Put equity first in access to the COVID-19 vaccine 

By Angela Ciolfi

The CDC guidance released on Sunday night leaves many heart-wrenching decisions to state and local governments regarding who will be given priority access to the lifesaving COVID-19 vaccine. We know these decisions are difficult, and we hope that Virginia officials will take this opportunity to follow the old biblical maxim, “the last will be first.” 

While many Virginians can easily lower their exposure risk through remote work, a stable living situation with family who can choose to isolate, easy access to protective equipment likes masks and hand sanitizer, the security of employer-sponsored health insurance, and regular updates on the pandemic from government officials in the language they speak, far too many must continue to risk their health each day just to get by. Farm and migrant workers, people who are incarcerated, low-income communities, and communities of color everywhere are too often the last to receive needed benefits and protections. Equity and public health demand that we put them closer to the front of the vaccination line.

As Virginia plans for vaccine distribution, we call on state officials to meaningfully address the ways COVID-19 has both ravaged the health and financial security of Black, brown, and economically disadvantaged Virginians and exacerbated distrust of the healthcare system. And we must proactively plan for these communities to receive meaningful vaccine access, care, and information. 

We must also reject a cruel and deadly calculus that values some lives over others, without regard to level of actual risk. Take prisons, for example. Recognizing that congregate living settings fuel the spread of the virus, health officials have rightly prioritized long-term care settings for the first phase of vaccine distribution. And recognizing that social distancing is not an option in carceral settings, the CDC guidance also includes prison guards on the priority access list—but not incarcerated people. Why not? It cannot be because confined persons have lower risk of contracting or dying from COVID-19. In fact, incarcerated individuals are 550 percent more likely to get COVID-19 than the average US population, and 300 percent more likely to die from it. 

It must be, then, that the lives of people who have been suspected or convicted of crimes or immigration violations have been devalued to the point that those most at risk are not viewed as worth protecting. But we do not need to put these precious humans at risk of a COVID death sentence. Five states—Connecticut, Delaware, Maryland, Nebraska and New Mexico—have already included incarcerated people in phase one of their COVID-19 vaccine distribution plans. Others are still deliberating, but Virginia should not have to think twice about joining those five, especially as deaths and infection rates inside Virginia’s prisons rise precipitously.

The CDC guidance rightly prioritizes teachers, childcare providers, and other essential workers. Indeed, the global pandemic has clearly demonstrated that those and other jobs are essential for our society to function. Virginia employers invite workers to come to our state to harvest and package our food. We count on them to feed us every year—but particularly this year. These workers often live in isolated camps; sleep, cook, and bathe in common facilities; are transported to and from work daily in packed buses and vans; work side-by-side in the fields; and do not have access to reliable information about this dangerous disease. Farm and migrant workers who do this arduous and essential labor must be prioritized in Virginia’s vaccine plan.

Finally, public officials must also prioritize all wage- and income-insecure populations, including low-income immigrant communities, for early vaccination. While many have lost their jobs altogether, others have been forced to work despite their well-founded fears of contracting COVID-19. These populations have not had the luxury of working from home or taking leave to mitigate their exposure to the virus. Many of these individuals live in multi-family and/or multi-generational housing where social distancing is difficult. Their families depend on income from these jobs to pay for rent, food, hospital bills, and other necessities. 

But simply making the vaccine available to those who need it is not enough. These communities must also be provided with clear, comprehensive, and culturally-sensitive guidance on how to access the vaccine, data about the vaccine’s safety and efficacy, and an explanation of a person’s right not to receive the vaccine. State officials should also make clear that any data collected in the dispersal of the vaccine will be kept private and used for no other purpose than protecting public health. We owe these communities—for whom forced sterilization, unwelcome experimentation, and misuse of private health information for immigration enforcement or other uses is an all too recent memory—nothing less than full transparency in how their information will be used.

We know it will take time for all Virginians to receive these lifesaving injections and finally end this pandemic, a pandemic that has so clearly exposed the vast inequities and shocking vulnerabilities in our social safety net. State health officials must plan now to ensure that historically marginalized populations—populations who are often highly vulnerable to the virus—are not left until last, or left out altogether.

Angela Ciolfi is executive director of the Legal Aid Justice Center.

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Put equity first in access to the COVID-19 vaccine