Deaths from COVID-19 are overwhelmingly concentrated among the elderly, and thus it would seem obvious that vaccinating older Americans should be a top priority. Yet the Centers for Disease Control and Prevention (CDC) have released guidance suggesting that millions of essential workers should receive the vaccine before many people 65 and older.
Part of the reason for this, according to a CDC report, is to mitigate and racial and ethnic "health inequities." Older Americans are disproportionately white, whereas the essential worker category includes a larger percentage of racial minorities and low-income people.
"Older populations are whiter, " Harald Schmidt, a professor of ethics and health policy at the University of Pennsylvania, told 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."
It's not as if there's a consensus that this is the right thing to do. The Times notes that this approach "runs counter to frameworks proposed by the World Health Organization, the National Academies of Sciences, Engineering, and Medicine, and many countries, which say that reducing deaths should be the unequivocal priority and that older and sicker people should thus go before the workers, a view shared by many in public health and medicine."
Indeed, this is a prime example of progressive thinking on racial justice leading otherwise intelligent people to take a position that actually hurts racial minorities. While it's true that the 65-and-up demographic is somewhat whiter than the general population, there are still millions of elderly people of color, and they have by far the greatest risk of dying from COVID-19—the age skew of the disease's victims is extreme. A policy of vaccinating police officers, firefighters, and grocery store employees before the elderly is clearly suboptimal, even from the standpoint of just trying to save as many people of color from dying as possible.
"The decision here is to not prioritize vaccinating them, but to instead vaccinate a different, less vulnerable group of people and then assert that this creates some kind of abstract collective racial benefit," notes Matt Yglesias in a terrific post on this subject. "There have been a lot of takes lately about woke liberals prioritizing symbolic racial issues over the concrete needs of non-white people, but this idea really takes the cake."
As Yglesias explains in greater detail:
Basically, if you take 1,000 prime-age Americans you'd expect to have 150 African-Americans in the pool versus about 100 if you take 1,000 senior citizens. So in that sense, vaccinating essential workers promotes racial equity because you're giving shots to more Black people. But since the infection fatality rate for senior citizens is at least 10 times the rate for non-seniors, you're not actually saving Black people's lives this way. You're opting for a strategy that leads to more Black deaths and more white deaths than the "vaccinate seniors first" strategy, but deciding that it's better for equity and this is what ethics requires.
There are other problems with vaccinating essential workers before senior citizens, in that the former is an expansive and debatable category. Depending on who gets counted, some 70 percent of the workforce can be deemed essential, though restricting it to just "front line" workers gets that percentage down significantly, according to the Times. And while it's true that vaccinating people in the workforce who are most likely to spread the disease to others could be a sound strategy for ultimately preventing deaths, this is a complicated approach and the current supply of vaccines is inadequate.
Yglesias recommends vaccinating health care workers, and then going by age: 85 and up, then 80 and up, then 75 and up, etc. This idea has a lot of merit, especially when the vaccine supply remains limited.
Ultimately, it's up to the states to determine who gets vaccinated first; the CDC's guidance is only a recommendation. Still, it's regrettable that the CDC has embraced an approach to racial equity that might keep people in need of the vaccine from getting it first.