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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Just do a lottery.
The mechanism is already in place. Power Ball is available at your local Circle K.
I’m sure the lottery company would take a federal contract to make tickets available. Then have a drawing for your place in line.
I don’t know what the “right” order is, but I know that I’m fine and there are others who need it more than me. Now, if I could win Power Ball on the other hand…
Ya know, Biden and Harris didn’t help matters when they both said on national TV, that they would follow the “science”, but also that they wouldn’t take a Trump vaccine, whatever the hell that means. ( I guess they think he made it up in the basement of the White House with his old chemistry set or something.)
I’ll gladly give up my place in line for all the disadvantaged people that want to jump in front of me.
Inoculations don’t make the virus disappear. Scott, you know what I do and the physicians with whom I get to have long discussions. Early on, I spent a bunch of hours with real I.D. docs, ones that actually do this stuff and worked on SARS1, MERS, Ebola, swine, bird. I’ll paraphrase the pertinent discussions.
This virus is highly lethal; it kills at a very high rate. From previous epidemics, medicine learned that when 70-80% of people are inoculated or are otherwise immune, a virus “usually” and “for some reason” begins to lose its lethality. I quote those words because they stuck with me. What is called “herd immunity” isn’t what the words seem to mean. It’s sort of like “deliberate indifference.” A decrease in killing power usually happens for some reason.
The vaccines aren’t about killing the virus; they’re about reducing the lethality of the virus. Reducing lethality, if that is the result, could save hospitals from becoming SRO, which makes beds available for others that could be saved form other lethal conditions. But this takes time. Two doses to 250 million people takes a shitload of time and there’s no telling how long immunity lasts. Odds are, people will still be in line when the first-inoculated need re-inoculation. All this line-jumping is like swerving across lanes and crashing into the parking lot when the “Hot Now” light comes on at the shitty doughnut place. There will be vaccine, just like doughnuts. The idea is to get the vaccines into the most arms possible. It doesn’t matter what the arms look like.
Forgive my ignorance, but how does any of this have anything to do with equity or even fairness?
Your donut place has a “hot now” light?
I think he’s referring to Krispy Kreme.
And I think he’s mistaken about the lethality too. It’s highly communicable, but fatality among those that get it is low, particularly for those younger than 75 or 80.
As to the post, I don’t know that all this makes that much either way, because you’re only talking about a difference of a month or so in terms of when people get vaccinated. But nothing should be decided by the government on the basis of race. What the virtue signaling has done in this case is give ammo to those opposed to the government being in charge of healthcare.
Knowing too many people who’ve died from COVID, I’m disinclined to engage in argument about its lethality. Maybe it’s my age group. Maybe it’s just the folks I know. Either way, dead is dead, and it sucks, whether you’re old or too young to die but dead anyway. And then there’s the numerous non-fatal issues, heart, lung and brain damage.
Maybe someday we’ll have a firm handle on how lethal (or otherwise disabling) it is, but I sure as shit don’t care to argue it here and now.
It wasn’t my intent to start an argument. Ultimately what fatality rate is high vs not so high is subjective anyway. And I agree about the serious impacts that don’t reach the level of fatal. People who minimize the death rates frequently ignore long term heart and lung issues.
Didn’t mean to take the thread off road.
Nope–I don’t go there because it’s shitty. My doughnut place has doughnuts as big as my face.
They don’t have Krispy Kreme shops in NY?
You’re missing out.
They’re almost as good as a Waffle House.
Someone once bought a 12-box of Krispy Kremes to a meeting. I took one bite and put it back. There were eleven and 9/10s left after the meeting. Repulsive. They’re not my beloved donuts.
I am right with you on this. They got to Austin a few years ago and I couldn’t eat them, grocery store doughnuts were better.
I think that some sort of dogooder impulse has won out over canny strategy. A plan to vaccinate in the hardest hit areas first could be designed to have a similar effect and be a lot less controversial.
Yeah, first give it to all the big names in politics, the [deleted] poor and dispossessed, all the media egos we can never avoid, the mega-rich who own the world, all the bureaucrats in their safe Govt jobs… by the time it gets down to the shitty middle-class who actually make the world go round we would have seen what the side-effects are.
Experiment on them all because you’ll need the world going around to clean up the mess if the side-effects are bad!
That was unnecessarily racist. Don’t do that here.