Estruth: COVID-19 vaccine rollout in Silicon Valley renews fight for health, racial justice

COVID-19 infections continue to rise across California, including in Santa Clara County, where ICU beds are nearly full.

The virus continues to harm people of color disproportionately. According to the Santa Clara County Department of Public Health Emergency Operations Center, Latinx people have suffered 51% of the county’s COVID cases, despite being only 25.8 percent of the population. Black and Latinx people have died at 2.8 times the rates of white people; American Indians have died at 2.6 times the rate nationally.

Given the racially disparate impact of the management of the virus, and the current COVID vaccine rollout, it is constructive to think about previous vaccination and racial justice campaigns in the South Bay.

Between 1965 and 1971, the new availability of Medi-Cal provided a basis for San Jose residents to make bolder political claims for racial justice in the provision of medical care.

In 1965, the federal government established the Medicare and Medicaid programs. Medicare launched a universal program that served the elderly and Medicaid was a means-tested program that provided health care to low-income and disabled people. The 1965 Medicaid legislation established Medi-Cal, California’s own administration of the federal program.

In 1971, the newspaper San Jose Red Eye reported a case of insufficient support from Medi-Cal in providing public healthcare coverage for Latinx women. Most doctor’s offices and hospitals were on the west side of San Jose, and transit access from the east side to medical facilities across town was a major issue facing the community. This was a real impediment to accessing Medi-Cal care.

An elderly patient contacted the newspaper to report that her Medi-Cal doctor’s office was indifferent to her inability to travel in for an appointment. She had said the distance was an undue impediment, and was outraged at the doctor’s office’s disrespect for her situation.

The newspaper demanded Medi-Cal care be provided by more Latinx doctors, and include transport from predominantly Latinx neighborhoods.

Around the same time, in the Mayfair district, longtime activist Sofia Mendoza established a clinic for the sole purpose of making vaccines available to children who lived in the neighborhood.

Mendoza had initially founded a child and mother development center there, where, on the model of the new federal program Head Start, neighborhood children, largely Latinx and African American, could enjoy pre-kindergarten educational activities.

The center had space, equipment and group time for mothers to teach their children things like how to count, how to identify the colors of the rainbow, developmental milestones such as how to tell time on a clock and build small motor skills such as how to tie shoelaces. Mendoza employed local mothers to run the center, which she called the Community Improvement Center.

During the early years of the program, Mendoza noticed mothers reported difficulties obtaining and maintaining their children’s early childhood vaccinations. Largely, the mothers attributed this hardship to the long commute and inadequate public transport to downtown for vaccination visits.

Coordinating mothers’ work schedules with the doctors’ available appointments, and the appropriate vaccination timetables with available public transit, often meant children did not obtain the vaccines on the schedules they needed for vaccines to be effective.

Mendoza began a campaign to broaden access to childhood vaccinations. She repeatedly took buses from east San Jose to the downtown hospital, and would time the long trip, documenting the journey.

Mendoza brought her evidence to the San Jose City Council and agitated at meetings for years. Ultimately, Mendoza received funding from the city to establish a small family clinic on the east side of San Jose. Her demands for racial and medical justice had gone hand in hand, and this clinic proved a great benefit to the health of a traditionally underserved neighborhood.

In those crucial years after the introduction of Medicaid, its expansion had opened space for Latinx people in San Jose to make deeper political claims on the state’s unequal provision of health care. These claims had long term and durable anti-racist implications.

Medi-Cal now serves about a third of the population of California, but state guarantees of free medical care still have a long way to go.

Under present labor conditions, Latinx Californians are more likely to work jobs that are categorized as in-person and less likely to have paid sick leave, paid family leave, paid time off and occupational safety and health protections compared to their white neighbors.

The United States, uniquely among industrialized nations, relies on for-profit health care providers and employment-based insurance, two systems which are racially and economically exclusionary.

For years prior to this pandemic, public health officials, researchers, health care workers and epidemiologists warned the country’s patchwork medical system, characterized by unequal access, high out-of-pocket costs and large numbers of uninsured and under-insured people was ill-equipped to weather a respiratory pandemic. These warnings have, unfortunately, come to pass.

Profound changes are urgently needed in how we administer and provision health care.

More than 400,000 Americans are dead. This is an agonizing and unpardonable loss of human life, the true social toll of which will take years for us to collectively understand. As the country continues to roll out the COVID-19 vaccines, we are faced with a large-scale challenge which can only be met with a large-scale response.

The new White House administration has an urgent mandate, and a critical need, to restructure our health care system.

This restructuring must include strong occupational health protections, ample paid time off work, paid sick leave, predictable hours, direct and unrestricted financial support for mothers and children, paid and year-long maternity leave, free long-term and elder care and a high enough minimum wage so people only need to work one job to support their families instead of moving between multiple workplaces.

Not only are these the bare minimum prerequisites for our national health and labor policies to begin to address the racial inequities that are causing the unequal impact of the coronavirus, but they will also, like Medi-Cal, Head Start and public clinics did in the 1960s, provide the terrain on which we can fight for the next horizons of racial justice in this country. This national restructuring is critical to racial and health justice. And it must happen now.

J.A. Estruth is Assistant Professor of History at Bard College, and Faculty Associate at the Berkman Klein Center for Internet and Society at Harvard University.