Should people of color get access to the Covid-19 vaccine before others?

By now, we all know that Covid-19 is not an equal-opportunity killer. Black, Latinx, and Indigenous people are getting the disease more often and suffering more severe outcomes than white Americans.

The most glaring statistic: 1 in 1,000 Black Americans have already died in this pandemic. In the US, Black residents have been dying at twice the rate of white residents.

There’s nothing about being Black, in and of itself, that makes people more biologically susceptible to Covid-19. Instead, the disproportionate impact is due to an accumulation of factors from centuries of systemic racism. Discriminatory housing policies like redlining have made it harder to maintain social distance. Unequal education and job opportunities have compelled people to take on higher-risk work. Worse health care access has bred more underlying medical conditions.

A society that has foisted all these conditions on minority groups, which now make them more vulnerable to Covid-19, has to ask itself: When a vaccine is discovered, should people of color get priority access?

There’s definitely a strong ethical and epidemiological argument for it. We’ve got a moral duty to redress injustice, plus a public health duty to prevent as much death as possible — and since people of color are dying at higher rates, maybe they should be at the front of the line for the vaccine.

Melinda Gates is among those making this argument. When Time magazine asked her who, aside from health care workers, should get first dibs on a vaccine, she said, “In the US, that would be Black people next, quite honestly, and many other people of color.”

But others have raised concerns. What if many non-Black people resent Black people for getting prioritized, heaping more stigma and racism on them? What if many Black people don’t feel comfortable being among the first in line for a new vaccine, given the horrific history of medical experimentation on African Americans? Some people of color expressed this worry in response to Gates, saying, “In other words, we’re the guinea pigs,” and, “We are not crash test dummies, we’ll go after you.”

Experts at the National Academies of Science, Engineering, and Medicine (NASEM) on Friday proposed a workaround in a new report, which they wrote at the request of the Centers for Disease Control and Prevention (CDC) and the National Institutes of Health. Instead of using race as the criterion, a vaccination program could use location — perhaps at the zip code level or census tract level — when deciding where to concentrate vaccine allocation. That would allow the US to target low-income communities with fewer health care options and more underlying medical conditions.

Before the NASEM report, the World Health Organization and the Johns Hopkins Center for Health Security also released reports about how to distribute vaccines fairly on the national level. (How to do this fairly on the international level is a whole other question, tackled here.) All three reports agree that the country should take a phased approach to allocation and that front-line health care workers should get the vaccine in the first phase, before other population groups.

They also agree that racial equity is key. NASEM specifies that it should be a crosscutting consideration in each phase of allocation, meaning that within each population group, vaccine access should be prioritized for geographic areas that are especially vulnerable.

In the preface to the NASEM report, the authors note that the US is at a moment when racism is at the center of national discourse. “Inequities in health have always existed, but at this moment there is an awakening to the power of racism, poverty, and bias in amplifying the health and economic pain and hardship imposed by this pandemic. Thus, we saw our work as one way to address these wrongs,” they write.

The question is: What is the best way to put that commitment into practice?

Two options — a race-based approach and a place-based approach — have emerged as dominant possibilities when it comes to ensuring equity toward minority groups. But each has pros and cons. Let’s break them down so we can tease out which approach works better, and whether there might be a third option.

https://www.vox.com/future-perfect/2020/10/2/21493933/covid-19-vaccine-black-latino-priority-access