Race and ethnicity could be the deciding factors in determining whether essential workers will be second in line for vaccination for the novel coronavirus.
Defenders of this position say COVID-19 harms a higher percentage of racial
and ethnic minorities, and so they should be prioritized by the Advisory Committee on Immunization Practices, the body within the Centers for Disease Control and Prevention charged with constructing a plan for allocating the vaccine. The committee is set to unveil its recommendations Tuesday.
"If you look at the burden of disease and death in the U.S., it is disproportionately impacting communities of color," Grace Lee, a member of
ACIP and professor of pediatrics at Stanford University School of Medicine, told the Washington Examiner. "It is heartbreaking to realize how much of the social and racial inequities that exist impact the health of these communities."
Critics contend that it amounts to racial discrimination.
"Apparently, the people on the committee implicitly believe that vaccine distribution and perhaps access to medical care generally should be
conditional on having the right race/ethnicity," said Linda Gorman, director
of the Health Care Policy center at the conservative Independence Institute.
Since there will not be enough vaccine to inoculate the general public until the spring of 2021, ACIP must prioritize which groups will go first. The
final decision on who to vaccinate first will be left to state governments. However, ACIP's recommendations have long influenced which vaccines private insurers and the federal government will pay for. Its recommendations for the coronavirus vaccine will likely shape state government decisions. ACIP will make its final proposal after it reviews the efficacy and safety data from
the clinical trials of the vaccine.
To determine which groups will go first, ACIP has divided the first part of vaccine distribution into three phases: 1a, 1b, and 1c. At its meeting on
Nov. 23, ACIP proposed that healthcare workers would go first in Phase 1a, given that they are essential to the COVID-19 response.
ACIP also proposed that the group vaccinated in phase 1b would be essential workers, a group that includes teachers, police, firefighters, and workers in energy, food service, transportation, manufacturing, IT, and wastewater management. The committee chose essential workers over two other priority groups: those with serious medical conditions and those aged 65 and older. Ultimately that decision came down to the fact that "Racial and ethnic
minority groups [are] disproportionately represented in many essential industries,” according to a PowerPoint presentation made by ACIP member Dr. Kathleen Dooling at the meeting. About 45% of essential workers are
minorities, according to the Economic Policy Institute.
ACIP considers three factors when deciding vaccine priority: science, implementation, and ethics. Comparing essential workers, people with high-
risk medical conditions, and those aged 65 and older on science produced a
tie, according to the Dooling presentation. Modeling showed that there was no real benefit to immunizing one group over another. Each produced a similar reduction in infections.
Implementation provided a small advantage for those aged 65 and older since they were somewhat more willing than the other groups to get vaccinated.
The biggest difference came in ethics, with essential workers having an advantage. On ethical considerations, such as maximizing benefits and minimizing harm and promoting justice, ACIP found little difference between
the three groups. The ethical consideration of “mitigating health inequities” appeared to be the tiebreaker, with the advantage going to essential workers.
Health equity is understood by public health officials to mean that every individual has an equal opportunity to be as healthy as possible. In
practice, it means removing poverty, discrimination, and other systemic obstacles to achieving good health.
Promoting health equity has become a bigger priority for the CDC in recent months. "Long-standing systemic health and social inequities have put many people from racial and ethnic minority groups at increased risk of getting
sick and dying from COVID-19," the CDC states on its website. According to
the CDC, blacks are 2.6 times more likely than whites to contract COVID-19
and 2.1 times more likely to die. Latinos 2.8 times more likely to contract
the virus than whites and 1.1 times more likely to die.
People with high-risk medical conditions did not fare as well under health equity because of disparities in access to healthcare. In particular, the committee has noted, people who have undiagnosed medical conditions because
of lack of access to healthcare would not have equal access to a vaccine.
Those aged 65 and older fared poorly under health equity because “Racial and ethnic minority groups [are] under-represented among" seniors, according to
the Dooling presentation. Census Bureau data shows that while blacks are 12%
of the U.S. population, they account for just under 9% of those aged 65 and older. Latinos are almost 18% of the population but only 8% of seniors.
“I do highly prioritize health equity as a strong consideration," said Lee. "Obviously, this will all depend on what the safety and efficacy and safety data look like. If for some reason the vaccine doesn’t work as well in one group, that will be important to decision-making on the whole. But given the information we have today, we have to address health equity as a core and essential aspect of decision-making. Vaccines give us a great opportunity to
But critics contend that seniors should receive priority since they are
highly vulnerable. Seniors have the highest rate of hospitalization due to
the virus, with those 65-75 years old five times more likely than young
adults to be hospitalized. Those 75-84 are eight times more likely to be hospitalized, and those 85 and older 13 times higher. Seniors also have the highest rate of mortality, accounting for 79% of deaths from COVID-19.
Indeed, under the ethical principle of maximizing benefits and minimizing
harm, the Dooling presentation states that vaccinating those aged 65 and
older would reduce "morbidity and mortality in persons with the highest
burden of COVID-19 hospitalization and death."
"People over 65 are less deserving of vaccine access because their population cohort does not meet some unexpressed standard for racial/ethnic makeup? This shows a complete disregard for traditional medical ethics," said Gorman.
"Maybe we shouldn’t let people who classify this kind of exercise as a
serious analysis anywhere near vaccine distribution?"
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