Ethics of Vaccine Allocation

By Nancy Tannler

As all Americans begin to queue up to receive COVID-19 vaccinations, medical ethicists want to be sure to prioritize racial minorities. In Oregon, our first allocations went to healthcare workers, teachers and the elderly, but who should be next?

The Oregon Health Association (OHA) asked Dr. Harald Schmidt, Professor in the Department of Medical Ethics and Health Policy at the University of Pennsylvania, to give a presentation titled, Is It Lawful and Ethical to Prioritize Racial Minorities for COVID-19 Vaccines?

We are all aware of the intense reckoning with structural racism we are experiencing here in the US. People of conscience are seeking ways to ameliorate injustices done to minorities in the past. Giving priority to the vaccine in communities hit the hardest by COVID-19 makes sense.

That is the recommendation of The National Academies of Sciences, Engineering and Medicine (NASEM) and the World Health Organization (WHO).

Dr. Schmidt said that Oregon’s number of COVID-19 cases is below average and there were more cases reported in our white population than Latino, Black and Indigenous. Most of those infected were older, lived rurally or were incarcerated.

These statistics don’t represent the rest of the country where the mortality rate, relative to population, is much higher in minority groups. It was noted that these elevated death rates are not due to biological differences.

Minorities with reduced economic mobility and healthcare access become super spreaders in their communities. That is why Dr. Schmidt and other like-minded individuals and organizations believe that moving forward we should reach these vulnerable communities first. 

By giving the more disadvantaged states a higher proportion of the allotments, the spread of COVID-19 would be greatly slowed down.

This would make a big difference in states like New Mexico, Washington, DC, California and New York where people of color make up about 35 percent of the population; Oregon is around 20 percent.

How we would expedite the process, says Dr. Schmidt, is to have easier to reach dispensing site locations, opening school gyms, community centers, sports stadiums and mobile clinics. Since not everyone has access to the internet, there should be different ways to sign up.

Oregon is a state where vaccine hesitancy is very high. Dr. Schmidt said this trend is becoming more prevalent in places with a higher socioeconomic level. This strata of people has been least affected by the virus. Statistics so far have about 68 percent of whites willing to vaccinate, 87 percent of Asians and 42 percent of Blacks.

Vaccine hesitancy is high in minority communities also. They are already wary of what is considered “best” for them due to the effects of past and current discrimination. 

Dr. Schmidt cited examples like the Oregon Eugenics Board that forcibly sterilized more than 2,600 prisoners, orphans and patients in mental institutions and wards of the state between 1917 and 1981. During the polio epidemic, the Cutter vaccine from a lab in California actually gave some children polio.

The messaging matters, Dr. Schmidt said, and it will be necessary to do more outreach and education. Facts about the vaccine will give each individual the information to make the right decision about what is best for them and to consider the greater good.

The ethical matter in question is whether the Supreme Court would rule on vaccine distribution based on what is referred to as “reverse discrimination” where policy deliberately favors people of color. It is more likely they would rule in favor of an Area Deprivation Index (ADI) to prioritize populations based on factors like geography, socioeconomic status and housing density that would in de facto favor racial minorities.

Governor Brown has stated that vaccine will be open to all on May 1, but the general population may still face delays as Oregon officials plan to allocate doses in a targeted way to reach the most vulnerable groups.

Photo by Mufid Majnun, Unsplash.

Ethics of Vaccine Allocation

Leave a Comment

Scroll to Top