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In the kickoff event of Rural Assembly Everywhere, the former acting director of the Centers for Disease Control and Prevention and the current head of one of the nation’s largest private healthcare philanthropies said the nation needs a more equitable response to the pandemic — one that empowers all Americans to protect their communities’ health.

“If you aren’t recognizing that different people in different communities have different needs and are saying everyone (should) do the same thing, you are by nature disadvantaging large sectors of our population,” said Richard Besser, M.D., who is now president and CEO of the Robert Wood Johnson Foundation. 

Besser served the CDC for more than a decade, primarily in epidemiology. He led the agency in 2009 during the H1N1 influenza pandemic.

Besser was joined by Ligia Cravo, senior program officer at Hearst Foundations and board member of the Center for Rural Strategies, in a wide-ranging conversation about the public health response to Covid-19, the difficulties of creating and distributing a vaccine, and the need to listen to people in rural areas and help them respond to the health crisis.  Rural Assembly Everywhere, presented by the Rural Assembly, continues throughout the week. 

Throughout the discussion, Besser painted a stark reality of the pandemic’s disparate impact on rural communities and people of color while also expressing hope for innovation to arise from the pandemic’s challenges.

As Covid infection rates in rural counties are setting record highs, those communities face unique challenges with larger proportions of the population living in multigenerational households and with chronic illness, Besser noted. Recent rural hospital closures and lack of health insurance also complicate the response. 

Many people are unable to follow the guidance issued by the Centers for Disease Control, Besser said. Housing, financial, health, and work circumstances influence whether the CDC’s guidance to call a doctor, isolate in a separate room, stay home, and use a separate bathroom when ill can be followed. 

“I was really blown away by the CDC guidance around what to do if you think you are sick,” Besser said. “What they said was — don’t go to the hospital or healthcare center, call your doctor. At the start of this pandemic, 28 million lacked health insurance and a greater proportion of people in rural communities lack health insurance. Who are you going to call if you don’t have health insurance?” 

Cravo and Besser also discussed the importance of collecting more detailed data about the pandemic. Information must be collected at the Zip Code level, Besser said. If not, researchers may overlook problems and miss opportunities to save lives. 

“You may miss a community that is not being well-served by testing sites …lack the broadband connection to do telehealth … or may be missing the access to hospitals with intensive care units that will lead to better outcomes with disease,” he said.

The data you collect also says a lot about whom you value, Besser said. Besser, a pediatrician and epidemiologist, was trained at the CDC. He is also the former chief health and medical editor at ABC News.

“At a time of crisis, I think there’s nothing more devastating than to feel you are not seen, that you do not have value, that your government and your representatives and your public health system doesn’t care about you,” he said. “That can be debilitating in terms of mental and emotional health.”

Besser said it is “really dangerous” to assume we will have a Covid-19 vaccine, reminding the audience that scientists have been working without success for years to develop vaccines for other global infectious diseases such as HIV, malaria, and hepatitis C. 

“While there are many (Covid) vaccine candidates that are in phase-three trials, there’s 

absolutely no guarantee that any of them – any of them –  will be safe and effective,” he said. “It’s so important that people right now follow the guidance of public health and wear masks and social distance and hand wash and do what they can to protect not just themselves, but those around them.”

If a successful vaccine is developed, distribution must be addressed. For example, one of the possible vaccines needs to be stored at minus 70 degrees celsius, which would require centralized storage and complicate distribution to remote locations.

“There has to be deep thinking about how you reach rural populations for that vaccine,” Besser said. 

Trust in the vaccine also will be key, he said. Now is the time to ramp up engagement with trusted community leaders so if there is a vaccine, people will take it, Besser said. 

Cravo and Besser both emphasized the importance of employing community health workers to extend the reach to all people. 

“People in rural communities know what they need; they know what their concerns are,” he said. “It’s engagement and listening, listening, listening and providing the resources to address the concerns and needs of each community.” 

Cravo asked Besser what the pandemic can teach us about building a nation that values all people throughout their lives. 

“One of the things about this moment that I hope is not missed is the potential for incredible transformation,” Besser said. “We are faced with this health crisis, this pandemic that is unlike anything in our lifetimes. I’ve never seen a health crisis of this magnitude. At the same time we are having an economic crisis that’s just shining a light on the disparities and inequities across our country, and added to that is an incredible movement across the country for racial justice. The occurrence of all three of those at the same time gives us an opportunity to think about what kind of society we want to have.”

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