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How can we deal with racial disparities in vaccination rates? | Opinion

Edward C. Halperin
Special to the USA TODAY Network

Black, Latino and Native American/Alaska Native people are up to 3.6 times more likely than whites to be hospitalized from COVID-19 infections. Blacks and Latinos are also roughly twice as likely to die from the disease compared to whites. Why? The commonly cited reasons are an increased risk of exposure to the virus as a result of working in front-line jobs, lack of access to health care upon becoming ill, dense multi-generational housing and the presence of a higher incidence of pre-existing medical conditions —a ll of which make people susceptible to the ravages of the infection. 

In light of these statistics, it is disturbing to note that the data from those U.S. vaccination sites which record the race of people receiving at least one dose of the vaccine shows that up-to-now whites are far more likely to have been vaccinated than Blacks or Latinos. Some concerned physicians, public health care workers and politicians, have called for Black and Latino citizens to be “explicitly prioritized for the COVID-19 vaccine.”

As a practicing physician with a special interest in medical ethics, I have thought about whether prioritizing the vaccine by race would be an ethically sound and a practical public health intervention. To understand this question, we must begin by exploring the origins of the disparity in vaccination rates.  

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Our first problem is that our data set is incomplete. Race and ethnicity data was missing for nearly half of all COVID-19 vaccine recipient reports during the first month shots were available. We can’t know for sure the magnitude of the disparity problem since vaccine reports have failed to record and report the necessary data. Second, the U.S. prioritized the vaccine in ways which will disproportionately favor the vaccination of whites. When you put doctors, intensive care unit nurses and people 65 years of age and older at the front of the line then you are, by definition, prioritizing a population which is whiter than the general U.S. population. 

Doryl Wolfe, 76, of Cortlandt Manor receives her first dose of the COVID-19 vaccine from Christina Gilkes at Save Mor Drugs in Croton-on-Hudson Feb. 4, 2021.

There are, however, a long list of other factors involved. In many places in the U.S., vaccine centers have been located at sites that are easier for whites to access than blacks. When you need access to a computer and the internet to make a vaccine appointment, then you will favor upper class individuals securing the slots. People in the knowledge-based economy working from home don’t lose pay for going for a vaccine. Hourly workers out in the community in low wage jobs do. 

Would it make sense to prioritize vaccine access by race? There are two basic problems with that approach. First, people typically self-report race. We have objective ways to determine how old people are with birth certificates or the birthdate on a driver’s license. We have objective ways of determining someone’s home address. We are not good at objectively classifying race — indeed many historians, anthropologists and sociologists, will say that race is a social construction, not a biological one, and will prefer the term ancestry. How would a public health official, standing in the reception area of a vaccination site, objectively verify that the next patient walking in the door has an “ancestry” which is white, Black or Latino, in a manner that would stand up under strict scrutiny? They could not. A second objection to trying to use race to prioritize vaccines is that there would almost certainly be immediate legal challenges to any such attempt.

We do have, however, multiple practical tools at our disposal to improve vaccine access in Black and Latino communities. In order to inform people about the availability of vaccines, we should provide information in languages other thanEnglish as well as offer appointments at night and on weekends when people might not be working. Providing vaccine sites close to public transportation routes or using other means to get the vaccine closer to peoples’ homes will also improve vaccine access. Laws could be passed forbidding people from losing their jobs as a result of going to be vaccinated. Vaccine centers could be placed in high-risk zip codes and people being vaccinated at those sites would be required to show proof that they live in the neighborhood. If you need to show a utility bill, an apartment rental agreement or a pay stub with your address in order to get a library card, then why not do the same for access to the vaccine? We could partner with public health departments and community health groups to move the vaccine closer to vulnerable populations. Health education provided by trusted sources will be required to deal with vaccine hesitancy and distrust of government. 

It is a well-established principle of medical ethics that when resources are limited you concentrate your efforts on those individuals and population groups most likely to benefit. A physician would recommend screening tests for breast, cervix or lung cancer, in those individuals most likely to have these diseases. In a mass casualty situation, you triage patients based on likelihood of benefit from a medical intervention. The first priority for preventing the spread of COVID-19 are those population groups most likely to be afflicted with and harmed by the virus. We are ethically obligated to gather the public health data we need to ascertain the true extent to which marginalized populations are being disadvantaged in being vaccinated, and undertake sensible public health interventions to promptly rectify the problem. 

Edward C. Halperin, M.D., M.A., is chancellor of New York Medical College in Valhalla, New York. The essay represents his opinion and not that of the College.