Who should be next? Should Oregon just try to vaccinate as many people as quickly as it can for COVID-19?
Should it prioritize minority populations? They have proven to be disproportionately impacted by the virus. Should it put people with chronic conditions first? They are arguably the most vulnerable.
Oregon basically began vaccinations with medical workers and residents and workers in long-term care. In some places, it is moving on to vaccinate educators. Then it will start with people who are 80 and older and gradually move down to people 65 and older. Any plan is going to be limited by the number of doses. But Oregon has choices to make about who goes next.
The state’s COVID-19 Vaccine Advisory Committee is developing a recommendation. When the committee left its meeting Thursday, there was a debate about options still flickering on the screen — prioritizing people with chronic conditions or starting with Black, indigenous and people of color, or BIPOC, populations.
“Chronic health conditions are more common in minority communities. (Starting with chronic conditions) targets the most vulnerable people within our communities and it is one approach to this very, very complicated problem,” said Dr. Kalani Raphael, of the Oregon Pacific Islander Coalition.
Kelly Gonzales, Ph.D., representing Oregon Health & Science University, Portland State University and the urban native community disagreed. “I don’t agree with removing BIPOC as the first priority,” she said. “I think it whitewashes the structural racism and systemic racism that we are trying to center. By centering on BIPOC people and then including chronic conditions, there is an overlap there.”
If that was not a difficult enough choice, there are more complications:
- The state does not have precise data about minority populations or who lives where with what chronic conditions.
- The state does not want health care workers to have to make judgments about a person’s race or ethnicity. (The state could ask people to attest to their race. Presumably, most people would be honest.)
- It is impractical to ask people to come to a vaccination clinic with a sheaf of medical records to prove a chronic condition. (Again, the state could ask people to attest that they qualify. Presumably, most people would be honest.)
- Any policy would need to be legally defensible.
- And then there’s what people call vaccine hesitancy — some people don’t want to get a shot. So even if the state tries to prioritize certain populations, it may not be able to.
First-come, first-serve might be faster in some ways. It would also exacerbate inequity. People with money, time and influence would skip to the front of the line.
The Centers for Disease Control and Prevention does have something called a social vulnerability index. The index puts together 15 variables from the U.S. Census to describe conditions within various census tracts. It looks at socioeconomic status; household composition and disability; minority status and language; and housing type and transportation. The Bend area has multiple tracts. An area around Redmond had the highest vulnerability score in Central Oregon, though that is dated information from 2016.
The state could update and build on that index. It could prioritize tracts with the highest vulnerability scores across the state and then even try to prioritize subgroups within those areas. But that approach would still be hampered by incomplete data and data that might be biased against minority groups.
The limits on vaccine supply make the recommendations from the committee even more critical.
The committee meets again Jan. 26. It seems the committee may make more final recommendations for prioritization at its Jan. 28 meeting.