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A healthy dose of justice: When the vaccine comes, a COVID vulnerability index can help achieve both

There’s been lively discussion about whether people will be willing to take a vaccine for COVID-19 when it becomes available. It’s a question each of us will have to answer for ourselves sooner or later. But the debate obscures a more complex reality: when an effective and safe vaccine finally arrives, it will initially be in scarce supply. No country or business has the manufacturing capacity to quickly provide enough doses for an entire population.

The big question we should be considering, therefore, is who should get vaccinated first, and who should be next in line thereafter? Do certain groups within the population deserve priority over others? And if so, what considerations should influence these decisions?

This is not the first time we’ve been faced with this type of “allocation problem.” Typically, vaccine allocation decisions are made with a view toward maximizing the overall health benefit: to achieve the greatest good for the most people, such as the total number of lives saved. For reasons of epidemiology, that doesn’t always mean that people most vulnerable to a disease are the first ones to receive a vaccine. The worst-off groups are prioritized only insofar as it aligns with maximizing the benefits of the vaccine.

But COVID-19 is an exceptional disease — not just because of the rapidity and extent of its spread, but because of the way it has highlighted and heightened the inequities that exist in the United States. It has a disproportionate impact on communities who are disadvantaged by their race and ethnicity, by underlying comorbidities and lack of access to good health care, by their living conditions, or even by the kind of work they do. In the United States, rates of COVID-19 infection among Black, Latinx, and Native American people are more than two-and-a-half times as high as among white people — while hospitalization rates are approaching five times as high, and Black people are dying at twice the rate of white people. Historically, it’s precisely non-white populations that have lower coverage of vaccination for common diseases.

This is why we developed the COVID Community Vulnerability Index (CCVI) — to identify the communities impacted most negligibly by the virus, so we can plan and respond accordingly. It builds on the CDC’s Social Vulnerability Index (SVI) to take into account additional vulnerability factors that come into play with a pandemic disease like COVID-19 — from minority populations and foreign languages spoken, to the amount of household crowding or limited transportation access in a community.

It’s therefore exciting to see that the National Academies of Sciences, Engineering, and Medicine (NASEM) has just launched a set of vaccine allocation recommendations for the United States that make an important departure from the traditional vaccine allocation framework. NASEM aims to achieve not only impact, but also social justice, by taking into account that ethnic minority groups are worse affected by COVID-19.

NASEM proposes a vaccine allocation framework with the goal of reducing severe illness, death, and societal consequences due to COVID-19. Its

Trump’s diagnosis shows US vulnerability to the coronavirus

ST. CHARLES, Mo. (AP) – President Donald Trump’s startling COVID-19 diagnosis serves as a cruel reminder of the pervasive spread of the coronavirus and shows how tenuous of a grip the nation has on the crisis, health experts said.

With U.S. infections rising for several weeks, Trump became one of the tens of thousands of Americans who test positive each day. He went through a “very concerning” period Friday and the next 48 hours “will be critical” in his care, White House chief of staff Mark Meadows said Saturday.

That differed dramatically from the rosy assessment by Trump’s staff and doctors, who took pains not to reveal the president had received supplemental oxygen at the White House before he went to a military hospital. Some of Trump’s top advisers and allies also have tested positive recently.

“No one is entirely out of the virus’s reach, even those supposedly inside a protective bubble,” said Josh Michaud, associate director of global health policy with the Kaiser Family Foundation in Washington.

Eight months after the virus reached the United States, worrying signals mounted of what’s ahead this fall. The NFL has postponed two games after players on three teams tested positive. Some hospitals in Wisconsin have run low on space, and experts warned of a likely surge in infections during the colder months ahead. Some economists say it could take as long as late 2023 for the job market to fully recover.

The U.S. leads the world in numbers of confirmed infections, with more than 7 million, and deaths, with more than 208,000. Only a handful of countries rank higher in COVID-19 deaths per capita.

“The statistics are so mindboggling, they make us numb to the reality of just how painful, unacceptable and absurd this is,” said Dr. Reed Tuckson, board chairman of the nonpartisan Health Policy Alliance in Washington. “Every single American must double down on their vigilance. If we don’t, then we are being foolhardy and irresponsible.”

Wallace Clark, 50, of Springfield, Illinois, said he was flummoxed by the president’s diagnosis but hopes it makes people realize they need to take the pandemic seriously.

“Some people probably think they’re immune or can’t get it, but it is possible. It does send a message,” Clark said Saturday.

The president’s infection occurred as the nation has reached a crossroads in its response to the virus.

The U.S. is averaging 40,000 cases a day. The situation is improving in Sun Belt states that were hot spots in the summer, and many loosened restrictions this week.

Mississippi’s governor ended a mask requirement, South Carolina’s governor said he would ease capacity restrictions on restaurants and New Orleans bars got the greenlight to sell carry-out drinks. Florida has moved ahead with an aggressive reopening that gives bars and restaurants latitude to allow as many customers as they choose.

The outlook is gloomier in the Midwest.

Wisconsin reported a record daily death toll Wednesday, and hospitals in multiple cities said they were running out of space. A 530-bed