Posted on December 29, 2020

California May Consider ‘Historical Injustice’ When Allocating COVID-19 Vaccine

April Dembosky, NPR, December 18, 2020

When Virginia Hedrick first heard about the coronavirus circulating on cruise ships off the coast of California back in March, it made her think back to some of the first ships of European settlers that arrived on American shores centuries ago, also teeming with disease.

Various outbreaks and epidemics spread across the continent in the following centuries, particularly measles and smallpox, and Indigenous people suffered hugely disproportionate rates of illness and death.

{snip} Now, during the 2020 coronavirus pandemic, American Indians are four times more likely to be hospitalized for COVID-19 than white people, and more than twice as likely to die. For all these reasons, past and present, Hedrick says, Indigenous people should be moved toward the front of the line to receive a vaccine.


California health officials have made clear they want equity and transparency to be among the main priorities in deciding how to allocate the first scarce supplies of a vaccine. For example, in divvying up the first doses for health care workers, the state is prioritizing hospitals located in low-income areas before those in wealthy areas.

“We will be very aggressive in making sure that those with means, those with influence, are not crowding out those that are most deserving of the vaccines,” Gov. Gavin Newsom said recently at a press conference.

Newsom is referring to current inequities of money, power and access — but state officials also seem willing and even eager to also take into consideration historic injustices when deciding vaccine allocation. The state asked more than 70 organizations to join the Community Vaccine Advisory Committee to help develop an equitable vaccine distribution plan, including the Sacramento-based policy advocacy organization Hedrick runs, the California Consortium for Urban Indian Health.

At the first meeting of the committee on Nov. 25, Hedrick introduced the idea of considering historical injustice as a factor in deciding which groups would be next to get the vaccine after health care workers. At the second meeting a few days later, Dr. Nadine Burke Harris, the state’s surgeon general and a co-chair of the committee, said: We heard you.


Rather than defining equity as everyone having a “fair opportunity to attain their full potential,” as the World Health Organization does, Burke Harris instead proposed adopting a definition from the U.S. Office of Minority Health, which says achieving health equity requires “efforts to address avoidable inequalities and historical and contemporary injustices.”


The details will matter. Experts warn California could open itself up to legal challenges if it uses race or historical injustice as a factor in prioritizing who gets the vaccine.

“That is affirmative action. That’s choosing one group over another,” says Lawrence Gostin, professor of global health law at Georgetown University.


Instead of using race, he says, the state should focus on a combination of other factors that can capture race, such as poverty, housing density or education disadvantage.

Eighteen states have indicated they would use the “social vulnerability index,” a metric created by the Centers for Disease Control and Prevention. It combines 15 socioeconomic measures to identify at-risk neighborhoods. California has relied on its own “health equity metric” during the pandemic to guide reopening plans on the county level, and Burke Harris indicated the state might use it to decide vaccine allocations.