“It’s racial inequality — inequality in housing, inequality in employment, inequality in access to health care — that produced the underlying diseases,” Dr. Matthew said in an interview. “That’s wrong. And it’s that inequality that requires us to prioritize by race and ethnicity.”
Harald Schmidt, an assistant professor of medical ethics and health policy at the University of Pennsylvania, is not a member of the committee, but has been suggesting other ways vaccine prioritization could work. He predicts that courts would strike down any guidelines explicitly based on race and ethnicity. Instead, he has proposed using an index that takes into account education, income, employment and housing quality to rank neighborhoods by socioeconomic disadvantage that he says could serve as a good proxy.
“It’s imperative that we pay attention to how Covid has impacted the health of minorities differently; otherwise it compounds the inequalities we’ve seen,” Dr. Schmidt said.
There may be substantial differences in how racial and ethnic groups view vaccines. A recent Pew survey found that a little over half of Black adults said they would definitely or probably get a coronavirus vaccine if one were available today, while 44 percent said they would not. Among Hispanic and white adults, 74 percent said they would get the vaccine, while around a quarter said they would not.
“Because of Tuskegee and structural racism within the health care system, you have to make a case much more strongly to the African-American population,” Dr. Schmidt said.
Whoever is prioritized for the first doses, it will not matter if the vaccines don’t work for those demographics. And that will not be determined unless the vaccine trials themselves include those groups. So far, several vaccine candidates have entered final Phase 3 trials.
At a Senate hearing last week, Dr. Robert R. Redfield, the C.D.C. director, and Dr. Francis Collins, head of the National Institutes for Health, emphasized the need for racial and other diversity within the trials.