Priority Access to COVID-19 Vaccine and American Healthcare


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Tag(s): Legacy post
Topic(s): Ethics Global Ethics Health Care Health Disparities Health Policy & Insurance Public Health Social Justice Vaccines Vulnerable Populations

by Susan L. Smith, PhD

On either side of our country’s northern border, outrage is brewing about the rich getting priority access to COVID-19 vaccinations. 

An extremely wealthy Vancouver couple is being met with scorn after chartering a plane to the Yukon, breaking quarantine regulations, and lying to take advantage of a vaccination clinic that was meant for an indigenous community already hit hard by the pandemic. The University of Rochester Medical Center in New York had to issue a formal apology for moving board members and donors to the front of the line, noting that many “are disappointed by this information, and rightly so.” After multiple reports of the well-connected getting guaranteed reservation times, the Washington State Department of Health admonished that such practices “are banned and will not be tolerated.” 

But while Canadians are right to be outraged about wealth being used to gain access to healthcare, such a reaction is illogical for those who support the current structure of the American healthcare system.

In America, we have a for-profit healthcare model. Accordingly, wealthy individuals receive preferential access every single day. Since long before the drive for COVID-19 vaccines, advantage has been conferred upon the affluent and those with good jobs in the form of quality health insurance. If we are suddenly disturbed by a lack of equal access in the U.S. healthcare system, then we are either being naïve, at best, or — more likely — hypocritical.

There are a plethora of studies that have established a relationship between socioeconomic status (SES) and access to healthcare and healthcare outcomes with poorer people facing increased barriers accessing timely care resulting in disparate healthcare outcomes.  Our current system is a shining example of one in which increased wealth correlates with improved healthcare outcomes. Perhaps even more troubling is the fact that our SES also correlates with race. The results of a recent survey showed the median wealth of white families to be $188,200 (mean $983,400) while the median wealth of black families was $24,100 (mean $142,500). Hispanic family median wealth came in at $36,100 (mean $165,500). All other reported racial groups, including mixed race families, had median and mean wealth below that of whites and higher than black and Hispanic families. 

The COVID-19 pandemic has clearly illustrated extremely problematic disparate healthcare outcomes falling along racial lines. Black and Hispanic people are dying at 2.8 times the rate of white people. Black individuals are being hospitalized at 3.7 times the rate of whites and Hispanics at 4.1 times that rate. These populations are also being infected with COVID at rates disproportionate to the percentage of the population they comprise.  We are well aware of the systemic issues that have already contributed to the disproportionate allocation of the COVID-19 vaccine. Early statistics have shown that black and brown people are receiving the vaccination at substantially lower rates than whites. Much of this is due to the systemic racial issues that exist in our healthcare system. However socioeconomic issues and our privatized healthcare system bear a large portion of the blame. My years of research as a bioethicist lead to the unpalatable conclusion that, as a consequence of the nature of our healthcare system, poor families and, because of the negative correlation between SES and non-white racial groups, we have communities of color consistently and persistently experiencing poorer healthcare outcomes and less access to healthcare.

Why the sudden fuss over fairness? We should have been outraged a long time ago. If Americans don’t like how these vaccines are being rolled out, it’s time to rethink the whole system.

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