Pathogen Genomics Centers of Excellence
Respiratory Illness in Underserved Communities

The COVID-19 pandemic brought to light many of the disparities that exist within the health care system in Minnesota. People with fewer socioeconomic resources and those in racial/ethnic minority communities were more likely to become infected and suffer the most severe outcomes. This is a trend previously seen with other respiratory conditions. Other characteristics, including living in rural locations and having limited English proficiency, also served as barriers to engaging with health care and biomedical research.

The COVID-19 pandemic also raised awareness of some of the factors that underlie these disparities. Distrust is based in:

• Historical trauma and institutionalized racism.
• Conflicting cultural beliefs about health care. 
• Lack of representation among health care and public health workforce.
• Lack of culturally and linguistically appropriate communication from the health care system
• Lack of convenient accessible services.  

The cumulative result is that there is too little research specifically about families in historically marginalized communities and their vulnerability to COVID-19 and other respiratory illnesses. With funding from the Pathogen Genomics Centers of Excellence program, the Minnesota Public Health Laboratory and the University of Minnesota aim to investigate this issue and address the disparities.

Community-based participatory research

A technique called community-based participatory research (CBPR) has proven effective in closing the gap between underserved communities and the American health care infrastructure. It entails equal partnerships between community members, health care providers, and academic researchers in all stages of the research process. 

Dr. Beth Thielen and her team at the University of Minnesota Medical School are leading the CBPR-informed effort to engage with community leaders to build trust and systematically address barriers to engaging in biomedical research. Dr. Thielen’s lab aims to diversify participation in public surveillance with the long-term goal of increasing access to prevention and treatment services. 

Central to achieving this goal are convenient home-based sampling techniques and engagement of community members in all steps of the research planning, implementation and dissemination. With greater participation in the health care system, communities will benefit from the system’s improved ability to quickly discover and address future outbreaks.

As part of this effort, Dr. Thielen and her team have begun a number of initiatives, including:

Fair outreach: At a booth in Driven to Discover building at the State Fair, representatives demonstrated the MnION portable DNA/RNA sequencer. The team used the MnION to run a genomic analysis on a corn dog. An earlier test on a grocery store corn dog yielded interesting results, which were mentioned in an episode of The Late Show with Stephen Colbert.

Rural outreach: Dr. Thielen and her team will be sharing study flyers with medical students participating in the Rural Physician Associate Program (RPAP) program. RPAP is a nine-month, community-based educational experience for third-year medical students at the University of Minnesota who live and train in rural communities across Minnesota and western Wisconsin.

Immigrant and refugee outreach: The project enabled the hiring of four community liaisons to facilitate outreach to immigrant communities. All are internationally trained physicians and are bilingual: Hassan Roble speaks Somali, Naol Olana speaks Oromo, Chanita Phichaphop speaks Thai, and Atefa Tavasoli speaks Afghan and Dari. The team also has fliers in Somali, Oromo, Dari and Thai that are awaiting approval from the Institutional Review Board at this writing.

Clinic-based outreach: The team is in the process of developing a partnership with Axis Clinics to better reach its patients.

Using cutting-edge technology

The Public Health Laboratory will use next-generation sequencing (NGS) to analyze patient samples and detect respiratory viruses. Recent improvements in NGS should enable us to efficiently characterize both established viruses and any newly discovered pathogens.

With this project, the Public Health Laboratory and the University of Minnesota are practicing the principles of health equity. To decrease health disparities, health care institutions must not rely on “one-size-fits-all” solutions. They must instead acknowledge the concerns of underserved and historically disadvantaged groups and address them in ways most likely to bring improved health outcomes.