Who gets to jump to the head of the COVID-19 vaccine line?
President Trump delayed initial plans, first disclosed by The New York Times, to fast-track distribution of the vaccine to most White House staff members, “unless necessary.” The scent of privilege for someone other than himself was too strong — even for a president whose cronies have shamelessly benefitted from COVID-19 treatments unavailable to others. But already there are other vaccine line-cutters, and their identity shows exactly whose work is valued by society. For example, congressional leaders who have yet to come up with a COVID-19 relief package for the country will be offered the vaccine before grocery workers who stock the shelves so the rest of us can eat.
Every day, COVID-19, which has taken more than 300,000 American lives, exposes the great divide between the powerful and powerless. The poor and people of color suffer the most from the disease, while small businesses continue to take a big economic hit. To control the spread of the virus, states mandate assorted business lockdowns. But the NBA can still create a bubble so basketball can be played. In California, a restaurant owner must shut down an outdoor patio, while next door, a television production crew dines under tents. In Massachusetts, gyms must cut back service, but casinos can still operate.
The pandemic also reveals America’s willingness to accept the basic unfairness that is baked into our health care system. “Medical ethics begins with the assumption that all people are equal, that every life has value,” Charles E. Binkley, a surgeon and director of bioethics at the Markkula Center for Applied Ethics at Santa Clara University, said in an interview. But in real life, there’s plenty of wiggle room. Anybody can get COVID-19, but not everyone gets access to the same treatment. Some people, because of what they do “to keep society moving,” get priority, said Binkley. Who these special people are is a judgment call. A president and his cabinet members? A president-elect and his incoming staff? And what’s the difference between jumping the line and instilling confidence by taking the vaccine publicly, as former presidents Bill Clinton, George W. Bush, and Barack Obama plan to do?
When it comes to national vaccine distribution, the Centers for Disease Control and Prevention has designated front-line health workers and people in nursing homes as the first recipients. But it’s also a given that some people who fall outside those categories are going to use their power and privilege to game the system and try to get what others can’t, said Binkley. Can such gaming be stopped? Only by “the conscience of the individual,” said Binkley, which today seems to be in short supply.
Rudy Giuliani is the face of privilege: Trump’s lawyer freely acknowledged his “celebrity” status got him access to treatment that others did not have. But privilege is also the difference between the quick service available, for a price, through private testing, versus the lines that stretch for hours at public sites and the delayed results that go with them. It’s the safety that comes with being able to work remotely from home in contrast to the risk of having to show up for work in a restaurant, grocery store, or classroom. It’s the comfort of being able to travel by car, versus the need to rely on public transit, and the threat of losing that service to cuts as white-collar workers abandon commuter rail and subway systems.
With the vaccine comes the opportunity for even sharper divisions between the haves and have-nots. Massachusetts, like other states, has a vaccine distribution plan that promises “safe, equitable, and effective delivery.” Phase One covers health care workers; long-term care facilities; first responders; congregate care facilities, including corrections facilities and shelters; and home-based health care workers and health care workers doing non-COVID care. How will that play out in reality? Will prison staff and prisoners get equal access?
During a pandemic, these are not theoretical questions. They are a matter of life and death.