Vaccinate those most vulnerable first
COVID-19 has moved like a heat-seeking missile into California’s Black and Brown communities, devastating low-income families and causing ruinous harm to essential workers and vulnerable institutionalized seniors.
The racialized disproportionality is impossible to ignore and represents the culmination of deep legacies of oppression and exclusion that have again been starkly unmasked.
As this unspeakable tragedy plays out, we have all stood aghast at the appalling and almost farcical abdication of leadership in Washington. We are living in extremely uncertain times that present fundamental choices and test our collective character and identity as Californians.
While California is responding to the equity challenge of enhancing food and economic support, ensuring eviction moratoria, improving unemployment benefits and developing protective workplace policies, albeit slowly, we are about to face our biggest equity test yet.
When a COVID-19 vaccine is ready for widespread use, the question of who will get it first will present a major equity stress test for California. This isn’t an academic question because the initial availability of the vaccine is already being decided, and if past experience with influenza vaccine supply shortages is any guide, I fear the vaccine will be aggressively acquired and hoarded by corporations and other deep-pocketed actors.
California officials must ensure that the vaccine, which will be in short supply at the start of its availability, is given to those who are the most vulnerable in our state: Non-English-speaking Latinos, who are bearing the brunt of the virus because they are essential workers, such as those employed in packing houses, warehouses and those working in the fields picking the food that we eat. Health care workers and nursing home residents must also be at the front of the queue.
Sixty percent of California’s COVID-19 cases have been among Latinos, and many of them are primarily Spanish and other indigenous language speakers. Even before the pandemic, they were among the most vulnerable people in our state. An equity perspective demands that they get the vaccine first.
This can be accomplished by using our existing local public health infrastructure to develop equitable prioritization. Grassroots community-based organizations that have trusted relationships must be engaged to broker this community strategy. We can create workplace vaccination centers for essential workers as well as popup locations in the hardest hit zip codes and neighborhoods where vulnerable families live.
However, with a much-coveted COVID-19 vaccine on the horizon, a free market vaccine distribution approach will instead stimulate vaccine hoarding. Deep pocketed actors will acquire huge supplies of the vaccine for their own uses. Some of our wealthiest corporations will acquire large stocks of the vaccine for their employees, and the most vulnerable will go without this protection. Contracts for these supplies are being drafted as we speak.
A decade ago, I wrote an academic journal article where I identified various legal tools that health departments must manage vaccines that are in short supply. I also drafted California legislation that gave health officials the ability to transparently inventory and, if necessary, take control of the vaccine supply and distribute it where it was needed most. The need for this legislation came after the nation experienced flu vaccine shortages and delays five years in a row. Those needing the vaccine the most weren’t getting it.
The Center for Disease Control and Prevention’s recently released COVID-19 vaccine guidance encourages three sequential phases of distribution but offers no clear equity strategy.
Unless, federal and state authorities use every instrumentality of power available to them to ensure an equitable COVID-19 vaccine distribution process, we will undoubtedly see a replay of the vaccine hoarding we saw in the flu vaccine shortage years. Given the atrocious vacuum of leadership at the federal level, it is likely that we will see unbridled market forces shaping vaccine distribution.
We can’t let that happen. This is a challenge that California’s leadership must meet. Our rhetoric about equity and inclusion is strong in this state, but will we ultimately stand by those words?
Dr. Anthony Iton is senior vice president of the California Endowment, tony@tonyiton. com. He has a medical degree from Johns Hopkins University School of Medicine and a law degree from the University of California, Berkeley. Follow him on Twitter @dr_tonyiton.