By Ellen Alt
Cabin fever and lockdown: we’re all sick of it. For those of us still locked inside our homes and following social distancing guidelines, the daily quarantine routine has become old, causing anxiety and desire for a quick resolution, which many have projected onto vaccines for COVID-19. The vaccination rollout and eventual endpoint of herd immunity has characterized a timeline of return to normal life, where vaccinated people will be resistant to contracting the coronavirus with newly developed antibodies. Although the FDA-approved Moderna and Pfizer vaccines have been distributed to about 10 percent of Americans so far, returning to normal will take longer than just the point at which we achieve herd immunity. Most people believe the vaccine will just end the virus since it is a tangible quick resolution to this seemingly unending pandemic. Although the vaccine will not be the panacea to the pandemic, the vaccine is our best hope for minimizing further sickness and death and a return to normal life for those not currently on the front lines.
The vaccine is thus desirable, but rollout has been limited to front-line healthcare workers in healthcare facilities, the elderly, and, depending on the state, people with pre-existing conditions, as distribution depends on first protecting those at most risk of contracting the virus or having a severe bout of disease. Yet within neighborhoods, vaccine distribution is already unequally monopolized by the white and wealthy rather than supplies going to poor people or people of color. Counties and cities that have higher proportions of Black citizens are seeing more white people receive the vaccine than is representative of their demographics: for example, Philadelphia’s population is 44 percent Black, but only 7 percent of vaccine recipients have been Black. Privileged white people are taking advantage of vaccine distribution in Washington and Miami-Dade County as well, diminishing the number of doses allocated to a given community by snatching up appointments across county lines and driving to other communities.
The disproportionate amount of wealthy white people receiving the vaccine raises serious bioethical questions when considering the pandemic in context. Already, Black and Brown people are dying from COVID-19 at rates 2.8 times higher than white people. Although race and ethnicity can be markers for underlying conditions that increase susceptibility to more severe cases of coronavirus, such as asthma or immunocompromisation, systemic racism in the healthcare system and issues of class and access to healthcare are major contributors to these disproportionate effects from COVID-19. Currently, the CDC vaccine distribution timeline has no consideration of these disparities to account for increased infection rates along race and class lines, but contextually, it situates the monstrous monopolization of vaccines by wealthy white people as unethical.
Bioethics modernly presents as the investigation into ethical problems, competing interests, and their resolution in the context of biology and life sciences, applied across the sub-contexts of categories ranging from genetics, to reproductive care, to social determinants of health. Considering the competing interests in vaccinating everyone, the social determinants of health, and a currently limited vaccine supply, bioethics applies in deciding who gets the vaccine when, or who should be prioritized. Applying resolutions of bioethics—determining who is most “worthy” or at risk to first receive care—to vaccine rollout appears as prioritizing healthcare workers, the elderly, those with pre-existing conditions, and people under more duress from their socioeconomic environment, all of which can increase coronavirus disease severity. The alarm associated with the bioethics of the social determinants of health resounds when considering one community sabotaging another poorer community or a community of color, disproportionately and more severely affected by the pandemic.
Beyond the self-interested individuals breaking vaccine roll-out rules and hurting a local community, we can consider bioethics in the vaccine rollout on an individual level. Vaccine roll-out by state has had hiccups in providing doses and there are inconsistent efforts with leftover doses, providing an outlet for bioethics to address the dilemma of how to deal with them. This does not include zooming to a clinic not associated with one’s community: true ethical applications might involve calling your elderly neighbor or friend with pre-existing conditions, and ensuring they have a means of getting to the point of vaccine dose distribution. For example, volunteers in the indigenous community on the Rosebud Reservation in South Dakota are distributing the vaccine at grocery stores and making announcements so that no vaccine dose goes to waste. To date, they have only lost three doses out of 5,000 received and distribution has successfully stayed in the target community of need. No dose goes to waste, but doses still benefit those who need it most. We all want this nightmare to end, but to be a menace to society and stop following guidelines by stealing from a neighboring community, even if following general CDC guidelines, further hurts communities. Normalcy will return eventually, but let’s de-center ourselves first.