Elevating health equity as a priority in an outbreak or a pandemic leads to real improvements in the health crisis, a White House official told a UNMC audience.
Nikki Romanik, DO, is special assistant to the president, deputy director and chief of staff for the White House Office of Pandemic Preparedness and Response Policy. She visited UNMC in December along with Major General (ret.) Paul Friedrichs, MD, deputy assistant to the president and inaugural director of The White House Office of Pandemic Preparedness and Response Policy.
At the UNMC College of Public Health, Dr. Romanik and Abbey Lowe, PhD, an assistant professor in the UNMC College of Allied Health Professions and scholar with the Global Center for Health Security who is an expert in ethics in public health emergencies, held a grand rounds presentation titled, “Health Equity and Preparedness and Response: From COVID-19 to Mpox.”
Dr. Lowe opened the grand rounds highlighting the need for more attention given to social determinants of health during preparedness efforts for public health emergencies, but she noted the challenges for programs where response teams are accountable for large regions of the country.
Dr. Lowe highlighted the way national guidance for equitably allocating scarce medical resources had not attended to the barriers that exist rural communities due to reliance on critical access hospitals. She gave an example of the way rural communities and critical access hospital leaders across Nebraska came together during COVID to develop guidance to fill the gap that existed in prior resources that had not considered the barriers to accessing care that exist for them.
Dr. Romanik spoke from her experience both with the White House and the U.S. Centers for Disease Control and Prevention.
At the White House, she earlier served as senior policy advisor for the White House National Mpox Response starting in August 2022.
On the Mpox response, Dr. Romanik said that health equity and reaching underserved populations must be built into every line of effort – including distribution of vaccines, therapeutics and community outreach and education – or the response will not be successful.
“We put all of those things together,” Dr. Romanik said, “and things started happening faster than anyone ever thought they would.”
Dr. Romanik cited several critically important issues for health officials involved in an outbreak or pandemic, including engaging with underserved communities and using data to analyze the health issues involved. From the vaccine experience in the COVID pandemic, she said she believed pharmacies were “the greatest health equity intervention the CDC has ever pulled off” because more than 95% of people in the United States were within five miles of a location.
From her COVID-19 experience while with the CDC, Dr. Romanik gave an example from early in the pandemic when she was involved in responding to a spike in cases from Charlotte, North Carolina, and Mecklenburg County. At the time, she said, the source of the spike was unknown.
But almost immediately upon visiting the community, she said, officials knew it related to multi-generational housing in the Hispanic community.
By the end of the CDC’s visit, officials learned that the state and county had simplified the process for requesting temporary housing, and multiple options were available for people testing positive. In addition, culturally competent COVID-19 education materials were created.
“There was a full-on intervention – that entire community was ready to go before we even arrived,” Dr. Romanik said. “All they needed was a little bit of guidance. It was incredible to watch.”
The White House Office of Pandemic Preparedness and Response Policy is staffing up after its establishment in early August 2023. Dr. Romanik said now is the time to build relationships and talk about how to handle the next event.