Prioritize Vaccine by Age, Not Race

by Carol J. Bova

The last thing the government needs to do is polarize citizens by prioritizing COVID-19 vaccination for favored races and ethnicities. Statements like those of Harald Schmidt, assistant professor in the University of Pennsylvania Department of Medical Ethics and Health Policy, amount to reverse racism.

“Older populations are whiter,” said Schmidt, as quoted in the New York Times. “Society is structured in a way that enables them to live longer. Instead of giving additional health benefits to those who already had more of them, we can start to level the playing field a bit.”

Those who decide who gets the vaccine should not consider race or ethnicity. Health departments should target those who, by virtue of their occupations and age, are the most vulnerable to catching and spreading the virus. Where possible, because there won’t be enough vaccines to do everything right away, priority should be given to those who, by virtue of their age and co-existing conditions, are most vulnerable to dying from it. Insofar as African Americans and Hispanics disproportionately work in exposed occupations or suffer from medical risk factors, they will be more likely to qualify for a vaccine — but not because of their race and ethnicity.

Aside from the questionable morality of consciously favoring people of one race over another regardless of individual circumstances, basing vaccine distribution on the basis of race/ethnicity is a tricky proposition for other reasons. For starters, the data is incomplete. Nationally, the Centers for Disease Control have data for only 50% of all cases and 77% of all deaths. It is hard to know how closely the reported numbers track reality.

Let’s look at the facts that CDC does have. We know that age matters: 95.3% of all who died of COVID were older than 50 years. Nineteen of 20 deaths occurred from just one-third of all cases.

Prioritize all those over 55 who are still working, then as vaccine is available, add those 50-54.

Ninety-four percent of workers 55 and older were working in November 2020. The Bureau of Labor Statistics reports that there were 37.24 million of them in 2019.

Whatever their roles in society, workers are supporting themselves and their families. They are keeping what’s left of the economy alive and supplying the needs of the nation. If there’s not enough vaccine for the entire 50-and-over workforce, give a higher priority to those who must interact with the public, whether that’s in health care, emergency services, law enforcement, transportation, education or retail, until the supply catches up.

That’s an appropriate way to level the playing field.

Update. The CDC Advisory Committee on Immunization Practices (ACIP) voted 13-1 yesterday, December 20, to recommend the next groups for COVID vaccine. The committee previously had recommended Phase 1a to vaccinate an estimated 21 million U.S. healthcare workers and 3 million residents of long-term care facilities.

The new phased additions to the recommendation are:

Phase 1b: 30 million front-line essential workers and 21 million adults aged 75 years and older “When overlap between the groups is taken into account, Phase 1b covers about 49 million people, according to CDC.”

Phase 1c: “adults aged 65-74 years (a group of about 32 million and adults aged 16-64 years with high-risk medical conditions (a group of about 110 million), and essential workers who did not qualify for inclusion in Phase 1b (a group of about 57 million). With the overlap, Phase 1c would cover about 129 million.”

The article announcing the recommendations at Medscape.com said:

But there will likely still be a period of months when competition for limited doses of COVID-19 vaccine will trigger difficult decisions. Current estimates indicate there will be enough supply to provide COVID-19 vaccines for 20 million people in December, 30 million people in January, and 50 million people in February, said Nancy Messonnier, MD, director of the CDC’s National Center for Immunization and Respiratory Diseases.

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56 responses to “Prioritize Vaccine by Age, Not Race

  1. Reports the Mail Online:

    “Half of the nation’s states have outlined plans that now prioritize black, Hispanic and indigenous residents over white people in some way, as the vaccine rollout begins.

    “According to our analysis, 25 states have committed to a focus on racial and ethnic communities as they decided which groups should be prioritized in receiving a coronavirus vaccine dose.”

    You can’t combat racism with reverse racism. You just create a new kind of racism. You want more Donald Trump? This is how you get more Donald Trump, resurrected from his political grave.

    • Reverse racism?
      Or is it strictly based on the obsevred frequency of need?
      Clearly, it is reverse occupationalism to inoculate 1st responders 1st.
      It must then be reverse agism to inoculate those over 75 next.
      It musr suely be reverse communism to inoculate the essential proletariat.

      Oh whenever shall we white bourgeoisie ever get a fair shake?

      Sucks to be 65 to 74 and lumped in with all of those over 16 with preexisting conditions in the 4th tier. Thank god we are not trying to buy healthcare insurance!

    • True, that is what happened before, will happen again. From what I’ve heard, that is about right. The other is that this targets more Republican/conservative types of voters and may not go well.

    • This Daily Mail report is wildly misleading, if not downright false. It states: “Every US state has been advised to consider ethnic minorities as a critical and vulnerable group in their vaccine distribution plans, according to Centers for Disease Control guidance.” As a matter of fact, the CDC guidance does no such thing; rather it emphasizes age, co-morbities, and front line workers. https://www.cdc.gov/vaccines/acip/meetings/downloads/slides-2020-12/slides-12-20/02-COVID-Dooling.pdf

      That map is curious: many of the states “focusing” on Black and Hispanic residents are Republican: Utah, Wyoming, Idaho, Kansas, Oklahoma, Louisiana, Indiana, and Iowa.

      The fact that Blacks and Hispanics are heavily represented in front line industries probably accounts for the “focus”.

      • Yup. Thanks for posting the actual guidance to go along with the Daily Mail crap.

        There are folks in this country who want to foster more racial division, no question and they actually do invoke Trumps name to “prove it” and what better example for misinformation than this article?

        • Larry – Was Harald Schmidt correctly quoted by the New York Times or not? Do you think his comments were polarizing?

          • Context is important but not to folks who are promoting one view:

            ” “Older populations are whiter, ” Dr. Schmidt said. “Society is structured in a way that enables them to live longer. Instead of giving additional health benefits to those who already had more of them, we can start to level the playing field a bit.”

            But to protect older people more at risk, he called on the C.D.C. committee to also integrate the agency’s own “social vulnerability index.”

            The index includes 15 measures derived from the census, such as overcrowded housing, lack of vehicle access and poverty, to determine how urgently a community needs health support, with the goal of reducing inequities.”

            Why zero in on one sentence and ignore the context?

            Why do people do this type of thing to start with?

            What’s the point other than to foster more hate and divisiveness?

          • Larry,

            “Context” notwithstanding, there was NO reason whatsoever for this “medical ethicist” to even MENTION race in his comments. None. No reason. And yet he DID mention it.

            Who is it that is being polarizing, again?

          • re: ” Instead of giving additional health benefits to those who already had more of them, we can start to level the playing field a bit.”

            But to protect older people more at risk, he called on the C.D.C. committee to also integrate the agency’s own “social vulnerability index.”

            The index includes 15 measures derived from the census, such as overcrowded housing, lack of vehicle access and poverty, to determine how urgently a community needs health support, with the goal of reducing inequities.”

            That’s what he really said. Why cherry-pick and claim he was advocating race?

            Some folks are bound and determined to make it about race but it’s really about equity – which they cannot seem to abide.

          • Larry, Why don’t you just answer people’s questions instead of assigning them motives.

            I’ve said it before and I’ll say it again:

            11-111
            01-011
            10-110
            10-101
            00-010
            01-000

          • sorry wayne – don’t get it.

            not assigning motives – asking why do what they are doing?

            what’s the purpose?

          • Why are you doing what you are doing?

      • Another reason is money… well, lack of money more to the point. Money allows people to buy room, large tract suburban yards. Lack of money means high-density living.

        Since this is an airborne contagion, any plan to distribute the vaccine to high density areas first will also put minorities disproportionately out front.

        “Dateline January 2029. Bacon’s Rebellion bloggers call for “colorblind” distribution of Novo Nordisk’s new FDA approved single injection sickle cell anemia preventative treatment.”

      • For the record the Virginia Department of Health (https://www.vdh.virginia.gov/news/2020-news-releases/virginias-covid-19-vaccination-priorities-announced/) refers to :

        “Advisory Committee on Immunization Practices (ACIP) ethical principles for allocating initial supplies of COVID-19 vaccine, namely to maximize benefits and minimize harms, promote justice, and mitigate health inequities…”

        We all know what “promote justice” means.

        The “Virginia Vaccination Prioritization Guidelines” (https://www.vdh.virginia.gov/content/uploads/sites/6/2020/12/Revised-Vaccine-Allocation-Prioritization-12.4.2020.pdf) makes no explicit mention of race but does mention Phase 1, “high risk adults.” At some point, we’ll get to see who VDH classifies as “high risk.”

    • There is no such thing as “reverse racism”. There is only racism or the lack thereof.

      Discriminating against white people because they are white is juts plain old racism.

  2. “This is how you get more Donald Trump, resurrected from his political grave.”

    What? By allowing the ignorant to continue to be ignorant? There is no public schooling for those who believe that Obama was born in Kenya.

    • Back to the point, I just saw an epidemiologist on CNBC make the same point: The US should start with over 65, and anybody with one of the recognized risk diseases: diabetes, hypertension, etc. That’s the first 100 million. Even in this latest surge, that is who is filling the hospital beds and morgues. I respect “the essential proletariat” but even among that population, those over 65 or with a pre-existing condition are the one’s truly at risk.

      But politics always trumps (can I start using that word again?) logic. Jim, you are shouting into a windstorm so strong that nobody can hear you. Identity politics rules and will do so for a while.

      • or if certain populations of people ARE already experiencing higher infection rates? just ignore that?

        I think this was inevitable and the forces that want to foment more divisness will portray it thus – was no surprise.

        • It is a about DEATH rates, and even in those populations the one’s dying are over 65 or have one of those conditions…..and the forces who want to play racial politics exist on both sides. In truth, as the vaccines are applied it helps everybody, fewer potential carriers are around. But if the goal is to reduce deaths, it is clear what needs to be done. Dare one wonder if saving lives is NOT the goal?

          • but the way you reduce deaths is by vaccination, no?

            And you would prioritize who to vaccinate by risk to become infected and infect others – that then leads to deaths.

            no?

            Yes, there are folks on “both sides” on the race issue but don’t you find it the least bit ironic that all this talk here about MSM “bias” and then this article gets posted and it’s way more than just bias – it’s overt disinformation. Apparently acceptable because others are “biased” ?

          • No. You prioritize those most likely to die first and spread out from there. I do get the health care workers and nursing home workers being in the first tier, but not some healthy 40 year old UPS driver.

          • but only 1% actually die, right?

          • Not among 65+ you troll. You add nothing today but annoyance….

          • That’s my job!

            Thing is 1000 doses would go a long ways to ending the epidemic in Wise Va.

          • ” Ultimately, the choice comes down to whether preventing death or curbing the spread of the virus and returning to some semblance of normalcy is the highest priority. “If your goal is to maximize the preservation of human life, then you would bias the vaccine toward older Americans,” Dr. Scott Gottlieb, the former Food and Drug Administration commissioner, said recently. “If your goal is to reduce the rate of infection, then you would prioritize essential workers. So it depends what impact you’re trying to achieve.”

            Seems like if you prevent spread – you ALSO reduce deaths.

            And the problem with the first choice is that when subgroups are created for prioritization, the issue of equity, not race per se, but different income classes of people of which people of color tend to have higher percentages of low income people.

            So for instance, for hospital workers – will orderlies and those who work at the lower paid jobs cleaning and such – get the same access to the vaccines when the catelgory is “front line workers”?

            THAT’S the issue – NOT really race. It’s just if you look at the lower-paid workers in a hospital, you’re likely going to find higher percentages of people of color.

            Some folks legitiately don’t understand this. Others are purposely highlighting the race aspect as if choices are actually being made by race – or should be.

            oh by the way:

            ” Ultimately, the choice comes down to whether preventing death or curbing the spread of the virus and returning to some semblance of normalcy is the highest priority. “If your goal is to maximize the preservation of human life, then you would bias the vaccine toward older Americans,” Dr. Scott Gottlieb, the former Food and Drug Administration commissioner, said recently. “If your goal is to reduce the rate of infection, then you would prioritize essential workers. So it depends what impact you’re trying to achieve.”

      • no CDC guidance that I’ve seen – actually says – prioritize blacks and hispanics.

        Did I miss it ?

        • Not from the recommending committee, but yes, elsewhere. Look at
          “Health Equity Strategy.”

          Populations and Place-Based Focus
          – Racial and ethnic minority populations
          and
          Intended Outcomes
          – Reduced COVID-19-related health disparities.
          – Increased testing, contact tracing, isolation options, and preventive care and disease management in populations at increased risk for COVID-19.
          Ensured equity in nationwide distribution and administration of future COVID-19 vaccines.
          – Implemented evidence-based policies, systems, and environmental strategies to mitigate social and health inequities related to COVID-19.
          -Reduced COVID-19-associated stigma and implicit bias.
          – Expanded cultural responsiveness and application of health equity principles among an increasingly diverse COVID-19 responder workforce.

          Note the inclusion of “implicit bias” in next to last statement.

      • I would be more inclined to head to those areas with the least capable medical facilities. Some measure of the ratio of population to distance and number of ICU beds, and give them a higher priority. You can always use age/comorbidity then.

  3. As a note, almost any college with a reasonable biology department could serve as an inoculation center for the Pfizer vaccine. They have the freezers required to store the vaccine and laboratory to prepare it.

  4. What is the “shelf” life of the vaccine once out of the freezer?

    I thought most pharmacies also had such storage?

    One of the vaccines in the pipeline does not require such cold storage. When that comes online, some of this freezer stuff logistcs will recede.

    The question is now, will the vaccines protect against this new UK variant!

    • Pfizer’s vaccine, once defrosted, is viable for five days. Cannot be refrozen, I think. The Moderna vaccine uses only normal temperature freezers and fridges. The same epidemiologist this morning said all the data indicates this overblown variant is just as sensitive to the vaccines. Not the first variant, actually, just the first one to get massive PR and create panic.

      • If the “overblown variant” is the more contagious mutation spreading in the eastern parts of England I’m not sure why it creates (unnecessary) panic. I have read it is 70% more contagious. According to Expedia.com there are 7 non-stop flights landing at Washington airports from London tomorrow. Does that sound like a good idea to you? Virginia is averaging just under 4,000 new COVID cases per day. I guess that would be 6,800 new cases per day if the disease was 70% more contagious. At what rate of transmission do you think NoPlan Northam will shut down all the restaurants, gyms, etc again. He may have no idea of what he’ll do and when but you are free to guess.

        Is it better to ban travel from England or see all of Virginia’s restaurants and gyms shuttered again?

        • Safe to say, that as a society, we absolutely SUCK at dealing with pandemics!

          • Apparently, the quarteback called an audible. “Okay! Rope-a-Dope on two!”

          • Oh, Olive Branch Miss. It’s a Moderna shipping point. Might as well make sure the shippers don’t get sick.

          • The prioritiztion process is essentially political but based on science. The problem is science is itself evolving as more data is gained and analyzed and then on the political side, we have differing values with respect to people and their station and role in life.

            And the skeptics and naysayers love it!

            It boils down to how to make something work versus how to break something.

          • Prioritization is about how to choose when there’s not enough vaccine to give all who need it. And the science shows 85+ have a death rate 630X higher than 18-29 years olds; 75-84 220x higher, 65-74 90X, 50-64 30x, 40-49 10x, 30-39 4x, 5-17 16x lower, 0-4 9 x lower.

            Why I suggested older workers first is front-line and nursing home residents were already in queue for the vaccine, and the number of older workers could be vaccinated within a month or two. That would not only help save their lives and prevent spread, but let them house and feed their families, let them pay rent and mortgages and utilities, thereby reducing the economic burdens on our society. Older persons not working could continue to stay safe at home until all the younger vulnerable were vaccinated. To my mind, that would ultimately save the most lives.

    • I heard that once thrawed, and diluted 5:1, the Pfizer is valid for 6 hours. Obviously better for high density areas.

      Moderna’s is days once thawed.

      But why guess? https://www.pfizer.com/news/hot-topics/covid_19_vaccine_u_s_distribution_fact_sheet

    • This is better since it addresses thawed and diluted too
      https://www.fda.gov/media/144413/downloadhttps://www.fda.gov/media/144413/download

  5. “Nationally, the Centers for Disease Control have data for only 50% of all cases and 77% of all deaths. It is hard to know how closely the reported numbers track reality.”

    What?! Is 9M not a large enough sample size for you…?! 🤦‍♂️

    • Only if the data falls along some predictable distribution curve. If the busiest medical facilities are in the inner city and those facilities are the most likely to omit race data then you would get skewed results from even a very large sample size. Is there any information as to why only 50% of the cases and 77% of the deaths have full information recorded?

  6. Carol’s article is excellent. It is concise. It is to the point, plain and direct. The truth glows within it, and shines through it direct to the reader. It is a breath of fresh air.

    As regards fresh air, contrast Carol’s article with this referenced therein:”

    “Harald Schmidt, PhD, MA, is an Assistant Professor at the Department of Medical Ethics and Health Policy, and a Research Associate at the Center for Health Incentives and Behavioral Economics, both at the Perelman School of Medicine, University of Pennsylvania. His research centers around personal responsibility for health, public health ethics and priority setting. His principal current research interest are the ethics of work requirement in Medicaid and the ethics of novel medication adherence monitoring technologies that can veer between depersonalizing surveillance and genuine patient empowerment. The overall goal of his research is to combine robust conceptual and empirical work to contribute to more evidence-based, equitable and efficient health care policy and practice. Before coming to the University of Pennsylvania, Harald was a Commonwealth Fund Harkness Fellow in Health Care Policy and Practice at the Harvard School of Public Health, and for seven years served as Assistant Director of the U.K.’s Nuffield Council on Bioethics in London. He completed his Ph.D. in Public Policy at the London School of Economics and Political Science’s LSE Health and previously studied Philosophy at the Universities of Bremen, Oxford and Münster. Harald is a member of the Management Committee of the International Society on Priorities in Health Care, and a member of UNESCO’s Ethics Task Force.”

  7. James Wyatt Whitehead V

    So school teachers need this shot. But most are white. What do we do? Too complicated. Calvin take me away!

    • Reminds me of one of those Venn diagrams for decision-making that resolves at each fork in the path into a choice of cusswords or return-to-where-you-started loops. An appropriate downhill-slope disaster looms for Hobbes, not to mention Calvin.

  8. Larry G, you always seem to find a way to turn a comment into doing nothing or very little. Nothing I said implies that. We need to make rational decisions based on both our knowledge and uncertainty. Over twenty years of experience demonstrates that following the worse case scenario involves wasting a lot of money instead of investing smartly. Do you think that the actions of China and developing countries are going to bend the curve down? China has plans to burn coal for almost another two decades. Think about that.

    • Bill – do we really know the worst case scenario? Why do you assume that?

      The basic question stays the same. If you don’t think it is real and you are wrong – how does that compare to believing it is real and youre wrong?

      Can you tell me how many pollution laws we have repealed because we overestimated impacts?

      Would you, for instance, undo the CFC s regs?

      Yes, we do have issues with other countries but if we don’t lead on the issue?

      Yes China is doing coal plants but they are also doing nukes as well as wind and solar.

      You, like other skeptics seem almost fatalistic about it – like someone with a cancer diagnosis.

      So much for for those who argue that what we leave the kids and grandkids – matters.

      How can you be THAT sure that MOST of science is wrong to start with? And if YOU are WRONG – what happens?

      Do you believe science in other areas? Why pick this one area as having the vast majority of scientists as having wrong science?

  9. Baconator with extra cheese

    I seriously want Dr Governor to dictate the vaccine rationing will be done by race, meaning blacks and latinos go first regardless of age.
    Maybe then, when people bury their elderly, they will realize how disgusting such practices are… and they are disgusting no matter what “race” is given the advantage by government.

  10. James Wyatt Whitehead V

    We should refer this decision Gunnery Sgt. Hartman.

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