As tensions surrounding equity and access to the shots emerge nationwide, the role that race should play in deciding who gets priority for the COVID-19 vaccine in the next phase of the rollout is being put to the test in Oregon.
Thursday, an advisory committee that offers recommendations to the governor and public health authorities of Oregon will vote on whether to prioritise people of colour, target people with chronic medical conditions, or concentrate on a combination of groups at higher risk of coronavirus. Others are also being considered, such as key workers, immigrants, prisoners and people under the age of 65 living in community environments.
In Oregon, a Democratic-led state that is predominantly white, the 27-member committee was created with the aim of maintaining equity at the core of its vaccine rollout. Its participants, from Somalian refugees to Pacific Islanders to tribes, were chosen to include racial minorities and ethnic groups. The recommendations of the committee are not binding, but provide important feedback to Gov. Kate Brown and direct the rollout by health authorities.
This is about unveiling the latent systemic inequality that exists. It affects the inequalities we faced before the pandemic and exacerbates the disparities we encountered during the pandemic, said Kelly Gonzales, a member of the Oklahoma Cherokee Nation and a committee expert on health disparities.
People of colour have been disproportionately affected by the virus. Last week, the Biden administration stressed the importance of incorporating “social vulnerability” in state vaccination programmes, with race, ethnicity and the rural-urban divide at the forefront, and asked states to define “pharmacy deserts” where it would be difficult to get shots into guns.
Overall, last fall, 18 states included ways to assess equality in their initial vaccine delivery plans, and more likely have done so since the shots began arriving, said Harald Schmidt, a University of Pennsylvania medical ethicist who has thoroughly researched vaccine justice.
Some, such as Tennessee, recommended that 5% of its allocation be reserved for “high-disadvantage areas,” whereas states such as Ohio plan to use factors of social deprivation to determine where to administer vaccine, he said. California has created its own metrics for measuring the degree of need of a population, and Oregon is doing the same.
Nancy Berlinger, who studies bioethics at The Hastings Center, a nonpartisan and independent research institution in Garrison, New York, said, “We’ve been telling a fairly simple storey:’ Vaccines are here.’ Now we have to tell a more complicated storey.” “Instead of just the group to which we belong and our personal network, we have to think of all the various overlapping areas of risk.”
In some areas, efforts to resolve inequities in vaccine coverage have also sparked backlashes. After Texas threatened to restrict the availability of vaccines in the region, Dallas officials recently reversed a decision to target the most vulnerable ZIP codes, predominantly communities of colour. As states step further into the rollout and struggle with tough questions about need and short supply, that kind of pushback is likely to become more pronounced.
Nearly all states looking at race and ethnicity in their vaccine programmes are turning to a method called a “social vulnerability index” or a “disadvantage index” to prevent legal challenges. Such an index uses more than a dozen data points, from income to schooling to health outcomes to car ownership, to reach vulnerable groups without directly referencing race or ethnicity.
“In doing so, because of the influence of decades of institutional prejudice, the index contains many minority groups while still scooping up socioeconomically marginalised individuals who are not people of colour and ignoring “very, very difficult and poisonous questions” about race, Schmidt said.
“The idea is not, ‘We want to make sure that in front of the Clinton family, the Obama family gets the vaccine.’ We don’t care. Both of them can comfortably wait,’ he said. We take note that the person who works in a crowded living environment in a meatpacking plant gets it first. It’s not a matter of colour, it’s a question of race and disadvantage.
Health leaders in Oregon are working on a social insecurity index, by looking at U.S. census data and then layering items such as job status and income levels, said Rachael Banks, director of the Oregon Health Authority’s public health division.
She said that approach “gets beyond an individual perspective and to more of a community perspective” and is better than asking an individual to explain “how they fit into any demographic.”
Recommendations from the committee would also be subject to legal review, Banks said.
To Roberto Orellana, a professor of social work at Portland State University who launched a programme to train his students in Hispanic communities to do touch tracing, that makes sense. Data reveals that Hispanic individuals are around 300 percent more likely than their white counterparts in Oregon to contract COVID-19.
Orellana hopes that his students, who are interning at state agencies and organisations, will put their skills to use in migrant and farmworker communities in both touch tracing and campaigning for vaccinations. It would hit people of colour by vaccinating critical staff, inmates and those in multigenerational families and placing them at the centre of the vaccination plan, he said.
I don’t want some other party to take me down. It’s a tough, challenging issue, and there are valid needs and valid concerns in every community. We’re not supposed to be going through this,” said Orellana. “For everyone, we should have vaccines, but we’re not there.”
