Almost as soon as the pandemic took hold in the United States, an unsettling and familiar picture emerged: Though COVID-19 had broad reach, it was disproportionately harming the same populations that had historically faced health disparities in the U.S.
To address this, the National Institutes of Health (NIH) established the Community Engagement Alliance (CEAL) Against COVID-19 Disparities, a program that has given more than $45 million to 21 groups since September 2020. Philly CEAL began in May 2021, led by Penn’s School of Nursing, in conjunction with the Perelman School of Medicine, the Annenberg School for Communication, and the City of Philadelphia.
“CEAL was established to accelerate our response to this pandemic for underserved ethnic and racial minority communities using evidence-based methods,” says Penn Nursing’s José Bauermeister, who is co-leading the Philadelphia effort. “Those who are underserved or living in the less-resourced communities are often left behind and not just in COVID but in other chronic and infectious diseases.”
Philly CEAL’s first few months have been spent creating workflows, learning from a “buddy” partner program in Texas, and tweaking its focus to center on message framing and resource mobilization. It recently began on-the-ground work in 19 neighborhoods across the city, partnering with community leaders to increase vaccination and testing rates and decrease new COVID-19 infections.
‘It all feels very familiar’
Based on coronavirus trends at the time of the initial NIH funding, the bulk of those first grants went to places in the southern U.S., with nothing on the East Coast farther north than North Carolina. As trends evolved, however, the agency identified more regions that needed help, including Philadelphia.
When the NIH put out a second call for proposals, a Penn-led team applied, and in April 2021 received $1.4 million to form what became Philly CEAL. Additional support from Penn’s Office of the Provost and School of Nursing brought total funding to $1.53 million.
Baumeister is at the helm, alongside Penn Nursing Dean Antonia M. Villarruel, who expressed excitement about the partnerships with the city, other Penn schools, and the community writ large. “We will work to synergize efforts to address the disproportionate impact of COVID-19 on underserved communities,” she says.
Other steering committee members include Terri Lipman, Penn Nursing’s assistant dean for community engagement; Stephanie Reid of Philly Counts; and Andy Tan, an associate professor in the Annenberg School for Communication. Eleven other collaborators from Penn are also involved, among them David Metzger, director of the HIV Prevention Research Division in Penn Medicine’s Department of Psychiatry.
“When I came to Penn in the late ’80s, one of my first projects was to prepare communities for testing HIV vaccines,” Metzger says. “The same issues we’re encountering now—communities feeling like they can’t trust being part of research, like they can’t trust the government—it all feels very familiar. They’re the exact issues we encountered back then. For individual health and certainly for public health there needs to be a real trust of science in the community.”
Philly CEAL is engaging trusted community partners to help frame culturally appropriate, respectful messaging and aims to build on the work of Philly Counts, an office run by the city and established to encourage participation in the 2020 Census. “Part of this is understanding the whys and the hows: Why aren’t folks getting access to the care they deserve? How can we make it more readily available and accessible?” Bauermeister says.
A three-pronged approach
Specifically, Philly CEAL is taking a three-pronged approach, which includes community engagement, mobilization and outreach, and data collection and interventions.
“We know the pandemic is not an equal-opportunity issue,” says Tan, whose Health Communication & Equity Lab focuses on how inequalities in marketing, media, and messaging affect different populations. “We can’t rely on a single national campaign or effort for what are a diverse set of challenges and issues facing individual communities.”
In that vein, the city identified a handful of neighborhoods to start, focusing on those underperforming in vaccine and testing rates or accounting for the greatest numbers of new COVID-19 cases. “We’re letting the data take us to the communities that need us the most,” Bauermeister says.
Using methods Philly Counts honed for Census data collection, the team has conducted a series of surveys, going door to door, block by block, to speak with residents about their fears and hesitations and to learn about their individual experiences. Those conversations help the Philly CEAL team understand what kind of communications—delivered by whom, when, and where—might best succeed.
“We need community participation so that the messages are appropriate, understandable, and trusted,” Metzger says. “We don’t want to ostracize people or embarrass or insult them. We need to listen as much as we need to give our ideas.”
A campaign called “I want my normal back” grew out of those surveys. It includes several videos and a series of brochures featuring local people who have gotten the COVID vaccine. Philly CEAL has also been working with community members, including clergy and barbershop and beauty salon operators, to disseminate public health information.
Philly CEAL is funded through March 2022. In the short time it’s been running, the delta variant and increasing case numbers have already forced a shift in focus.
That wasn’t unexpected, Tan says. “In terms of the life cycle of the pandemic, we’re really mindful of the dynamic changes in people’s perceptions of what’s going on. I anticipate there will be many more twists and turns,” he says. “This coalition has to be nimble enough to address the latest concerns.”
Such flexibility is one way Bauermeister says he will measure the success of the group along with numbers, including fewer infections and more vaccines and testing in the identified neighborhoods.
“It’s important that we don’t get complacent,” he says. “Much work remains to remove the inequities of both COVID exposure and the long-term ramifications that COVID will bring to our communities, physically, socially, and fiscally.”
José Bauermeister is the Albert M. Greenfield Professor of Human Relations, a professor in the School of Nursing and the Perelman School of Medicine, and a senior fellow at the Center for Public Health Initiatives and the Leonard Davis Institute of Health Economics at the University of Pennsylvania.
David Metzger is a research professor and director of Penn’s HIV Prevention Research Division in the Department of Psychiatry in the Perelman School of Medicine.
Andy Tan is an associate professor of communication at the Annenberg School for Communication and director of the Health Communication & Equity Lab at Penn.
Antonia Villarruel is a professor and the Margaret Bond Simon Dean of Nursing at the School of Nursing, as well as a senior fellow at the Leonard Davis Institute of Health Economics at Penn.
Other members of the Penn community involved in Philly CEAL include Alison Buttenheim, Melanie Kornides, Terri Lipman, Adriana Perez, Subhash Aryal, and Ed Federico of the School of Nursing; Florence Momplaisir, Ian Frank, and Robert Gross of the Perelman School of Medicine; John Jemmott of the Annenberg School for Communication; and Penn Integrates Knowledge professor Karen Glanz, along with Grace Ma of Temple University and Stephanie Reid of Philly Counts.