Following the release of COVID vaccines, America is fortunately having a robust conversation on how government, health professionals, and vaccine manufacturers must gain the trust and confidence of justifiably skeptical Black and brown communities. According to one recent (and not so surprising) national COVID Collaborative survey, just 14% and 34% of Black and Latino respondents, respectively, trust the coronavirus vaccine. This is particularly worrisome because COVID 19 kills Black and brown folks at a much higher rate. For Black populations, the legacy of medical violence is a long one and will not go away — public leaders must tackle it.
Yet, one major question we’re about to all get blindsided on is this: Who will get the “best” vaccine available — and who won’t?
Because of the rather narrow way we’ve been having the national coronavirus vaccine discussion, many have assumed it’s just one type or one standard of vaccine. If we let headlines and cable TV talking heads tell it, there’s a public sense of the big singular “vaccine” that’s “95% effective.” However, most of us in the know have failed to focus on one major detail: There are several vaccines, and not all are created equal.
The farthest-along vaccines for use in the United States are Pfizer, Moderna, and Astra Zeneca. Both Pfizer and Moderna show 95% effectiveness. However, AstraZeneca, reportedly, has only seen “moderate” effectiveness, with trial efficacy ranging anywhere from 62% to 70% and sometimes 90%, depending on the level and sequence of dosage.
That’s not to say AstraZeneca’s vaccine is not effective. Indeed, trial studies show it is. But, we have not yet had that open conversation about how Pfizer and Moderna appear to outperform AstraZeneca, and maybe others. As vaccines are gradually available, people will have questions about if they are getting the “best” option, and whether vaccine gets distributed based on zip code, income, health insurance, and, some will wonder, race.
We need to get ahead of that inevitable now. The fear here is that vaccine distribution or, rather, who gets what grade of vaccine will be determined by where they live, how much they make, and the color of their skin. Expectations on vaccine supply have already been dramatically reduced as we’re now finding out the current administration didn’t purchase the “several hundred million doses” of COVID vaccine it promised. Instead, states are planning for about 40 million doses to start with. We’ll have only a limited supply of that 95% effective Pfizer and Moderna, but initially — and likely — a greater supply of the potentially 70% effective AstraZeneca. What happens if word gets out that the 95% effective vaccine will be used up before certain communities or populations can get in line?
It’s a valid question because we see it unfolding every day in the delivery of health care, particularly as well-researched and documented bias — conscious or not — often drives health-care decisions. Race and income often dictate level and quality of care. We know, for example, that Black and Latino patients face numerous barriers to needed prescription drugs; Black and brown children were found less likely to receive antibiotics for respiratory infections than white children. If this is a norm, why should those populations expect the equitable distribution of coronavirus vaccine?
That’s the critical question I’ve seen unfold in terrible and tragic ways firsthand. As chief public health officer in Washington, D.C., leading the response to the first bioterrorism attack on our nation’s capital in 2001, I had to explain to outraged Black postal workers why they were receiving a different and thought to be cheaper anthrax antibiotic, doxycycline, compared with the Ciprofloxacin, taken by mostly white Capitol Hill personnel and postal workers in Manhattan. Two Black postal workers had already died from anthrax. The decision to pick “doxy” was based on risk vs. benefit, not cost, and ultimately did not lead to disparate care. But that’s difficult to explain in a setting of disparate mortality along racial lines.
We might very well be headed down this same road in the distribution of coronavirus vaccine. Even as we resolve the question over trust, we’re going to hit the thornier topic of quality. How vaccine is dispersed could potentially come down to bias selection: the battle between haves and have-nots.
To ward off dangerous levels of skepticism, public health professionals and elected officials must be clear: 1) We now know we’ll have limited vaccine supply to start with and 2) limited medical and emergency supply chains, including the cold storage needed to preserve the 95% effective Pfizer and Moderna. Hence, there will be heavier reliance on the 70% effective AstraZeneca which, incidentally, doesn’t likely need the cold storage.
Policymakers on all levels should huddle with public health officials and consider measures to prevent vaccine distribution that would appear to be based on income, health-care access, and race. All approved vaccines, must be distributed equitably. As we navigate our nation out of this pandemic, let’s ensure our national biases don’t further ruin the path to recovery.
Ivan Walks, M.D., is former Chief Public Health Officer of the District of Columbia and Principal of Ivan Walks & Associates. Charles D. Ellison is Host/Executive Producer of “Reality Check” on WURD, Senior Fellow at the Council of State Governments Eastern Regional Conference’s Council on Communities of Color, and Publisher of theBEnote.com