Dr. Marcella Nunez-Smith is an associate professor of internal medicine, public health, and management at Yale University and one of the co-chairs of President-elect Joe Biden’s Transition COVID-19 Advisory Board. Dr. Nunez-Smith has spent much of her career studying the effects of social and racial inequality on health outcomes, making her appointment to the committee a powerful signal that the incoming president seeks to address the disproportionate impact that this pandemic has had on communities of color. But, as Dr. Nunez-Smith outlines, it’s all but impossible to find an individual who has not, at this terrible point, been affected by COVID-19. Vogue spoke with her about her priorities, her plans, and how she maintains hope in these very dark times.
Vogue: Tell me a little about your background, and how that has influenced your career.
Dr. Marcella Nunez-Smith: I grew up in St. Thomas, in the U.S. Virgin Islands. It was an amazing, remarkable childhood for lots of reasons: a vibrant, supportive community of people; a lot of natural beauty and wonder; a tremendous family that offered lots of support, love, and encouragement. As I got older, I became more aware of the structural realities [of] living in a territory when it came to questions of health care and access—the fact, for example, that health insurance policies didn’t cover certain things just because we lived in a territory rather than a state. I had and have many people in my life who are part of the health-care system, and being able to hear through their stories and the stories of folks in the neighborhood how hard it was to get and maintain care later informed some of my research questions and interests.
I came to the mainland for college and started at Swarthmore when I was 16. It was a place that offered a tremendous liberal arts education combined with the experience of small campus life—that was important to me as someone who came from a high school that had something like, 42 people in it. In my family, education and deep curiosity were valued, but Swarthmore was a formative part of my formal education in terms of developing a spirit of inquiry and acquiring a set of tools to ask deep questions.
You’ve spoken about confronting racism in the medical community. In one interview, you talked about patients handing you their food trays and asking you for their doctors after you’d introduced yourself as their doctor several times. Can you tell me more about your personal experience and how it’s influenced your thinking about racism in medicine?
It is not uncommon for me to run through a plan with a patient and then have them say, “I’m going to wait until a doctor comes in”—and this is after having been really clear about my role. Sometimes I’ll be working with a team as the attending physician, and the resident will have explained that I’m the supervising doctor, and the patient will still look to the resident for the final word. There have been many times when patients have said, “I don’t want a black doctor” to my face.
The experience of health-care workers of color in the system is really important in and of itself, but it also relates to patients moving through the system. If we have an environment in which the people who work there find difficulties and closed doors and micro- and macro-aggressions, what is this like for our patients? Sometimes we have patients of color who express relief—relief and pride—in having a provider of color. This can be very healing for me. Medicine as a profession has been really silent on issues of race and discrimination for a long time, and that normalized things like patient mistreatment of providers or different patients getting treated differently.
Tell me about being appointed co-chair of Biden’s Transition COVID-19 Advisory Board. Did you have a relationship with the other advisors before this began? Were you working on the campaign?
I am really deeply honored to have the opportunity to serve the president-elect and VP-elect in this way. I have been working on COVID-19 issues from the beginning of the pandemic, particularly the way that the virus has disproportionately impacted certain communities. I was not very involved with the campaign, but I did some briefings in late August. It’s really notable that both President-elect Biden and Vice President-elect Harris are committed to issues of equity and that they see their work as [creating] equity in the short and long-term recovery from COVID. The other co-chairs, Dr. David Kessler, Dr. Vivek Murthy, as well as all the members, bring a huge wealth and depth of experience, and we’re grateful to be able to offer that experience to the teams who have been working behind the scenes, around the clock to put a plan in place.
Do you feel there’s a danger in the way the Trump administration has fought a smooth transition?
There is risk when we don’t have open lines of communication between current career officials in the federal government and the transition team, and the president-elect has spoken about this, saying that lives will be lost because of this unprecedented lack of transition communication. But the policy team and the advisory board on the Biden-Harris side are working every day to make sure there are plans in place and ready to go on day one. Would it be more efficient and better if there were open lines of communication? Absolutely.
I think most people understand that this virus has hit communities of color the hardest. What do people not understand about the racially and ethnically related effects of the virus?
It is true that we continue to see mortality rates two times higher among communities of color, particularly among Black Americans. In Black communities, 50% of people know someone who has died. There has been a gap in grief and suffering and disproportionate economic impact. But it’s important for people to understand that these realities are the effects of systemic policies and intergenerational denial of access to resources. That’s what is driving the disparities we see now.
When we talk about preexisting conditions and the risks that are conveyed with those conditions, we don’t look backwards. It can be easy to say people have made bad choices and that’s why they are living with diabetes or hypertension. But prevention begins with access to high-quality health care. We don’t think about the environment: Is there access to healthy food, safe outdoor space for exercise? We don’t talk about the environmental toxins that contribute to asthma or other conditions. We don’t talk about the over-representation of Black and brown people in frontline jobs that we have deemed essential—or people who have to go out to sustain their livelihoods. It’s important to put those factors on the radar. Otherwise, it can seem like race is a biological phenomenon—which it is not—and it puts the onus on the individual to do better without understanding the broader picture.
We have surpassed a number of deaths that seemed inconceivable when the pandemic began, with more than 250,000 people dead from COVID-19. And yet, people continue to behave in ways that put themselves and others at risk. Do you think that this is persisting because of a degree of racism in the way that people are processing those deaths?
From my perspective, it is troubling how slowly the reality has been sinking in. This is all anecdotal, but I have heard that some people, in more affluent communities early on, said things like, “This is a disease that affects people of color.” It became this othering that allowed people to say, “I’m not part of that group, I don’t need to curtail my behavior or socially distance or use face coverings.”
But the sad reality is that it’s getting harder and harder to find a person of any background who doesn’t know someone who has been significantly affected by COVID. So much of how we experience information and how we experience truth is through our tight social networks. There might be, for many, an understanding now that they didn’t have in March.
According to a PEW Research Center survey from September, the number of people who say they would get a vaccine is fairly low and has been declining over the course of 2020. [This was before the Pfizer and Moderna announcements in recent days.] Reluctance is particularly high among Black Americans, who have cited racist medical interventions of the past in their reasoning. How do you counter this kind of thinking and help people become comfortable with the vaccine?
There are a lot of shared concerns across communities and across different demographic groups. People have been looking for reassurance around safety primarily, so it is important [that] we are communicating around safety in all messaging surrounding the vaccine. I think another lesson that we’ve learned is that messaging is not one-size-fits-all. Early on, we said that everybody needed to stay home. Well, we know that legions of people couldn’t stay home. Maybe the guidance wasn’t as sharp as it needed to be about how to protect yourself at work, how to navigate transport. People need to hear the message and say, “That message is for me.” In that same way, we have to think about what the concerns are about the vaccine and make sure people can see those concerns reflected back to them. Yes, the level of skepticism is higher among Black Americans. And if the concern is about historical mistreatment, the message needs to be about research and safety.
You have spoken about finding joy in the challenges of your work. How do you maintain optimism, especially this year?
We are in the darkest place now—period, full stop. We are on a precipice, and there isn’t a way to color that differently. Can we disrupt this? I think and hope so, if we can all get unified around the things we know work. Where I find hope and optimism is that we know a lot more now about how to treat COVID 19, and the vaccine is on the horizon. We also know the public health measures that work: tight social bubbles, using a face covering. I also find some optimism in the national reckoning we’re having around race and racism, and [the idea] that so many are now thinking about equity in the work that they’re doing. Those are moments where there can be light and hope.
This interview has bee edited and condensed.