WASHINGTON — Four months into a pandemic that has disproportionately devastated Black, Latino, and Native American communities, leading minority health experts within the Trump administration remain conspicuously quiet and have conducted minimal outreach to communities of color.
The directors of two federal minority health offices, as well as the government’s $336 million health disparities research institute, have not conducted TV or radio interviews since the pandemic began in early 2020. None has testified before Congress, or appeared at a White House coronavirus task force meeting or public press briefing.
In an interview, Eliseo Perez-Stable, the director of the National Institute for Minority Health and Health Disparities, applauded several Trump administration figures’ recent efforts related to Covid-19 and protecting vulnerable populations. But at the pandemic’s outset, he said, it was largely Anthony Fauci, the prominent infectious diseases expert, who filled the vacuum, urging action to address devastation among people of color.
“We’re acting on this,” Perez-Stable told STAT, referring to concerns about Covid-19 health disparities. “Could this have been done earlier? You know, you can always say yes. The only person who really had a voice at that table from our perspective was really Dr. Fauci.”
Felicia Collins, the director of the Department of Health and Human Services Office of Minority Health, has been on leave for much of June; a spokesman declined requests for an interview and would not specify when she’d return. Leandris Liburd, the director of an equivalent office within the Centers for Disease Control and Prevention, did not begin public outreach efforts until mid-June, according to a spokesman, who also declined requests for an interview. Liburd and Perez-Stable have served in their roles since the Obama administration, while Collins has held her post since early 2019.
In a range of interviews, scientists and policy experts inside and outside the Trump administration acknowledged that from the start, there have been few voices spotlighting minority health concerns to White House decision-makers — or serving in any public outreach capacity.
Outside experts say the relative silence underscores a flawed response that was particularly concerning at the pandemic’s outset, when leading scientists and administration officials failed to anticipate the toll the novel coronavirus would take on people of color. At a recent congressional hearing, the director of the Centers for Disease Control and Prevention, Robert Redfield, apologized to lawmakers for the agency’s inability to estimate the rates at which people of color became sick and died.
While there was no single figure who oversaw messaging on minority health issues during the Obama administration, many experts said the urgency of the Covid-19 pandemic and its disproportionate toll on people of color called for a more urgent response — and more aggressive efforts to spotlight minority health concerns to White House decision-makers.
This lack of advocacy is especially apparent amid a broader national reckoning over police violence and other systemic forms of racism in the U.S., including in health care, critics said.
“We’ve not observed any meaningful attempt by this administration to engage the African American community in shaping its response,” said Kristen Clarke, the president of the Lawyers’ Committee for Civil Rights Under Law. “At no point has this administration set forth a plan that speaks to the racial inequities that have existed from day one.”
Instead, many of the administration’s attempts at engagement have fallen to Jerome Adams, the surgeon general, and have appeared scattershot.
The White House’s outreach to minority communities and groups focused on health disparities has largely consisted of a pair of April conference calls led by Adams. Ben Carson, a surgeon who serves as housing secretary and is the only Black member of Trump’s cabinet, participated in one, but some participants later said they were unsatisfied. Clarke referred to the calls as “one-way White House briefings that just scratched the surface in terms of providing detail.”
Adams, the administration’s only high-profile Black health official, has taken flak for perceived racial insensitivity in comments he made in an April press briefing, when he counseled that Black and Latino Americans should “avoid alcohol, tobacco, and drugs.”
Courtney Cogburn, a professor of social work and researcher of racial health disparities at Columbia University, called Adams’ remarks “a bio-racist framing of health.”
“You’re suggesting that there’s something inherent about Black people that leads them to having higher rates of disease, when you don’t take an additional step to interrogate why those rates of disease are there,” she said. “In a whole swath of our population, you’re observing this pattern, and you’re essentially reducing it to individual choice.”
The administration has at times touted its efforts on minority health fronts: It circulated a fact sheet on outreach to the Black community and other historically marginalized Americans that highlighted the administration’s data-collection efforts. It also emphasized efforts to channel Covid-19 relief funding to hospitals that disproportionately serve low-income patients, though the administration only sent funds to Medicaid providers, which serve low-income Americans, in early June, after weeks of criticism. Federal officials have also been criticized for being slow to send funds to some hospitals in some communities, including to hospitals in the Southwest serving a heavily Navajo population.
And on May 1, the HHS Office of Minority Health announced $40 million in funding to conduct targeted public health outreach to minority communities; the funds won’t be disbursed until July.
When that program was established, there was no public announcement from high-level administration officials. Six weeks later, during weeks of protests over the police killing of George Floyd and other Black Americans, White House press secretary Kayleigh McEnany announced the program, from the White House podium — without mentioning its rollout date over a month prior.
The administration has also fallen short on lofty promises floated early in the pandemic to use epidemiological data to shepherd resources toward the hardest-hit communities.
In April, Adams pledged in an interview that the administration was “working with the CDC to make sure we’re collecting the data about all populations, but in particular looking at breaking it down by race and by age.”
Democratic lawmakers first called for a detailed racial breakdown of Covid-19 infections and deaths among Medicare beneficiaries in late March. Nearly three months later, and roughly four months after the country’s first documented case, Medicare officials have not released that data. On a nationwide level, Perez-Stable acknowledged, no such analysis exists.
No comprehensive estimate became available until mid-June, when a preliminary CDC analysis showed the Latino and Black communities accounted for 33% and 22% of the country’s early Covid-19 cases, respectively — both of which represent nearly double each group’s share of the population.
Redfield, the CDC director, acknowledged in a recent congressional hearing that the country’s system for collecting demographic information about race was fundamentally inadequate.
“I personally want to apologize for the inadequacy of our response,” Redfield told Rep. Barbara Lee (D-Calif.) when pressed about the administration’s inability to provide a detailed racial breakdown of Covid-19 infections and deaths. “It wasn’t intentional.”
Perez-Stable, however, called a weekly CDC mortality report “extremely helpful,” and said Brett Giroir, a top HHS deputy, was “attentive to the science and the minority health issues.”
The CDC has also been criticized for failing to require commercial testing partners, like private laboratories and local pharmacy chains, to submit demographic data along with the results of Covid-19 tests they’ve supplied around the country. Federal guidance requiring that data was only issued in early June, and does not fully take effect until August 1 — a delay that Trump administration critics and public health experts view as inexcusable.
“That directive from CDC should have come out months ago,” said Howard Koh, the assistant secretary for health during the Obama administration. “I just don’t understand why it took so long. Because we knew, when the crisis started to erupt, that it was going to expose the fault lines of health inequity yet again. This is what always happens.”
While some outside experts have blamed the federal government, others have cautioned that federal officials only wield so much power. It is state officials, said Vickie Mays, a UCLA health policy professor, who are most responsible for understanding and addressing the systemic barriers to care that local communities face.
“We kept talking about doing drive-through testing, and you would have said, who drives in New York [City]?” she said.
The same is true for the seemingly simple mandate of frequent hand-washing, she said — a task made difficult in poor communities where high water bills, or lack of access to clean water altogether, make compliance impossible. In particular, she cited statistics that show households in hard-hit Native American communities, particularly in the Southwest, are 19 times more likely than white households to lack running water.
“That was a state and local issue,” she said. “The federal government could have made some pronouncements, but I would have said it was the delay of states in recognizing: ‘Oh, who of my people can’t wash their hands frequently, and don’t have access to water?’”