On December 1, the Centers for Disease Control and Prevention (CDC) issued recommendations for administering the initial doses of the COVID-19 vaccine, one major step towards at last bringing the pandemic to an end. The recommendations prioritize healthcare personnel who “serve in healthcare settings.” However, what jurisdictions consider as a healthcare setting may not include those where healthcare workers may be most vulnerable: communities. Community health workers, or CHWs, are trusted members of their communities who provide individualized health services, health education, and support to community members. They form the backbone of local health systems. While the CDC’s guidelines aim to protect at-risk healthcare workers, they don’t explicitly include CHWs. State and local jurisdictions can close this gap by categorizing CHWs as healthcare personnel who receive the first doses of the COVID-19 vaccine.

Researchers at the University of Pennsylvania found that a CHW intervention called IMPaCT resulted in a return of $2.47 for every dollar invested. The reason? CHWs focus on factors like employment, housing, and access to healthy food to meet community members’ social needs. By removing barriers, CHWs make it possible for their patients to fully focus on achieving good health. However, because healthcare systems and policymakers often view CHWs as outside the scope of traditional medicine, they are underpaid and undervalued. Despite this, CHWs have continued to risk their lives to serve community members during the pandemic.

CHWs serve communities that COVID-19 has hit hardest – and those which are disproportionately communities of color, low-income, or homeless. As the federal government remains deadlocked on COVID-19 relief, these communities experience an even deeper deficit of resources stemming from historically minimal social safety nets. On top of this, many of these communities battle racial inequality that has struck through the heart of America and recently captured national attention. Facing a fatal virus and inequitable social structures that exponentiate COVID-19’s death toll, CHWs fight on two fronts to protect communities. They do so unwaveringly, but not without fear. This tension became clear to me while conducting interviews with CHWs in New Haven, Connecticut. As one CHW expressed, “With COVID, it just put in perspective. We also are vulnerable.”

The Brookings Institution reports that low-wage essential health workers have worked alongside their physician and nurse counterparts during the pandemic but with much less prestige, compensation, and access to personal protective equipment (PPE). In other words, not all healthcare workers are treated equally. It’s a truth we must reconcile by taking every means possible to protect community health workers. Reconciliation starts with the COVID-19 vaccine.

Surveys estimate that 77% of CHWs are people of color and 89% are women. Allowing CHWs to continue providing essential health services without adequate protection would embed racial COVID-19 health disparities into the healthcare system. It would permit injustice among those who work so hard to help vulnerable individuals achieve good health – individuals who often slip through the cracks of healthcare. In their efforts to prevent COVID-19 transmission, one CHW shared that, “Every client that we have been in contact with, we have to make sure that we went over the proper way to wear a mask.” These, among many other services that CHWs offer, she explained, “has helped us to keep our numbers down.” Community health workers’ efforts during the pandemic have been indispensable. By providing them with the first COVID-19 vaccine doses, their work can safely continue.

Some may question the need to prioritize vaccinating workers whose responsibilities aren’t always medically-related. After all, “CHW” is an umbrella term. It encompasses positions like community outreach workers and patient navigators, who don’t always work in hospitals. But research estimates that medical care accounts for only 10 to 20 percent of people’s health outcomes. Behavioral, socioeconomic, and environmental factors make up the other 80 to 90 percent. They’re factors that CHWs are most equipped to address through their lived experiences and unique skills.

Promising COVID-19 vaccine news brings renewed hope. The CDC, state task forces, and scholars around the country have worked tirelessly to develop a plan for vaccine distribution that will protect our most at-risk healthcare personnel. It’s no easy task to identify who they are. To do so, we must look beyond the walls of healthcare facilities to see the people who have been putting themselves at risk to serve others from the very beginning.

Serena Ly is a master of public health student at the Yale School of Public Health.

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