Race and Prioritization of Access to COVID-19 Vaccines

Chris Kaposy proposes that prioritization plans for new coronavirus vaccines should take race into account as an important factor that makes people vulnerable in the COVID-19 pandemic.

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Worldwide, over 100 coronavirus vaccine candidates are currently at various stages of development. Research, however, is only one step toward using vaccines for ending this pandemic. Further steps will have to follow. The task of producing and administering enough vaccine doses for everyone will be daunting. Consequently, access to new coronavirus vaccines for COVID-19 will inevitably occur in phases. At first, there won’t be enough doses for everyone. Some people will be at the front of the line, while others will have to wait.

The Public Health Agency of Canada has already begun to deliberate about how to allocate new vaccines for coronavirus as they become available. The Agency’s National Advisory Committee on Immunization is busy preparing an interim guidance document outlining which groups should be prioritized for early vaccination.

This committee is likely to recommend that groups such as health care workers necessary for pandemic response, and people who are especially vulnerable to COVID-19 because of age or underlying health conditions, should be given priority. However, the committee should also consider race as a reason to give some groups early access to these vaccines.

Photo Credit: CDC/ Judy Schmidt. Image Description: A nurse giving a middle-aged man a vaccination shot.

The Public Health Agency does not currently compile data on the race of people with COVID-19. The Agency has been criticized for neglecting to collect this data. Other jurisdictions, such as the City of Toronto, have begun to collect race-based and other demographic data on their own. According to data from Toronto, Black people made up 21% of cases of COVID-19 in the city, while only comprising 9% of the population. A shocking 83% of all cases of COVID-19 in Toronto were people from racial minority groups. In Montreal, the poorest neighborhoods with the highest representation of immigrants and refugees have been the hardest hit by COVID-19.

In contrast, the American Centers for Disease Control and Prevention collects race-based data on COVID-19, and found that Black and Latino people are three times more likely to be infected by coronavirus than white people. These groups are almost twice as likely to die from COVID-19 as white people. These disparities were found in rural areas of the US, suburban areas, as well as urban areas. There were similar findings among Native American populations.

Protecting the most vulnerable in a population is a strong ethical principle of vaccine allocation during a pandemic. Preventing death is more important than preventing minor flu-like symptoms among people less at risk. The pandemic is a world-wide crisis because of the serious illness, associated mass hospitalization, and death caused by COVID-19. Vaccines should be used to reduce these outcomes by putting those who are most vulnerable at the front of the line, regardless of the reason for their vulnerability.

Unlike factors such as age, or having an underlying medical condition, race is not a characteristic tied to a clear biological mechanism causing this virus to be more deadly for some people than others. Being elderly, for instance, comes with a weakened immune system. A chronic respiratory illness like COPD makes recovery from a respiratory virus more difficult. In this way, race is not a biological category. Instead, in the context of susceptibility to COVID-19, race is a social category. But race is an important source of risk nonetheless because of racism. Factors associated with racial minority status, such as being a frontline worker, living in crowded housing conditions, and having poor access to health care, make exposure to coronavirus more likely, and carry a greater risk of serious illness. These structural conditions of vulnerability are the consequences of racism – the underlying cause of the disproportionate impact of COVID-19 on minority communities. The social determinants of health are legitimate causes of vulnerability, and racism is a determinant of poor health. Allocation strategies should not exclude race even though racism is a social cause of vulnerability rather than a biological cause. Other social risk factors are relevant for vaccine prioritization, such as living in a long-term care facility, or working in a meat-packing plant. Race should be considered relevant as well.

Canada is a country beset with systemic racism, which has become manifest in this pandemic in the greater susceptibility of some of our fellow community members to serious illness from COVID-19. We need to address the inequities that create this greater susceptibility during this pandemic. As part of a strategy designed to protect those most at risk, vaccine prioritization schemes should take race into account. To fail to do so would be a further contribution to systemic racism.

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Chris Kaposy is an Associate Professor in the Centre for Bioethics at Memorial University and an editor of the Impact Ethics blog. @ChrisKaposy