We’re already seeing the consequences of these decisions. In Washington, DC, residents over 65 were encouraged to sign up for the vaccination program online or by phone in a first-come, first-served system. When data on vaccine administration became available, the racial disparities were dramatic. Ward 7, which is 92 percent Black, accounted for only 8 percent of vaccinations, although 15 percent of the city’s deaths were in that neighborhood. Ward 2, which is 69 percent white, received almost 22 percent of available vaccines, despite having only 5 percent of the city’s deaths.
A first-come, first-served system won’t “achieve the desired effect of getting access to the residents that are hit hardest,” says DC councilmember Kenyan R. McDuffie. “Because you’ve got the digital divide, residents who don’t have access to the internet, and residents who are our frontline workers and have to work, face all types of obstacles.”
McDuffie successfully pushed for a new prioritization system in DC, which reserves some appointments for those from hardest hit areas, including Ward 7.
Although the starkest disparities in coronavirus deaths fall along racial lines, the causes are social and environmental, not biological. How people live and work hugely impacts their chance of contracting Covid. People of color are more likely to have public-facing jobs, live in apartments as opposed to single-family homes, are more reliant on public transportation, and have less access to sick leave or jobs that allow them to work from home. They’re more likely to live in polluted areas where toxic air quality can increase susceptibility to the virus.
So far, distribution systems “have tended to favor those who have the time to sit online and watch for when appointments open up, be the first to sign up, have access to internet in the first place, or can sit in a line and wait for a vaccine for hours,” says Jessica Heier Stamm, an engineering professor at Kansas State University who studies how to improve public health and humanitarian operations. “These are not the same people whose jobs require them to be in person or whose living situations are crowded or whose health circumstances would put them at greater risk.”
Heier Stamm has studied the H1N1 vaccination campaign. She says officials’ first instinct is to “put something together and try something similar to what we’ve done in the past.” But she says officials should move more deliberately and consider other factors: Are they vaccinating as many as possible as quickly as possible? Or building data collection systems to target vulnerable groups with precision? Do they have the time to?
Giving vaccines to the most vulnerable requires more logistics and more sophisticated data collection than many areas have established. That’s a problem when new outbreaks and mutations threaten to erode the modest progress being made.
The desire to move quickly makes it difficult to prioritize racial and ethnic groups. California originally planned to weight age, race, and socioeconomic factors in its plans, but pivoted to a simpler approach: everyone over 65, with no special considerations for race.
Either way, people feel left out. In Dallas, the state first rejected, then accepted, a plan to prioritize vaccinations based on zip code. The decision led to a series of contentious meetings among county officials.
J.J. Koch, a county commissioner, suggested prioritizing 11 lower-income zip codes with particularly risky comorbidities like heart disease. He says opponents misrepresented his proposal as excluding everyone outside the specified zip codes. But he argues it was necessary after the initial rollout favored wealthy, white residents.
“Everyone that had good internet and was able just to hop in a car during that first week, they were disproportionately advantaged,” Koch said. County data shows that in that first week of vaccinations, 20 percent of registrants were Hispanic, even though they account for 38 percent of the county’s cases. White registrants made up over 60 percent, despite being 31 percent of cases.
“So the idea that somehow leveling the playing field by prioritizing certain groups for a couple of days is somehow unfair, just totally flies in the face of what justice is,” Koch says. He’s concerned that, left unchecked, the disparities will grow, leading to an explosion of cases among nonwhite residents, while white residents benefit from greater vaccine availability.