Minorities and Marginalized Groups

Introduction

Scientific sources largely agree that minorities and marginalized groups should be prioritized for COVID vaccination. Scientists agree that it is ethical to prioritize them because they are more likely to benefit and systemic inequities are addressed (Wu), and they argue that since prioritizing the disadvantaged is fundamental to good public health practice, minorities should have preferred access to a vaccine (Emanuel).

Arguments in Favor

Both the NASEM and the WHO recommend prioritizing “worse-off” minorities and allocating vaccines in a way designed to reduce existing unjust healthcare disparities (Schmidt). They draw on massive healthcare disparities and discrepancies in COVID mortality rates to do so. Those mortality rates are listed below.

• • • Black people experience 3.4x the COVID mortality rates of white people

    • Indigenous and Latinx people experience 3.3x the COVID mortality rates of white people

    • Pacific Islanders experience 2.9x the COVID mortality rates of white people

    • Asians experience 1.3x the COVID mortality rates of white people

Harald Schmidt, a professor of medical ethics at the University of Pennsylvania, argues that race neutral policy would exacerbate existing inequities; thus, there is a need to consider race and socioeconomic status in vaccine deliberation. They state that since racial minorities tend to be more dependent on regular income with less savings and less ability to work remotely, the social factors of pandemic isolation have affected them more. They state that black people have experienced higher rates of COVID related unemployment, eviction, and hospitalization. They also state that since ethnic minorities tend to live and commute in close proximity, physical distancing is more difficult.

Mechanisms for Implementation

Schmidt provides two statistical measures for vaccine allocation for underprivileged groups.

1. SVI (Social Vulnerability Index): A statistical measure that assesses geographic areas for their vulnerability to natural disasters such as COVID, but also earthquakes and other events. It has been used before in resource allocation in those times. Among other factors, it does include race in its allocation mechanism.

2. Area Deprivation Index (ADI): A similar mechanism to the SVI, but does not explicitly include race. Instead, it prioritizes geography, socioeconomic status, and population/housing density, which would automatically favor racial minorities without explicitly naming race as a factor.

Current US Policy

The Supreme Court is likely to require a race-neutral vaccine distribution policy, so the ADI might be more feasible and practical to use than the SVI.

Opposing Arguments

It's very clear that scientists and researchers support prioritizing minority groups for COVID vaccines. However, the same public opposition to vaccine preference for minorities exists as does public opposition to affirmative action and other similar programs. It's difficult to see the systemic factors that influence real necessity for preferential vaccine treatment; thus, attempts at medical equity come across as unfairness and bias.

My Take on a Solution

Use a "race neutral" policy in vaccine allocation that places heavy emphasis on factors more likely to affect minorities such as poverty, but also housing density, commute density, number of generations living in the same household, etc. Doing so would create a legally and socially digestible program (because, as stated, public buy-in is the most important part of any allocation plan because there is no plan if people don't buy into it) that would still prioritize those who need it most.