Denise M. Dudzinski, PhD MTS (Chair of the Department of Bioethics & Humanities, UW Medicine)
I am Chair of the Department of Bioethics & Humanities at UW School of Medicine (Seattle). I am supportive of many aspects of the allocation scheme proposed. However, if PPE is provided appropriately for front-line healthcare workers (HCWs) and first responders (FRs), I question the ethical rationale for prioritizing them for vaccination. My concern arises for three reasons:
1) In general, proper use of PPE protects FRs and HCWs from SARS CoV-2, especially now that it is more plentiful and some of the risks of re-use have been resolved or addressed. Frontline HCWs and FRs certainly do assume greater risk. However, just as PPE protects them from other respiratory viruses, so they are reasonably protected from SARS-Co-V2 as long as other social distancing practices are also practiced. Social distancing practices may not be possible for some HCWs in BiPOC communities who live in close quarters, however. Priority for vaccination belongs to those without PPE protection who are frequently in close contact with the public & SARS-Co-V2 carriers, such as those without the option to isolate at home (those living in close quarters) and essential workers who do not utilize full PPE (bus drivers, school teachers, etc.)
2) The risk of severe disease and death is extremely high among Black, Hispanic/Latinx, and AI/AN communities and this increase risk is a result of systemic racism that leaves a greater percentage living in poverty, with essential service jobs, and without adequate healthcare. Black, Hispanic, and AI/AN people, including HCWs, should be prioritized over white HCWs/FRs.
Non-white HCWs and FRs are at far greater risk of infection and severe illness, consistent with community infection rates for minority populations. This might be because, when testing HCWs we generally do not differentiate between community and occupationally acquired disease. We assume that the infection was acquired at work, but it might have been acquired at home.
• Data from early in the pandemic shows that there was increased risk of contracting SARS-Co-V2 among white HCWs. However, HCWs from BiPOC communities had a far greater risk. Black frontline workers were at greatest risk. (https://www.thelancet.com/journals/lanpub/article/PIIS2468-2667(20)30164-X/fulltext#sec1) “Non-white health-care workers were disproportionately affected by scant PPE adequacy and more likely to work in clinical settings with greater exposure to patients with COVID-19.” (https://www.thelancet.com/journals/lanpub/article/PIIS2468-2667(20)30164-X/fulltext#sec1)
• The greater incidence of hospitalization and death among BiPOC communities means these communities should have priority access to effective vaccines. Blacks are 4.7 times more likely to be hospitalized and 2.1 times more likely to die. Hispanic/Latinx people are 4.6 times more likely to be hospitalized and 1.1 times more likely to die. AI/AN people are 5.3 times more likely to be hospitalized and 1.4 times more likely to die.(https://www.cdc.gov/coronavirus/2019-ncov/covid-data/investigations-discovery/hospitalization-death-by-race-ethnicity.html)
3) The greatest risk may NOT be to frontline HCWs after all. Incidence of severe Covid-19 disease was lower among frontline HCWs. Primary care physicians were more likely to be infected. “Frontline physicians including anesthesiologists, ICU specialists, emergency room physicians, and nurses form a much smaller group of COVID-19 cases, likely due to better access to personal protective equipment,” said senior author Basavana Goudra, MD, a clinical associate professor of Anesthesiology and Critical Care at Penn. (https://www.pennmedicine.org/news/news-releases/2020/july/among-healthcare-workers-family-primary-care-doctors-most-at-risk-of-dying-from-covid19#:~:text=A%20new%20study%2C%20led%20by,reported%20deaths%20were%20among%20physicians).
Please prioritize the communities who are suffering the most at the hands of COVID-19. Based on a plethora of data about rates of hospitalization and death, BiPOC communities should have access before HCWs and FRs.
