Why is Race Being Considered in the Distribution of a COVID-19 Vaccine?

For the past several months, there has been an intense discussion between the medical community, the government, and health organizations on an ethical and fair way to distribute a future COVID-19 vaccine.

Both the Center for Disease Control and Prevention (CDC) and the National Committees of Science, Engineering, and Medicine strongly suggest that critical health care workers should have priority once a vaccine has been fully developed. The real question is, how will state governments decide on a fair and equal distribution of the vaccine, and what does this have to do with race?

Healthcare Inequality and COVID-19

Racial minority groups in the United States have been disproportionately affected by covid-19 for the past several months. The CDC explains why minorities have an increased risk of contracting the disease and dying. This is due to factors such as limited healthcare access, socio-economic discrimination via healthcare, housing, etc., wealth gaps, and inequality concerning education and income. This wide variety of factors all comes down to one simple fact: COVID-19 is more likely to kill minorities due to systemic inequalities in the United States. The CDC and Brookings scholars describe healthcare inequality and race gaps concerning COVID-19, comparing death rates by age and race.

So, What Does this Have to do with a COVID-19 Vaccine?

In the past, an equal distribution for vaccines, and even testing for COVID-19, has typically been implemented from a utilitarian standpoint: to do the most good for the most amount of people. However, this has led to racial minorities distrusting the healthcare system, because historically the healthcare system has not prioritized minorities in determining equal treatment. This lack of prioritization has led to racially biased rationing in the form of direct and indirect discrimination (such as a lack of venilators and resources in diverse communities). Since utilitarianism can lead to discrimination, it is important for healthcare professionals and government officials to overlook this dilemma.

With this in mind, the National Academy of Medicine used a utilitarian approach for fair distribution across the United States that states can decide whether or not to implement. This utilitarian approach highlights the fact that there are inequities in the United States and seeks to add a socio-economic factor in determining where to distribute vaccines.  This is different from the past utilitarian healthcare standard where systemic inequities may not have been put into account when determining equal treatment. In order to distribute a future vaccine fairly, an equitable solution should take inequities throughout the healthcare system into account.

If a vaccine is distributed from the purely utilitarian standpoint, the large majority of people who would receive a vaccine after critical healthcare workers would be people who are most likely to survive the virus. This leads to discrimination against racial minorities, as Black and Latino patients to have higher comorbidity rates, the presence of multiple health conditions at once, because of structural inequality.  

While these distribution plans have the intent of doing the most good for citizens of the United States, it could be a failure if structural inequalities are not taken into account in order to protect every citizen.  

Both the CDC and National Academy of Medicine’s plan to emphasize equal distribution, but how it will be implemented is of primary concern. A first come, first serve basis is present in both plans; however, it immediately creates an inequity for essential minority workers who may not have the time to wait in line for a vaccine for a long period of time. While the CDC’s current plan is to vaccinate healthcare workers and high-risk individuals, a first come, first serve approach would possibly do more harm than good if inequalities are not taken into account. 

Health professionals continue to discuss whether or not geography should play a part in distribution, which could help the issue of minorities being impacted disproportionately. The National Academy of Medicine’s proposal suggests a first come, first serve plan that would compound inequalities, most likely through measuring socioeconomic inequalities geographically.

Daniel MacKay, a public policy professor at the University of North Carolina at Chapel Hill and member of a UNC-Chapel Hill hospital ethics committee, stated in an interview that “state governments will probably look to the National Academy of Medicine for guidance for critical care allocations”, meaning that states will have the ability to decide whether or not to follow the recommendations put forth by the CDC and National Academy of Medicine rather than being required to follow a federally mandated plan. 

It is an ongoing battle to ensure that after critical health care workers and people with higher risk factors receive a vaccine, racial minorities will have some sort of weighting as states determine where to distribute the vaccines. The CDC’s social vulnerability index would be useful for states as officials consider the allocation of a future vaccine. Professor MacKay mentions that the plans for vaccine distribution must be race neutral but because of structural inequalities, distribution plans should be heavily conscious on how solutions could further disadvantage racial groups.

While Health Organizations Work on a Solution, What Can You Do?

It is important to note that while it is meaningful that structural inequalities are being taken into account during the development of distribution plans, minority communities are still disproportionately suffering from COVID-19.  In the meantime, there are several things that you can do in your community to help mitigate the impact.

• Donate Personal Protective Equipment to healthcare workers and essential workers in your community
• Check out the NAACP’s website for advocacy resources and more articles on COVID-19’s impact on African-American communities
• Schedule an appointment at redcrossblood.org to give blood and potentially help with a plasma shortage (if you have recovered from COVID-19)
• Find or create a mutual aid network in your community

race and covid-19 vaccine