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Experts explain why CDC chose to de-emphasize the elderly: ‘White people dying will level the playing field’

The Centers for Disease Control and Prevention (CDC) says that at least 19 states will utilize a “Disadvantage” Index that will consider measures of inequality, including poverty and race, in order to deliver the new COVID-19 vaccines to those who are worse off first. The New York Times had several experts chime in with one doctor named Harald Schmidt voicing the unthinkable: “Older populations are whiter…Instead of giving add’l health benefits to those who already had them, we can start to level the playing field a bit.”

Also in the New York Times, a little bit later on, another doctor named Marc Lipsitch stated that teachers should not be considered essential workers and given the vaccine upfront because “They are often very white.”

Many believe this sounds a lot like the promotion of a form of racist eugenics. In other words, ‘death panels’.

In the same article, an economist named Elise Gould says that teachers should be prioritized because the families they teach are disproportionately “Black and Brown” and those groups would benefit more than white people.

Because of the limited supply of vaccine doses, at least 26 states and Washington, DC, will rely on what’s known as the Social Vulnerability Index, or SVI, to determine who should be immunized. The SVI tries to account for social, economic, racial, and ethnic factors. Then there’s the “Disadvantage” Index.

An advisory committee to the Centers for Disease Control and Prevention suggested that healthcare workers and nursing-home residents get shots first, followed by those with preexisting medical conditions. The thinking is that because ethnic and racial minorities are overrepresented in those groups, the plan will be equitable. But healthcare experts and government officials, including President-elect Joe Biden, believe that plan will miss too many people who are poor, Black, Latino, or members of other minority or disadvantaged groups.

“Even if just 10% of states decide to use the index, it makes a big difference,” said Harald Schmidt, assistant professor of medical ethics and health policy at the University of Pennsylvania, who recently co-authored an analysis of equitable vaccine allocation. “Everybody is still trying to figure out this equity piece, and I’m hopeful we will see quite a bit of change.”

The index uses 15 measures, including household composition, disability, minority status, housing type, English fluency, minority-group identification, and employment status.

“People are starting to understand the connection between equity and the SVI,” said Ruqaiijah Yearby, a professor at Saint Louis University School of Law who has focused on equity in health care. “But I hope it will go beyond the vaccine and be connected to our overall response.”

Originally, it was going to be the elderly and first responders. Now race and poverty have entered the mix. Vaccine campaign managers have typically paid more attention to the number of lives they can save than the demographic details of those lives.

According to these same experts, COVID-19’s outsized effect on people of color is injecting an element of social justice into vaccine allocation. A variety of experts, from the World Health Organization to the US’ National Academies of Sciences, Engineering, and Medicine, are suggesting reducing inequality should be a goal of COVID-19 vaccination regimes.

“We can’t just continue with the same framework that simply seeks to maximize benefits, because that will very likely mean that minorities are not given the attention they need,” says Schmidt who analyzed the state plans. “They’ve been hit much harder.”

Many people of color would get priority under some of the categories the CDC is considering. Its Advisory Committee for Immunization Practices is in charge of issuing federal recommendations on vaccine allocation. For example, members of these populations may be more likely to have two or more health conditions that increase their likelihood of getting sick from Covid-19.

But some states are also planning to use a “Disadvantage” Index to focus on vulnerable populations. Most of them have settled on the CDC’s Social Vulnerability Index, which in addition to poverty and race, considers factors like car ownership, crowded living situations, and even English proficiency to rank a community’s degree of need in case of a disaster.

Only seven states, including Tennessee, Louisiana, and Michigan, will use the index to give disadvantaged people spots farther up the queue. Other states will use the information more broadly to decide which groups get priority, how to reach out to vulnerable communities, and where to set up vaccination sites.

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