Stephen P. Thomas, director of the Center for Health Equity at the University of Maryland, considers himself an eternal optimist. When he reflects on the devastating pandemic that has been raging for the past three years, he chooses to focus less on what the world has lost and more on what it has gained: powerful antivirals, powerful vaccines, and most importantly the unprecedented collaboration between the clinicians, academics, and community leaders who helped provide those lifesaving resources. life for the many people who need it most. But when his efforts during the pandemic helped turn more than 1,000 black barbershops and salons into COVID-vaccine clinics, he’s looking ahead to the next few months, worried that the momentum will start to fade — or worse, that it will start to go in the opposite direction.
The Biden administration announced this week that it will allow a public health emergency declaration over COVID-19 until it expires in May — a transition expected to put shots, treatments, testing and other types of care out of reach for millions. of Americans, especially those without insurance. The move has been a long time in the making, but for community leaders like Thomas, whose vaccine-advocacy project, Shots at the Shop, relied on emergency funds and White House support, the move could mean putting local infrastructure at risk. And his colleagues have been building for years. It shouldn’t be an inevitability, he told me, that community vaccination efforts will eventually die out. “The silver lining of the pandemic has been the realization that local strategies are working,” he said. “Now we are seeing the erosion of that.”
I called Thomas this week to discuss how the emergency declaration has allowed his team to mobilize resources for outreach efforts — and what might happen in the coming months as the nation tries to return to normal life.
Our conversation has been edited for clarity and length.
Catherine J. Wu: Tell me about the genesis of Shots at the Shop.
Stephen B Thomas: We started our business with hair and beauty salons in 2014. This business is called: HAIR: Health Advocates In-Reach and Research. Our focus was on colorectal cancer screening. We brought medical professionals—gastroenterologists and others—into the store, recognizing that black people in particular were dying from colon cancer at rates that were unacceptable but that could have been prevented with early diagnosis and proper screening.
Now, if I could talk to you about a colonoscopy, I could probably talk to you about anything. In 2019, we held a national health conference for barbers and stylists. They all came from all over the country to talk about different areas of health and chronic diseases: prostate cancer, breast cancer, and more. We brought them all together to talk about how we can address health disparities and have more agency and visibility for this new frontline workforce.
When the pandemic hit, all plans coming out of the National Convention were put on hold. But we continued our efforts in the barbershops. We started Zoom Town Hall. And we started to see misinformation and disinformation about the pandemic spreading in our stores, and there were no countermeasures.
We were picked up in the national media, and then we got the White House nod. That’s when we launched Shots at the Shop. We’ve had 1,000 stores sign them in, shall I say, in less than 90 days.
Wu: Why do you think Shots at the Shop was so successful? What was the network doing differently from other vaccine outreach efforts that spoke directly to black and brown communities?
Thomas: If you come to any of our clinics, do not feel like you are coming to a clinic or hospital. You felt like coming to a family reunion. We had DJ music going around. We had food. We had a festive environment. Some people showed up undecided, some left undecided but vaccinated. We didn’t have to change their worldview. But we treated them with dignity and respect. We didn’t tell them they were stupid and didn’t understand science.
And the model worked. It worked so well that even health professionals were thrilled, because now all they had to do was show up with the vaccine, and arms were ready for needles.
Barbers and stylists saw themselves doing health-related things anyway. They’ve always seen themselves as doing more than just cutting hair. No self-respecting black barber would say, “We’ll be in and out in 10 minutes.” It doesn’t matter how much hair you have: it’ll stay in there for half a day.
Wu: How different do you think your network’s outreach efforts are in narrowing the racial gaps in COVID-19 vaccination?
Thomas: Attribution is always difficult, and success has many mothers. So I will tell you this: I have no doubt we made a huge difference. With a disease like COVID, you can’t afford an unprotected pocketbook, and we’d be vaccinating people who wouldn’t otherwise be vaccinated. We were dealing with people at the wall of Hell.
We were also vaccinating people who were homeless. They were treated with dignity and respect. In some of our stores, we have rounded up coats and booties for boots. We had dentists who provided us with oral hygiene items: toothbrushes, floss, toothpaste and other things. It makes a huge difference. When you meet people wherever they are, you have to cater to all their needs.
Wu: How different has declaring an emergency and freeing up resources, tools, and funds to your team’s communication efforts?
Thomas: Even with all the work I’ve been doing at the barbershop since 2014, the pandemic got us our first grant from the state. Money poured in. We had resources to go beyond the typical mechanisms. Managed to secure thousands of KN95 masks and distribute them to stores. Same with rapid tests. We even sent them boxes of Corsi-Rosenthal, a DIY filtration system for cleaning indoor air.
Had it not been for the emergency declaration, we would still be in the desert screaming for help. The emergency declaration made it possible to get resources through unconventional channels, and we were doing things that other systems—the hospital system, the local health department—couldn’t do. We have extended their reach to populations that have historically been underserved and mistrusted.
Wu: The declaration of a public health emergency has not expired yet. What signs of problems are you seeing now?
Thomas: The bridge between the barbershop and the clinical side has closed in almost all places, including here in Maryland. I go to the store and they say to me, “Dr. T., when are we going to get the boosters here?” Then I call my clinical associates, who give injections. Some won’t even answer my phone calls. And when they do, they say, “Oh, we don’t design pop-ups anymore. We don’t do community outreach clinics anymore, because the grant money is gone. The staff we hired during the pandemic, they’re using pandemic funding—they’re gone.” But people are here. They want the booster. And my partners at the clinic say, “Send them to the pharmacy.” Nobody wants to go to a pharmacy.
You can’t see me, so you can’t see the smoke still coming out of my ears. But it hurts. We made them trust. If you abandon society now, it will simply reinforce the idea that it doesn’t matter.
Wu: What is the response to this from the communities you are talking to?
Thomas: It’s “I told you that, they didn’t care about us. I told you they were going to leave us with all these other basic conditions.” You know, it shouldn’t take a pandemic to build trust. But if we lose it now, it will be very difficult to rebuild it.
We built a bridge. it worked. Why break it up? Because that is exactly what is happening now. The infrastructure we created to bridge the racial gaps in vaccine acceptance is being dismantled. It is totally unacceptable.
Wu: An emergency declaration was always going to end at some point. Was it necessary to play this way?
Thomas: i don’t think so. If you speak to hospital officials, they will tell you the emergency declaration and the money that allowed them to add outreach. And when the money was gone, they went back to business as usual. Although awareness has proven that you can actually do better. The disinformation and disinformation campaign did not stop. Why go back to what doesn’t work?
Wu: What is your team planning to do in the short and long term, with limited resources?
Thomas: As long as Shots at the Shop can connect with clinical partners to get access to vaccines, we will certainly continue to do so.
Nobody wants to go back to normal. Many of our barbers and stylists feel like they are on their own. I am doing my best to provide them with KN95 masks and rapid tests. We’ve been keeping the conversation going in our bi-weekly Zoom town hall. We just launched a podcast. We offer some of our stories in the form of a graphic novel, Barber shop story. And we’re trying to launch a national association of barbers and stylists called Barbers and Stylists United for Health.
The pandemic has galvanized innovation, the recognition of community-wide brilliance, and the recognition that you need to culturally tailor your strategy. We need to keep those relationships intact. Because this is not the last time we will see an epidemic even in our lifetime. I do my best to knock on doors to keep putting our proposals out there. We hope people realize that reaching out to the Black and Hispanic communities is worth continuing.