A Model for a Just COVID-19 Vaccination Program

Scientists have now produced apparently effective vaccines at sufficient scale to vaccinate most vulnerable populations in the United States in the next few months, and the U.S. population more broadly in the next year. How can the distribution protect the masses without perpetuating inequalities? There are no simple answers but the way forward must be informed by understanding the complex interactions among the virus, vaccines, individual health and socio-economic status, and the societal structures in which these are all embedded.

COVID-19 has exposed complex racial injustices in a medical system that aims to protect as many people as possible, but often fails to protect the most vulnerable. Epidemic models that don’t account for structural racism and other social determinants of health result in policies that perpetuate inequality, even as they reduce disease transmission in the general population. Disparities in disease spread and mortality as well as inequitable disease treatment and access to testing have become increasingly evident in the growing pandemic.

An early analysis of COVID-19 showed the elderly had a 15 percent mortality rate, and it was three times higher for people with comorbidities. We counted up the comorbidities in our immediate families (hypertension, diabetes, kidney disease, heart disease, dementia, sickle cell trait, asthma), and realized the extreme risk they faced. One of us has a sister with Down Syndrome—a condition we later learned carries 10 times the COVID-19 mortality of the general population. She lives with elderly parents and loved her job at the local grocery store until she had to leave it to protect the family from exposure to a likely deadly disease. The tragedy became even more real when one of us lost a relative who had comorbidities to COVID-19.