NON-WHITE Americans have suffered disproportionately from covid-19. According to A3.AI, a research group, black Americans, Hispanic Americans, Asian Americans, Native Americans, and Pacific Islanders are 38% likelier than white people to be infected with covid-19, even after controlling for income, underlying health conditions and other variables that potentially affect the disease. Its analysis suggests that a non-white 18-year-old is indeed likelier to contract covid-19 than a white 50-year-old. Vaccinating America’s non-white population is therefore crucial to reducing the country’s rate of infection.
Vermont, America’s second-whitest state (after Maine), has taken that exigency to heart. On April 1st, it made all non-white residents, and those in their households, eligible for the vaccine. In contrast, in order to qualify white Vermonters not living in households with non-white people must be essential workers, 40 or older, have one of various pre-existing conditions, be a primary caregiver of a child with high-risk health problems, or live in a multi-generational household. The move has raised some legal concerns, but proponents defend it on public-health grounds.
According to Mark Levine, the state’s health commissioner, Vermont hit on this strategy only after trying and failing with other approaches, including giving priority to multi-generational families and partnering with groups that primarily serve non-white Vermonters. Public-health officials found that non-white residents were still not getting vaccinated at the same rate as whites. By April 9th, 41% of white Vermont residents had received at least one dose of the vaccine, compared with only 29% of non-white residents.
“From an ethical perspective, I think [Vermont’s policy is] justified,” says Lawrence Gostin, a professor of global health law at Georgetown University, citing the disproportionate impact of covid-19 on minority communities. “From a legal point of view, I think that there would be smarter ways for Vermont to accomplish the same kinds of goals.” Mr Gostin recommends using measures other than race alone, such as the Social Vulnerability Index (SVI) originally developed for public-health emergencies.
The SVI would identify areas where people are at highest risk of covid-19 using several census-based variables, including poverty levels, housing crowdedness and race. Alaska uses the Area Deprivation Index, a similar measure to SVI that does not incorporate race, to allocate vaccines. “The Supreme Court has been, I would say in the last decade, increasingly suspicious of race-based prioritisation,” explains Mr. Gostin. “And the courts are only getting more conservative.”
Walter Olson of the Cato Institute, a libertarian think-tank, agrees the race-based policy could run into legal trouble. According to Mr Olson, Vermont’s Department of Health, if challenged, would have to prove that it had recently discriminated against the groups now being given priority. But he thinks that Vermont is unlikely to have performed such discriminatory acts, compared to other states. “Vermont has less of a record of racial discrimination than any other state in the union,” he notes.
Vermont is not the only state to consider race in vaccine distribution. Montana and Utah gave precedence to people of colour in their first phases of vaccination. Other areas, including Rhode Island, Texas and Washington, DC, used zip codes to focus on non-white communities. In January, Texas state officials threatened to revoke vaccines from Dallas county after officials there attempted to give them first to residents living in predominantly minority zip codes. The county rescinded its plan, but the federal government established its own vaccination sites and did the same thing.
Mr Olson says that these zip-code-based policies are also on shaky ground, but he hopes that lawyers will resist the temptation to sue. “You really don’t want to see litigation against the vaccination programme because you don’t want to hurt the energy,” he says. “We can have the arguments in principle...but please don’t allow this to delay anyone’s vaccination.” Mr Olson thinks Vermont’s policy will run its course before any legal action could stop it. All Vermonters will be eligible for vaccination from April 19th.