Mayor Eric Garcetti, the 42nd Mayor of Los Angeles.
Mayor Eric Garcetti, the 42nd Mayor of Los Angeles.

The Logistics of Leadership: Mayor Eric Garcetti on Vaccine Distribution, Equity, and Pandemic Preparedness in Los Angeles

Stretching from the edge of the Pacific Ocean to the top of the Hollywood sign, Los Angeles (L.A.) is the second largest city in the United States with a population of nearly four million people. The sprawling metropolis has faced intense challenges grappling with the pressures of pandemic response, vaccine distribution, and systemic racism. With a rapidly declining COVID-19 case count, L.A. continues to lead the way in implementing preventative public health measures through equitable vaccine distribution.

On Friday, March 19, 2021, the Voices in Leadership webseries welcomed Mayor Eric Garcetti, the 42nd Mayor of Los Angeles, and Dr. Howard Koh, Harvey V. Fineberg Professor of the Practice of Public Health Leadership at the Harvard T.H. Chan School of Public Health and the Harvard Kennedy School. Their discussion covered leadership during the COVID-19 pandemic, combating social factors of health, and addressing systemic racism across the city.

Eric Garcetti graduated from Columbia University as part of the John Jay National Scholars Program, where he studied political science and urban planning. Upon graduation he accepted a Rhodes Scholarship to Oxford University, before studying for his PhD in ethnicity and nationalism at the London School of Economics. First elected as mayor in 2013 and reelected in 2017, he is the city’s first Jewish mayor and second consecutive Mexican-American mayor. At the time of his inauguration, he was 42 years old, becoming L.A.’s youngest mayor in the last 100 years.

Collaboration during COVID-19

The ongoing pandemic has elevated the public health response in L.A. to the national stage. As the epicenter of southern California, the city has faced insurmountable pressures on healthcare systems and local governments. Both L.A. and California were among the first to implement strict public health measures to prevent large gatherings and deter the spread of COVID-19, as early as March 12, 2020. Since L.A. lacks its own city-level health department, Mayor Garcetti partnered with mayors and healthcare officials from all 88 cities in the larger L.A. county, encompassed under the Los Angeles County Public Health Department. In reference to leadership during a crisis, he stated: “I learned that leadership is not about what you say. It’s what you do. And it’s really about your ability to execute on logistics.”

During this time of crisis, L.A. has instituted some of the U.S.’ most progressive policies on extended paid leave benefits in an effort to alleviate economic strain on city residents. Preventing income loss is one of the most effective public health strategies to prevent lack of housing, ensure childcare, and deter excessive COVID-19 exposures. As a founder of Mayors for Guaranteed Income, Mayor Garcetti’s work continues to support the implementation of “pro-human” policies to first support Los Angeles residents.

Initially, the U.S. was consistently ranked as one of the countries likely to be most prepared to handle a pandemic; however, the COVID-19 response has been left largely to state and city governments, instead of being nationally implemented at the federal level. Leadership at the local level varies widely, exposing greater inequities within the healthcare system. For example, ongoing vaccination efforts enacted by local leaders has hindered the response of large metropolitan areas. Mayor Garcetti noted: “L.A. city is bigger than 23 states. L.A. county is bigger than 45 states. But yet, we still have to go through three layers of bureaucracy before we get our vaccines.” While he anticipates the challenges ahead in continuing vaccine distribution, his leadership has prepared the city to address vaccine allocation in an equitable manner, curbing concerns of elderly populations and other deeply impacted groups, while simultaneously addressing the repercussions of medical harm against historically and currently oppressed communities.

Mayor Eric Garcetti, the 42nd Mayor of Los Angeles (Right), was virtually interviewed by Dr. Howard Koh, Harvey V. Fineberg Professor of the Practice of Public Health Leadership at the Harvard T.H. Chan School of Public Health and the Harvard Kennedy School, (Left) for the Voices in Leadership web series for the Harvard T.H. Chan School of Public Health.
Mayor Eric Garcetti, the 42nd Mayor of Los Angeles (Right), was virtually interviewed by Dr. Howard Koh, Harvey V. Fineberg Professor of the Practice of Public Health Leadership at the Harvard T.H. Chan School of Public Health and the Harvard Kennedy School, (Left) for the Voices in Leadership web series for the Harvard T.H. Chan School of Public Health.

Addressing Preventable Public Health Outcomes

Known for its highly diverse population, L.A.’s leadership must take into account the various inequities in health, income, and education when implementing policy. L.A. is home to the wealthy Hollywood elite. It also encompasses some of the most impoverished and exploited communities in the U.S. With white families earning 90 times more than Black families, L.A. is home to one of the U.S’ largest income inequality gaps.

Along with income disparity, L.A. has a large population of unhoused people. Within unhoused populations, there are large degrees of racial inequities, with 42% of L.A’s 44,000 unhoused individuals coming from Black communities. As the city’s budget to address lack of access to permanent housing has increased 16 fold, there is still a largely unaddressed need for affordable housing that is not being adequately achieved using Section 8 vouchers. Mayor Garcetti opined that money is not the answer in dealing with housing inequities, stating: “until we have two things in this nation, a right to housing and a substantive mental healthcare system that reaches everybody at stage one, we will continue to see unhoused Americans on our streets and in our communities.”

L.A. has implemented a goal to end the chronic transiency of unhoused people by 2028; however Mayor Garcetti acknowledged the struggles the city will face in addressing increasing inequity and connecting affordable, safe housing with public health outcomes. He stated: “when it comes to housing, [it’s] probably as important as eating and as your health, right up there, tied with it. We say nope, it’s a lottery. You qualify for it [Section 8 Housing], but sorry. In this nation, it’s a one in four chance” and “in my city it’s a one in eight chance.”

Reallocation of police Funding

Along with the entirety of the U.S., L.A. has a long history of systemic racism. Reflecting on the pandemic response, the murder of George Floyd by police, and the recent violence against Asian women in Atlanta, Mayor Garcetti shared: “These are reflections of the same thing — inequity. Health inequity, racial inequity, housing inequity all tie together.” And “when you tie these things together, you start to understand how the solutions are also tied together.”

Mayor Garcetti has promised to allocate US$250 million to Black communities, with US$150 million being reallocated from L.A. police departments. Acknowledging the need for adequate mental health responses, L.A. plans to roll out 24/7 mental healthcare vans to respond to mental health-related 911 calls. The intention of these initiatives is to reduce police violence and afford additional health protections to Black communities.

As the U.S. pushes national vaccination efforts and faces the realities of an inequitable healthcare system, Mayor Garcetti continues to pursue progressive, logistics-based leadership and set an example for the importance of effective local leadership.

Story written by Samantha Tracy, a Master of Science candidate in Environmental Health, concentrating in Environmental Exposure Assessment, at the Harvard T.H. Chan School of Public Health. Samantha is a member of the Climate Leaders Program, a part of the Council of Student Sustainability Leaders, and a former Rose Service Learning Fellow. She grew up in coastal North Carolina where she connected with the dangers of the climate crisis and the threat of natural disasters on public health. She holds a dual Bachelor’s degrees in Biology and Psychology from the University of North Carolina at Charlotte and currently interns at the Region 1 office of the U.S. Environmental Protection Agency. Outside of school, Samantha is interested in the connections of ecosystems and health and has a passion for exploring and protecting the environment.

Story edited by Sherine Andreine Powerful, MPH (ID: Sherine, Mx., she, they), a Doctor of Public Health candidate at the Harvard T.H. Chan School of Public Health. As a Black Caribbean Feminist, she is committed to celebrating and furthering pleasure, healing, and liberation for Black, Brown, and Indigenous peoples and persons of diverse a/genders and a/sexualities, particularly those from the Caribbean. In this current critical juncture, her lived experiences are moving her towards the creation/curation of a life in which pleasure is greater than productivity. Her present interests additionally include feminist global health and development; gender and sexual health, equity, and justice; and resilience and anticolonial sustainable development in the context of climate change.

Voices in Leadership webcast series enhances leadership, connecting high-profile leaders with the Harvard School of Public Health community. hsph.me/voices