Giving Health Equity a Fair Shot

“All of the big multicounty, multistate entities had already received Pfizer on the first day,” said Abraham, a family physician, global injury epidemiologist and medical quality specialist for Kedren. “Meanwhile, we had health care workers dying from COVID, and no one had called us about vaccines. We were left out right away, and you have to wonder why. That was another testament to the challenges we face with achieving health equity in our community.”

Abraham, who has taken on the added role of director of vaccines for Kedren during the pandemic, started making phone calls. Before long, he was knocking on the door of the county health department’s warehouse.

“We said, ‘We’re not leaving until we get some vaccines,’” he said.

By Dec. 30, Kedren had started vaccinating its own staff, and then kept the work going.

“We quickly turned to our neighbors and made sure Black and brown health care workers who had been shut out because they worked at small or solo doctors’ offices were vaccinated,” he said. “We weren’t going to let barriers stand in their way.”

Then Abraham started knocking down barriers for his patients and others in the largely minority community, finding interpreters who could communicate in the many languages spoken in Los Angeles, as well as volunteers who could assist patients (many of whom lack internet access) with paper forms. The result was access to immunizations, without appointments, for people who were undocumented, people who were experiencing homelessness and other marginalized populations.

By mid-March, Kedren was vaccinating up to 15,000 people a week.

“That’s not easy because we were only getting 6,000 doses a week,” he said. “We’ve had to come up with creative solutions, like racing around the county and working in collaboration with the Department of Public Health to find expiring doses that were literally being thrown in the garbage.”

Abraham said nursing homes, hospitals and even grocery stores were allocated more doses than they could administer, while smaller facilities like Kedren were scrambling to meet demand.

“If you’re a nursing home or an acute hospital, it’s not your job to open the doors and vaccinate the public,” he said. “Nursing homes got a lot of allocations at the very beginning, as they rightfully should have, because nursing home patients were dying. If it was a reoccurring allocation, they didn’t know what to do with any extras. People were throwing them away. I understand why it happened. We’ve made it clear that’s not the right way to handle it.”

Abraham said efforts to round up those “extra” doses have been crucial to his organization’s success, accounting for thousands of doses of vaccine administered each week.

On one Friday night, for example, Kedren received 600 soon-to-expire doses from a nursing home at 5 p.m.

“We had to race to get 600 doses into people’s arms before midnight,” he said. “Everybody stayed well past closing to get it done. That’s the kind of tenacity, perseverance and commitment we talk about. Our intensivist colleagues in the ICUs are racing around the clock to keep people from dying. We have the same intensity and passion at the vaccine center. There’s not a minute to lose and not a drop to waste. We can’t stop and won’t stop until 70 percent of our population is vaccinated so we can end this pandemic, and we’re well on our way there.”

Abraham’s vigilance and tenacity were noticed by the local media, which led to national attention. A Feb. 5 interview on MSNBC with Rachel Maddow got the attention of California Gov. Gavin Newsom and Los Angeles Mayor Eric Garcetti, who visited Kedren’s vaccine clinic, as well as the state’s representatives in Washington.

“That’s when they realized we can and should do things differently when it comes to equitable vaccine distribution, not only in Los Angeles but across California and the whole country,” said Abraham, who testified before the Senate Committee on Health, Education, Labor and Pensions on March 9. “We became the exemplary role model — the center for excellence for how to equitably distribute and administer these vaccines across America. It’s a template others can follow across the nation.”

Kedren has administered more than 160,000 doses of the COVID-19 vaccine. It has launched a fleet of mobile vaccination units and opened a second vaccination satellite site in the Watts neighborhood in South Los Angeles. Kedren not only has offered vaccination to its own patients but to thousands of others in the community. Abraham likened the vaccine to a “gateway drug” for primary care, mental health and preventive services.

“We’re hoping this vaccine helps people enter the primary care system in a way they haven’t before,” he said.

He also hopes innovation and outreach don’t end with the pandemic.

“What we’re building here isn’t just about COVID and vaccines,” he said. “What it’s really about is building public health infrastructure where one was lacking. We need to transform and revolutionize the health care delivery system so that during the next crisis people don’t die needlessly because they live in a predominantly Black and brown community where resource allocation just isn’t there. We have to get it right because this won’t be the last time. We’ll be better prepared for it because of what we’re doing today. We cannot afford to go back to business as usual once this pandemic ends.”

Abraham prepared for his role in the pandemic with an abundance of local, state and national leadership roles. He is the secretary of the Los Angeles County Medical Association, a trustee of the California Medical Association and a delegate of the AMA House of Delegates.

“Role after role has shaped my trajectory,” he said. “Those things aren’t coincidences, warm fuzzies or events we go to get CME credit. They’re things that transform the work we do. I’ve been listening and paying attention. The investment family medicine made in me helped me be prepared to answer this call.”

Abraham, who was chief resident at the family medicine residency at the University of Southern California Family Medicine Residency Program at California Hospital Medical Center and president of the Student Government Association at Rollins School of Public Health at Emory University, said his leadership roles go back to being class president as a second grader. He’s been on a health care career path almost as long.

Abraham’s mother was a nurse at St. Joseph’s Hospital in downtown Houston. During Take Your Child To Work Day in seventh grade, he observed his first colonoscopy.

“I was like, ‘Woah, what is going on here?’” he quipped.

More importantly, Abraham said, he saw “what compassion could be.”

“I went there as much as I could because I loved that environment,” he said. “I loved the marriage between ministry and medicine that I saw at a Catholic charity hospital serving the inner city as a safety net. It was so powerful to see nuns who were nurses, priests who were physicians, the laity and deacons serving patients. I’m drawn to that kind of service.”

Abraham, in fact, was studying to be an Episcopal priest when he was accepted to medical school at the University of Texas School of Medicine San Antonio.

“I had to choose between caring for people’s souls and emotional lives and physical healing,” he said. “It was a hard decision to make. But I know I’m doing what I’m supposed to do, which is helping as many people as I can, and I don’t necessarily need to wear a collar to do it.”