Who gets the COVID-19 vaccine before someone else is both an easy and difficult question. The first group on line are uncontroversial, healthcare workers in the trenches trying to save the lives of those suffering. But things quickly get fuzzy after that.
While federal officials have issued broad recommendations about who should be first in line—healthcare workers and residents of long-term facilities—individual states will be making the final decision of how to distribute the limited number of vaccines. At least 19 will consider measures of inequality, including poverty and race, in order to reach those who are worse off, according to a review of state plans filed with the Centers for Disease Control and Prevention (CDC).
The olds in homes are certainly at extreme risk, and while some contend that they’re close to death anyway and their loss isn’t as significant as that of a younger person, most people aren’t quite so harsh toward grandma. But what do “measures of inequality” have to do with it?
It’s an unconventional approach. Vaccine campaign managers have typically paid more attention to the number of lives they can save than the demographic details of those lives. But Covid-19’s outsized effect on people of color is injecting an element of social justice into vaccine allocation. A variety of experts, from the World Health Organization to the US’s National Academies of Sciences, Engineering, and Medicine, are suggesting reducing inequality should be a goal of Covid-19 vaccination regimes.
If the point is that black people are disproportionately affected by COVID, regardless of why, then that would be a rational justification for allocating the vaccine based on race, just as giving it to old folks in homes. But then, it’s not about social justice, but saving lives. And it’s not about ignoring saving the most lives in favor of racial justice. The two happen to align, but it’s still about saving the most lives if black people are disproportionately dying from COVID.
It’s notable that not all black people are poor. Similarly, not all black people suffer from the co-morbidities that scientists believe put people at greater risk. And then, not all people who suffer from the co-morbidities are black.
“We can’t just continue with the same framework that simply seeks to maximize benefits, because that will very likely mean that minorities are not given the attention they need,” says Harald Schmidt, a medical ethics expert at University of Pennsylvania who analyzed the state plans. “They’ve been hit much harder.”
Putting aside the stereotypical “they” in the “they’ve been hit much harder, this is where the “black lives matter” runs head first into “all lives matter.” The underlying concept is that the value of black lives have been singularly dismissed in the past, but not that other lives should be cavalierly ignored now and in the future. Black lives certainly matter. Other lives matter too. Unlike the questions raised by police abuse toward black people, COVID does not engage in “systemic racism” and the dead from COVID are just as dead, no matter what their race.
Has bioethics now shifted from maximizing the saving of lives to saving the socially correct lives?
Only seven states, including Tennessee, Louisiana, and Michigan, will use the index to give disadvantaged people spots farther up the queue; in Ohio, the index will also help officials track whether their efforts are working. Other states will use the information more broadly to decide which groups get priority, how to reach out to vulnerable communities, and where to set up vaccination spots.
It appears that the inflammatory social justice rhetoric doesn’t quite jive with the practical considerations of how and where the vaccine will be distributed. The use of the index as a proxy for risk remains aligned with general and sound notions of bioethics in that the vaccine will be distributed to those who need it, and have need of it, most before it’s distributed to those who for whom the risk of infection or death are significantly lower.
In other words, it largely makes sense to use this disadvantage index and doesn’t have much of anything to do with putting social justice ahead of maximizing the saving of lives. It’s unfortunate, then, that those trying to link a rational and ethical method of allocation can’t control their impulse to link it to their need to virtue signal.
Worse yet, it only feeds into the last thing anyone needs, conspiracy fearmongering.
Regardless of how they use the index, states might find they first have to prove their good intentions to the people they want to help. Given the US’s ugly history of race-based medical experiments, people of color have good reasons to be suspicious.
For those people with co-morbidities, who can’t work from home and whose work is essential to the functioning of society during this pandemic (and deeply appreciated by those of us who can shelter in place), they should be ahead of us in line for the vaccine. Not because of their skin color, but because it’s the medically and socially appropriate thing to do based on need and reason.
And please, when your place in line comes up, get vaccinated.
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