Role of race in US vaccine rollout put to the test

The role that race should play in deciding who gets priority for the COVID-19 vaccine was put to the test Thursday in Oregon, but people of color won't be the specific focus in the next phase of the state's rollout as tensions around equity and access to the shots emerge nationwide.

An advisory committee that provides recommendations to Gov. Kate Brown and public health authorities discussed whether to prioritize racial minorities but decided on a wide range of other groups: those under 65 with chronic medical conditions, essential workers, inmates and people living in group settings.

The 27-member panel in Oregon, a Democratic-led state that's overwhelmingly white, said people of color likely fell into the other prioritized groups and expressed concerns about legal issues if race was the focus. Its recommendations are not binding but offer key guidance on vaccine distribution. The committee was formed with the goal of keeping fairness at the heart of Oregon's vaccine rollout. Its members were selected to include racial minorities and ethnic groups, from Somalian refugees to Indigenous people.

The virus has disproportionately affected people of color. Last week, the Biden administration reemphasized the importance of including "social vulnerability" in state vaccination plans — with race, ethnicity and the rural-urban divide at the forefront — and asked states to identify "pharmacy deserts" where getting shots into arms will be difficult.

Overall, 18 states included ways to measure equity in their original vaccine distribution plans last fall — and more have likely done so since the shots started arriving, said Harald Schmidt, a medical ethicist at the University of Pennsylvania who has studied vaccine fairness extensively.

"We're not gonna undo all injustice and inequality during a time-sensitive vaccination scheme," said Nancy Berlinger, who studies bioethics at The Hastings Center, a nonpartisan and independent research institute in Garrison, New York.

"What we want to do is work from the evidence of who is relatively more vulnerable to this illness and avoid replicating or worsening injustice."

Attempts to address inequities in vaccine access have already prompted backlashes in some places. Dallas authorities recently reversed a decision to prioritize the most vulnerable ZIP codes — primarily communities of color — after Texas threatened to reduce the city's vaccine supply. That kind of pushback is likely to become more pronounced as states move deeper into the rollout and wrestle with difficult questions about need and short supply.

To avoid legal challenges, almost all states looking at race and ethnicity in their vaccine plans are turning to a tool called a "social vulnerability index" or a "disadvantage index." Such an index includes more than a dozen data points — everything from income to education level to health outcomes to car ownership — to target disadvantaged populations without specifically citing race or ethnicity.

By doing so, the index includes many minority groups because of the impact of generations of systemic racism while also scooping up socio-economically disadvantaged people who are not people of color and avoiding "very, very difficult and toxic questions" on race, Schmidt said. 

(Image Credits: AP)