Thank you for putting together this very important document. I have two comments.
First, your document treats Asian Americans, Native Hawaiians, and Pacific Islanders as if they do not exist. The racial/ethnic groups with COVID-19 disparities that you highlight clearly need to be there. However, there is no justification for excluding AANHPIs. The early reports from the pandemic did not show that they had disparities, but this was partially due to the lack of adequate data collection and classification on the race/ethnic variable as pertained to AANHPIs. More recent studies do show disparities for Asian Americans, including work from our institution, the Asian American Research Center on Health (ARCH). We showed that there was a consistent pattern of Asian Americans having among the highest ratio of deaths to cases for COVID-19 across different counties and states (https://www.healthaffairs.org/do/10.1377/hblog20200708.894552/full/). The CDC recently reported that Asian Americans had disparities in hotspot counties for COVID in July 2020 (https://www.cdc.gov/mmwr/volumes/69/wr/mm6933e1.htm). We have conducted analyses soon to be published that show that Asian Americans had excess death rates during the early part of the COVID pandemic that were similar to Black Americans in California. We demand that you add these populations in your document wherever you mention racial/ethnic disparities related to COVID-19.
Second, while it is understandable that you chose to focus on priority risk groups in the distribution of the potential vaccines, it is important to note that structural racism creates unequal access. Thus, by not including race/ethnicity as a priority in distribution, you run the risk of perpetuating access problems for other health conditions, including for COVID-19 treatment, that have led to the huge disparities observed already. In other words, if you choose to vaccinate people with high levels of co-morbidities or older adults without regards to their race/ethnicity, you can expect the outcome that a higher proportion of non-Latino white older adults or non-Latino whites with high levels of co-morbidities will receive the vaccine than the corresponding Asian, Black, Latinx, Indigenous, or Pacific Islander group. Please consider adding race/ethnicity as a qualifier in the determination of who gets the vaccine.
