Thanks to the tireless efforts of scientists and the competitive drive of pharmaceutical companies, a covid vaccine is forthcoming. The next question, however, is painfully obvious: In a country that has seen hundreds of thousands of deaths as a result of the virus, who gets the vaccine first? Will this vaccine be like the latest iPhone release where people are just standing outside for hours wrapping around five city blocks only to be told there’s nothing left once they get to the door? Though vaccine distribution is a complicated process that medical ethicists and public health experts have been working out since long before a vaccine was on its way, where there’s money, there’s always a way to shoot to the front of any line.
According to Stat News, though the Advisory Committee on Immunization Practices has already released a tiered system for distribution, and it looks like we’re in for some good old-fashioned class warfare.
Theoretically, the ACIP is suggesting a distribution plan that is objective and prioritizes those who are most at risk to contract the virus, in an effort to limit the spread. But even if an extremely strict tier system was put in place—deemed fair and ethically responsible—there are still loopholes left to be finessed by anyone with a sizable bank account. Stat reports that ACIP is recommending essential workers be first to receive the vaccine, in an attempt to ensure that people of color who have been most affected by the virus for socio-economic reasons are able to be vaccinated. However, considering that the term “essential worker” has morphed from meaning nurses, doctors, and EMTs to athletes, production assistants, and the guy that dresses up as Gaston at Disneyland, it’s unclear who exactly is getting pushed to the front of the line.
Take financial services workers, who keep money moving and can include anything from a local bank teller to a trader on the floor of the New York Stock Exchange—someone who makes millions and whose budget affords top of the line care administered by a doctor who travels to their Hamptons home. Certainly, the money people are important. But if you can tell a convincing enough story, any worker can make a case that the true essence of their work is invaluable so the debate isn’t over who is important rather it’s whose safety is a priority. Using the essential worker method for the vaccine may, in fact, privilege white affluent workers who have already been at an advantage and are able to double down.
According to Stat, “another opening that could be exploited to skip the line involves high-risk medical conditions that warrant early access to the vaccine.” This seems perfectly reasonable and fine until you recall the existence of private doctors and concierge medicine. One doctor argued that this model could provide a space for doctors to embellish the severity of their patients illnesses for the sake of keeping them within the practice, “It’s a market-based economy. You as a doctor want to keep your clients coming back.” I’ve never had a doctor refer to me as a client rather than a patient but considering I’m not white or wealthy, I suppose there are some words I’m just too poor to hear.
The U.S. health care system is generally designed to give preferential treatment to those with wealth and connections, ethicists said. “When we talk about the concept of individuals being able to get to the front of the line, that’s not difficult, because our system is designed to advantage those people with means like that,” said Tuskegee’s Ellis. “They don’t have to really do anything sinister. All they have to do is access the system that they are a part of.”
It shouldn’t still come as a shock that the healthcare system is flawed, considering that for the last few months we’ve seen it at its worst. Civilians waiting hours and hours on line for covid tests that take ten days to provide a result, while major sports leagues had daily tests delivered to them while they were quarantined in bubbles the size of small cities. Maybe more—the vaccine, and with it the promise of complete safety, is rocketing up the stakes of having enough power to manipulate the system. With an end to a pandemic that’s disproportionately killed the poor and people of color on the horizon, this imbalance feels particularly nefarious. Or maybe I’m just jealous that no one ever lobbied for bloggers to be labeled essential workers.