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Is It Lawful and Ethical to Prioritize Racial Minorities for COVID-19 Vaccines?

Educational Objective
To identify the key insights or developments described in this article
1 Credit CME

Coronavirus disease 2019 (COVID-19) has disproportionately affected racial minorities in the United States resulting in higher rates of infection, hospitalization, and death. With a limited supply after the initial approval of a safe and effective vaccine, difficult legal and ethical choices will have to be made on priority access for individuals.

The National Academies of Sciences, Engineering, and Medicine (NASEM) has recommended prioritization of racial minorities who are “worse off” socioeconomically and epidemiologically.1 The World Health Organization (WHO) similarly cautioned that “colorblind” allocation frameworks could perpetuate or exacerbate existing injustices. Both NASEM and WHO urge policy makers to allocate vaccines in ways that reduce unjust health disparities.2 The ethics and legality of race-based policies in the United States have been fraught with controversy.3 This Viewpoint considers how COVID-19 vaccine priority allocations could be implemented ethically and legally.

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Article Information

Corresponding Author: Lawrence O. Gostin, JD, O’Neill Institute for National & Global Health Law, Georgetown University, 600 New Jersey Ave NW, McDonough 568, Washington, DC 20001 (gostin@georgetown.edu).

Published Online: October 14, 2020. doi:10.1001/jama.2020.20571

Conflict of Interest Disclosures: None reported.

References
1.
Gayle  H , Foege  W , Brown  L , Kahn  B , eds. A Framework for Equitable Allocation of Vaccine for the Novel Coronavirus. National Academy of Sciences, Engineering, and Medicine; August 2020. Accessed September 21, 2020. https://www.nationalacademies.org/our-work/a-framework-for-equitable-allocation-of-vaccine-for-the-novel-coronavirus
2.
World Health Organization Strategic Advisory Group of Experts (WHO/SAGE). Values framework for the allocation and prioritization of COVID-19 vaccination. September 14, 2020. Accessed September 14, 2020. https://apps.who.int/iris/bitstream/handle/10665/334299/WHO-2019-nCoV-SAGE_Framework-Allocation_and_prioritization-2020.1-eng.pdf?ua=1
3.
Persad  G , Peek  ME , Emanuel  EJ .  Fairly prioritizing groups for access to COVID-19 vaccines.   JAMA. Published online September 10, 2020. doi:10.1001/jama.2020.18513PubMedGoogle Scholar
4.
APM Research Lab Staff. The color of coronavirus: COVID-19 deaths by race and ethnicity in the US. Published September 16, 2020. Accessed September 29, 2020. https://www.apmresearchlab.org/covid/deaths-by-race#age
5.
Schmidt  H .  Vaccine rationing and the urgency of social justice in the COVID-19 response.   Hastings Cent Rep. 2020;50(3):46-49. doi:10.1002/hast.1113 PubMedGoogle ScholarCrossref
6.
Covid-19 vaccination program interim playbook for jurisdiction operations. Centers for Disease Control and Prevention. September 16, 2020. Accessed September 16, 2020. https://www.cdc.gov/vaccines/imz-managers/downloads/COVID-19-Vaccination-Program-Interim_Playbook.pdf
7.
Persad  G. Allocating medicine to address disparities. SSRN. Posted September 28, 2020. Last revised October 5, 2020. Accessed October 5, 2020. http://ssrn.com/abstract=3699769
8.
Kind  AJH , Buckingham  WR .  Making neighborhood-disadvantage metrics accessible—the Neighorhood Atlas.   N Engl J Med. 2018;378(26):2456-2458. doi:10.1056/NEJMp1802313 PubMedGoogle ScholarCrossref
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