Nurses and doctors in the US could start administering the Covid-19 vaccine as early as next week, with the Food and Drug Administration expected to authorize Pfizer’s version imminently. But whose arms they will be jabbing, exactly, will be up to states.
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).
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.
“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.”
Many people of color would get priority under some of the categories the CDC is considering putting close to the top of the line; its Advisory Committee for Immunization Practices is in charge of issuing federal recommendations on vaccine allocation. For example, members of these populations may be more likely to have two or more health conditions that increase their likelihood of getting sick from Covid-19.
But some states are also planning to use a disadvantage index to more deliberately target vulnerable populations. Most of them have settled on the CDC’s Social Vulnerability Index, which in addition to poverty and race, considers factors like car ownership, crowded living situations, and even English proficiency to rank a community’s degree of need in case of a disaster.
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.
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.