, we have to do that community outreach.

We have to reach out to our service providers, not just the executive directors, the community organizers, the case managers, the people who work for organizations that don't even have 501c3 statuses.

Anyone and everyone who is in community and who works with immigrants and refugees, we want to hear from you.

So we convened three roundtable discussions.

One was with the mayor's office and two other ones we convened.

There were large legacy organizations like ACRS and El Centro, and there were smaller organizations like El Comite and CERC.

And so we heard from them some of the things that people have already talked about on this panel, including what the city should do to make sure that vulnerable English language learner or limited English proficient residents can access the vaccine.

We heard from them on recommendations on messaging and spokespeople for vaccine-hesitant community members.

And, of course, we want to be that conduit to provide information to DOH and to our partners to let them know what we're hearing around language access and other access issues regarding online forms or collateral, aka flyers and informational sheets.

And, of course, One of the things that was the takeaway from that group is that the City of Seattle is embarking on a process of partnering with community-based organizations, community-based organizations specifically who have access to eligible older residents.

So folks who have email lists, phone numbers, cell phone numbers for texting, folks who are 50 years of age and older who live in multi-generational households, which is mostly immigrant and refugee households, as well as folks who are 65 and older.

And there are a ton of amazing community-based organizations who are doing this work across the city.

One specific example is Ethiopian Community Services.

This is an example of what I think how government should work.

I saw a email from Sophia, the executive director of ECS.

I saw that they partnered to do a clinic much earlier in, I believe, January.

And I called her up and said, you know, how's the clinic going?

Is there anything that we need to know?

And she said, we have over a hundred people on the waiting list.

If there's anything that the city of Seattle can do to launch another pop-up with us, that would be wonderful.

So we quickly got her connected to the vaccination team signups, which includes Seattle Fire Department, mayor's office, and of course our office.

And then we We launched a pop-up clinic last Friday, and over 200 East African refugee and immigrant residents who are eligible under Phase 1B1 were vaccinated, thankfully.

That was an example of what we plan to keep doing as we move forward with our limited vaccine supply.

So we're compiling a list of other CBOs who would be also appropriate for this type of work.

And we're in the process every day, long hours, and being on the phone, calling folks and figuring out, okay, when's the best time to work with you?

When's the best time to work with you?

We have clinics coming up with El Comite, for example, as well as El Centro, of course, and Via Comunitaria in South Park.

Next slide, please.

So when it comes to equitable vaccine outreach, so there's, of course, the distribution and partnering with folks to make sure that they're bringing people to the actual clinics to get them vaccinated.

But of course, there's disseminating that information to folks who either are vaccine hesitant or they want the vaccine and just don't know the details.

So we're, of course, going to be meeting regularly with immigrant refugee community members.

I think at this point, it's going to be biweekly check-ins to let them know What we're doing and to learn from them with a gap star so we can course correct or let our partner government agencies know what needs to be done.

We're also again working with CBOs to identify those partnerships that are coming up.

And then, as I mentioned before, Ethiopian Community of Seattle, that was last Friday, and that resulted in over 200 eligible folks getting vaccinated.

And we're continuing to partner with the mayor's office, and we have a training opportunity with Public Health Seattle King County, where we're having folks get trained to be vaccine ambassadors.

And I'm going to put that link into the chat.

We have a Facebook event.

page that leads to a Microsoft form where people can put in their information, sit in on a training session, and then be able to confidently talk to their community members about the facts of the COVID-19 vaccine, the ingredients in the vaccine, how it's being distributed, what the emergency use authorization means, even kind of explaining the science behind the mRNA vaccine, all that and more.

Next slide, please.

And we're also working closely, and this is a huge team effort.

One of the things that I think has come out of the COVID-19 pandemic is a lot of the silos that exist in the community have been very much destroyed.

No silos, grains everywhere.

We are working across departments, the mayor's office, Seattle Fire Department, and other departments to really try to make sure that we have language access.

integrated in the front end and not later on in the process to communicate important information to vulnerable community members.

Just putting into the chat also the link to the City of Seattle's vaccination page.

You'll see at the top, I think it's at the top now, there's multiple pages that you can click to get information just relevant to immigrant refugee communities.

We heard loud and clear from our community partners.

They want to know about public charge.

Is there a cost?

Will their information be stored and given to immigrant enforcement agencies?

No on all counts.

And it's really easy for folks to get a vaccine.

As I understand it, the city of Seattle's vaccination Eligibility is pretty open.

We wanna make it as low barrier as possible.

People show up and they present their IDs and that is it.

And really we wanna put it on the CBOs who have those trusted relationships with on the ground folks to do that work, to bring people to the vaccine sites.

We've heard loud and clear that they want to do this work.

It's just a matter of getting the vaccine to them and to create those partnerships between Seattle Fire and our community-based organizations.

Another thing that we at the Office of Immigrant and Refugee Affairs excel at is our relationship to media organizations, community media organizations that publish or broadcast in languages other than English.

We know, based on all the years that we've been doing this, that you know, vulnerable immigrants and refugees are not reading the Seattle Times or the Stranger or the Seattle Weekly.

They're reading the Seattle Chinese Post.

They're watching Univision.

They're picking up a print copy of Northwest Vietnamese news.

So we need to make sure that news about the vaccine is in, accurate news about the vaccine, are in these publications all day, every day, all week, every week.

And so one of the things that we did was we found out that the Archdiocese of Seattle was organizing a vaccine clinic, this wasn't our vaccine supply, I think it was with Swedish, and that was at Holy Family Church in White Center, and they didn't have any relationship with Univision, and I said, oh, totally happy to connect you with Pablo, he's great, he's going to go there, cover it, and maybe he can get some shots of the pastor of that church getting a public shot, and they came, and now that video is being broadcast across Seattle, showing that the Holy Father and that Catholics around the world can get this vaccine.

There's no fetal human tissue in it, et cetera, et cetera.

So we're trying to make sure that in-language news and information is all over social media, yeah, to some extent, but very much in ethnic media outlets.

Also, public health Seattle King County, they have some translated materials and frequently asked questions on their website.

So we're doing our best to make sure that that is out there, and that our ethnic media partners know where to go when they have questions about the vaccine, or they want to point people in the right direction.

And then.

We're also helping make sure that the City's Customer Service Bureau, which has access to LanguageLine, as we mentioned, I think someone mentioned before, that's over-the-phone interpretation services, they have access to the same information we do.

And sometimes, you know, people, they just get intimidated by a website.

I know I do.

And they just want to talk to someone on the phone about it in language, even with an interpreter.

And so the Customer Service Bureau operators have been doing an amazing job of patiently explaining some of the information on our pages and letting folks know where they can go for more information.

Next slide, please.

And I think that is it for me.

I also just wanted to put down public health's translated information because we found we've been posting that a lot.

Oh, yes.

Also just want to mention that You know, again, we've been collaborating very closely with department neighborhoods, Seattle Fire, Mayor's Office.

We are, you know, a lot of people say building the plan as you fly it.

Okay, that's fine.

But we can just say that we're simultaneously developing and launching a citywide vaccination outreach and engagement plan because we can't waste any time to stop.

We have to keep moving.

And so that's what we are trying to And do we get it right?

Heck no.

But that's kind of our office.

Our office is like, you know, we're big fans of Hamilton.

We're big fans of immigrants to get the job done.

We're also big fans of we're never satisfied.

We always are harsh on ourselves, always know we can do better.

And so this is something that we know lives are on the line and we have to do better and we will do better.

And we'll do that with your help.

So thank you so much for having me be here.

Thank you, Joaquin, for that.

I am so happy that we ended on this note.

I know we heard a lot of heaviness in the community voices and that is not misplaced heaviness.

There's a lot of reason for that heaviness to exist because this has been a real struggle and as you mentioned in your closing, one of your closing lines, lives are literally on the line and it's mostly black, brown, immigrant, refugee lives that are on the line.

So I really appreciate all of the work that OIRA has been doing and look forward to continuing to support the efforts of OIRA as we intentionally and simultaneously develop and launch a citywide vaccination outreach and engagement plan.

We don't have a lot of control over what the state does.

We don't have a lot of control over what the county does, but we have a lot of control and a lot of power to influence what we do at the city to reach deeply into our own communities and our own community-based organization infrastructure to have a equitable vaccine outreach strategy.

So I really appreciate all your effort in that space.

I see that Council Member Strauss has his hand up and want to invite any of my other colleagues who might have comments or questions to do the same.

Thanks, Council President, and thanks, Joaquin.

I just wanted to take this moment to express my gratitude.

We are lucky to have you here in the city of Seattle.

Your enthusiasm is radiating through this computer.

So just thank you for all you do for our city.

We're lucky to have you.

Thank you.

It takes a team and I'm glad to have an executive and a council that are so dedicated to issues of equity and social justice.

Thank you so much.

Council Member Mosqueda.

Thank you very much, Madam President.

Hi, Joaquin.

Thanks again for the presentation and the overview.

I appreciate this overview and the ones that you've also shared with our team.

I just wonder, in light of all the conversation that we had today, if you had an endless budget and a magic wand, is there like two or three things that you would want to lift up that you wish you would be able to do so that maybe we can have that in mind as we think about these next steps to follow through on not just creating a table but, you know, reshifting of power dynamics and resources that was called on us?

Endless budget.

Well, I don't know if this is possible, but it would be so amazing if we could just directly buy vaccines from companies so that we could get a supply independent of the federal government right now, because the supply really is dictating so much of the issues that are happening right now.

So an infinite supply of vaccine would be wonderful.

And I would also love for there to be a core, like some kind of, you know, resident stakeholder core of people who are trained up to communicate to communicate about the vaccine and to be able to counter some of the misinformation out there and to really go to communities.

And if they're comfortable door knocking and talking to their folks, or they wanna just do Zoom calls, or they want to text message or call people, it really is one of those person to person things.

I mean, COVID-19 has so damaged our ability to be face to face and to really communicate one-on-one to people like this is, What I'm hearing.

This is why I took the vaccine.

This is why I believe in it.

This is why I think you should do it and it's really impaired our ability to Spread information out there and we heard loud and clear from our immigrant refugee partners.

It's people people Whether they're faith leaders, community leaders, the auntie who's the gossip that everyone knows and fears, those are folks who really are the ones that are out there doing amazing work.

And if we could organize them to do that more or to resource them, oh, that'd be so great.

You know, one of the things, I come from a community organizing background, And if there's anything that I'm an advocate for, it's more community organizers being in city government entities like this and informing policy and what we should be doing.

And if we can't do that, then we should be funding them to do the work, because it's community organizing that really is going to ensure that people, especially our most vulnerable, are vaccinated, who elders listen to.

Elders will listen to someone they know or someone they trust.

And we can put as many press releases, stories, or ads out there in newspapers.

That's like a baseline, but it really does come down to that person-to-person contact.

And, you know, there are ways to do it, be outside or, you know, obviously be double-masked and be socially distant.

But that, those trusted messengers, they'd be great if they're funded and they're out there in communities.

amazing grassroots organizations who don't have 501c3s that are doing the darn work.

And so if we can figure out ways to get them funded to do that work without having to go through, you know, the whole nonprofit system, that would be amazing.

And just more money to community-based organizations that are doing it that we heard from earlier and who may not be here and who are actually so True confession, there's actually an equity and education gathering happening right now about vaccine distribution.

And I'm trying to listen in because I was invited to appear on that.

And I'm just trying to do my thing and hear what's going on.

And a lot of the same issues are coming up.

But I'm looking at the separate Zoom screen of faces there.

And these are all amazing folks who should absolutely be funded to do the work and figure out on their own based on the community organizations or communities that they focus on.

what they should be doing for vaccine distribution.

And it's inspiring to see folks doing that work because the messaging for Chinese elders and the CID is going to be very different for the messaging for recent arrivals from mainland China.

We have to like really specify the message and how we're messaging to each like hyper local, hyper segmented community.

And that's what community members know how to do.

So more funding for that.

Thanks for that question, Casimira Mosqueda, and thanks for that answer, Joaquin.

I do sort of wonder if there's an opportunity for us to look at models like the Parent-Child Home Program, like the Nurse-to-Home Partnership Program that really centers on trusted messengers with understanding of what the information is and brings that information to people.

as opposed to requiring people to go through the bureaucracy of the system to try to understand how to access something as simple as a vaccine is something that I think we should be taking a serious look at.

I'm not saying that the exact model would be perfect, but I wonder if it could serve as inspiration as we're sort of developing and launching this vaccination strategy, if those two models might serve as inspiration for a model that would be appropriate in this case, because I am hearing and I did hear a lot on the community panel about how important navigators are to this system.

And, and, and that, you know, goes beyond just language and cultural access, but just sort of, you know, where do I even start, you know, I like to joke that I speak English, I speak Spanish, and I also speak lawyer.

And I still have, and I still had a hard, I still am having a hard time, right?

Figuring out how to get my own mother and my mother-in-law, both in phase one, into sort of the system to get vaccinated.

So I think that that sort of connectivity from the community network perspective is so important.

And we have an opportunity to really intentionally build that capacity of those networks through some emergency funding and through some really creative thinking about how to accomplish that goal.

Okay, colleagues, any other questions or comments before we send Joaquin off into another Zoom room to wow that audience?

Okay, colleagues, I really appreciate you all hanging in with me.

This was a really important conversation.

I hope that you all learned as much as I did.

And this is the start of this conversation, not the end.

As a reminder, Jeff Sims did circulate a draft version of a resolution for city council's consideration next Tuesday.

That has been in part informed already by some outreach and engagement with council member offices, but it's certainly still very much in a draft form.

And really do want to invite all of you to provide us with feedback.

My office will follow up with the community panelists who were here.

to engage them on the content of the resolution to make sure that we are appropriately reflecting not just our equity values and goals at the city, but really connecting that with action items and accountability mechanisms as we continue to move forward on this issue.

And then lastly, just want to thank Vee Nguyen from my office.

She had the did all of the work to identify panelists, to invite them, to organize them, and to bring them here to us, both on the government panel and on the community panel.

Really want to thank her for all of the work she did to make sure that we had as many perspectives and voices represented on those panels as possible.

So huge thanks to me.

Anything else for the good of the order, colleagues?

All right.

Well, thank you so much.

That's our last item.

We are adjourned.

We'll see you soon.