OP-ED: Who gets the COVID-19 vaccine first? Social justice must be a factor

Craig Klugman and Angira Patel
Chicago Tribune (TNS)
A sign on the entrance to a pharmacy reads "Covid-19 Vaccine Not Yet Available", on Nov. 23, 2020, in Burbank, California. (Robyn Beck/AFP via Getty Images/TNS)

The news of successful clinical trials for three COVID-19 vaccines provides hope in the middle of a pandemic that has cost so many lives, illness and economic hardship. However, even if all three are approved during the FDA meetings on Dec. 11-17, supplies will be very limited initially.

The White House wants to put Americans over age 65 at the front of the line to receive the vaccine. The Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices prioritizes health care workers and long-term facility residents followed by essential workers. This plan acknowledges two realities of the COVID-19 pandemic — essential workers are at significant risk and that more Black and Latino people get sick and die of this disease than other racial groups.

In Chicago, Latino patients are 36.6% of all COVID-19 cases and Black patients are 18.1%. Blacks are also 40.8% and Latinos are 33.3% of all COVID deaths. These rates are out of proportion with their populations: Blacks make up 30.1% and Latinos 29.0% of Chicago residents. These are similar numbers to the national data where Black and Latino people are being hospitalized 4.7 times more often than white patients, and Black patients are twice as likely to die.

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Why the disparity? First, people of color are more likely to work in essential jobs such as food service, transportation, energy, manufacturing, waste and agriculture. These are not jobs that can be done remotely from the safety of home. Second, people of color experience greater challenges in the social determinants of health (built environment, access to health care, social and community context, education and economic stability). The interplay of these factors has an impact on health outcomes across many diseases such as high blood pressure, diabetes and obesity. With regular medical care disrupted and record high unemployment, these at-risk populations have faced a second epidemic — lost and delayed access to the medical care they need to manage these illnesses.

In distributing the COVID-19 vaccine, we should strive to do better. Although the CDC will release guidance, Health and Human Services Secretary Alex Azar says each state will decide how to distribute their portion of vaccine doses. There is a brief window for Illinois to make explicit prioritizing people of color in vaccine distribution.

As bioethicists, we endorse the argument that the greater disease and death burden borne by communities of color combined with lack of improvements in combating social determinants of health, mean that communities of color should be at the head of the distribution list. Medical ethics and the principle of justice compels us to create health care policy that is not only equal (treat everyone the same) but equitable (get everyone to the same starting place).

The CDC placing essential workers in Phase 1b is an important first step to include race and socioeconomics in determining who gets the first doses of the vaccine. However, given that the supply of vaccines will initially be limited, we must prioritize people of color who have suffered most from this virus.

Distributing a scarce medical resource such as a vaccine is an imperfect art at best. Such plans combine science (who is at risk; for whom is the vaccine safe and effective) and ethics (justice, equality and equity) to decide who will get the first doses. Eventually, there will be enough doses for everyone who wants them, but until that time these hard choices must be made. Crafting a COVID-19 vaccine allocation policy that acknowledges trying to address health inequities is a step in the right direction.

— Craig Klugman, Ph.D., is a professor of bioethics and health humanities at DePaul University. Angira Patel, M.D., M.P.H., is an associate professor of pediatrics and medical education at Northwestern University Feinberg School of Medicine, a pediatric cardiologist and a bioethicist.