OPINION: Inequitable Vaccinations

by Glenn Nelson 

Count me underwhelmed by Gov. Jay Inslee’s announcement that Washington soon will receive more doses of the COVID-19 vaccine. That’s rather like the U.S. Postal Service  (USPS) announcing it has reached an additional distribution agreement with Amazon. Both entities, the State and the USPS, were having a hard enough time delivering what they already had.

It’s messed up. My wife and I secured appointments for coronavirus vaccinations this week, meaning we will receive our first doses before my mother-in-law, an immigrant from Colombia who has late-stage cancer and, as of now, no appointment. And the three of us almost certainly will be vaccinated before her older sister, who also is in her 80s and a breast cancer survivor.

Meanwhile, I keep seeing on social media the hoards of younger non-essentials receiving their shots in the arm because they are whiter, more privileged, and therefore more connected. That’s not even counting the $10,000-plus donors who were offered opportunities to cut in the vaccine line from Overlake Medical Center or other special-access clinics, according to The Seattle Times, or the board members and generous donors who received vaccines from an upscale nursing home in Florida.

Or the fact that the wealthiest nations, including the U.S., have been hoarding initial supplies of a vaccine during a global pandemic.

So much for the equitable distribution of the COVID-19 vaccine promised from every political mountaintop since the first concoctions received emergency approval in the U.S.

The novel coronavirus has been a racialized experience from the beginning. Asian Americans were harassed on the streets and blamed for the “Kung flu,” as our former president called it. I’m sure “Yellow Fever” would have been invoked by Trump and his accomplices if it weren’t already a real disease. The disproportionate impact of COVID-19 on Black, Brown, and Native communities is such a well-documented and oft-recited phenomenon, I’d bet even QAnon adherents and other conspiracy theorists accept it. 

Getting from there to where we are now would be mind-boggling were it not so predictable and in step with our country’s history. But that doesn’t mean we shouldn’t be outraged and embarrassed by it.

We’ve known for a while that this moment was coming, yet we still had our pants down when it arrived. With barely perceptible communications, unpredictable supplies, and unreliable websites, for a non-cheating user, the process of obtaining a vaccine appointment has been like playing Whac-A-Mole. In this case, the targeted rodent has supersonic speed and is impossibly elusive.

At some point in my lifetime, we were the most technologically advanced nation in the world; now we can’t even keep a database from crashing. I finally broke through after visiting every possible vaccine provider over and over again, signing up for every waiting list, and hitting the refresh button on my insurance provider’s website like I was going for Beyoncé tickets on Ticketmaster. It felt like the early days of Obamacare, when I literally spent the equivalent of days on the phone tracking down clarifications and correcting errors.

And this has been the experience for someone like me — a highly educated journalist, presumably well informed, who is technologically savvy enough to have published websites and help run digital media companies. I’d say that I couldn’t imagine the challenges for those who aren’t as privileged as even I am, but I’d be lying.

There is an 88-year-old woman who has raised the children of Hollywood’s rich and famous, yet remains invisible because she is an immigrant who over the years has acquired passable English skills and a sense of accepting the usual fate of America’s marginalized. During the holidays, she suffered a mild stroke, was in and out of hospitals, and now is in a rehabilitation center. Because of COVID precautions, her family is unable to visit and barely able to advocate for her. I know this because she is my wife’s aunt and co-parent.

The COVID vaccine was being administered to health workers during the aunt’s most recent hospital stay. We requested a dose for her, believing logic would apply. Even though she was in her most vulnerable state, in a supremely vulnerable environment, rules are rules (except when they aren’t), and the request was denied. She received her first dose at the rehabilitation center on Sunday, which means she’d better still be there in a couple weeks to get her second shot. Or she’ll be playing Whac-A-Mole without a paddle, like so many others.

Like everyone else, the aunt had to take what she could get. Arguably, knowing that you’re in a firefight for a second dose, you’d opt for the Moderna vaccine. That one is 80.2% effective after the first dose (86.4%  if you’re over 65) vs. 52% effective after a single dose of the Pfizer vaccine. Consider that the typical seasonal flu shot fluctuates between 40% and 60% effectiveness, according to the Centers for Disease Control. That’s a big difference. In exchange for that initial potency, you’ll wait more time — an additional week — for the Moderna booster, but that’s immaterial since you don’t get to choose anyway.

In some ways, the aunt is better off than her younger sister, the breast cancer survivor. She has a very faint command of English and her technological proficiency is probably capped at being able to turn on her television to watch Univision. She’s never owned a mobile phone and never had an email address, which makes scheduling her for a vaccine basically impossible. She’s at the mercy of my wife being able to find a spare moment from her job as a media executive and caring for her institutionalized aunt and health-compromised mother.

Those who see potential in pop-up clinics don’t view them through the lens of someone with vulnerabilities (and lacking capacity) — that is, as possible death traps because of the potential wait, exposure, and chaotic environment. Besides, pop-up opportunities come with pop-up notice. Try attempting a lightning response when you’re mobility challenged and technophobic.

I write all this knowing there are people who are worse off and most likely also Brown or Black. The U.S. is the worst place to be “underserved” (or whatever euphemism you want to use for being slapped down). The zero-sum, dog-eat-dog nature of landing a COVID-19 vaccine shot reflects just about every aspect of American life, where we like to kick you when you’re down because it keeps you down.

Toss in the whole debate about the composition of the vaccination line. Ideally, I’d want everyone I interacted with to be vaccinated, marking them all in my world as essential workers. Our governor says younger teachers should not get vaccinated ahead of at-risk elderly people, and there are arguments either way. Some seniors say they’d allow teachers to skip ahead in line. My wife and I don’t have the luxury of being so altruistic because we are responsible for the welfare of three immigrant women in their 80s with ruinous underlying conditions. If we get the coronavirus and pass it to them, they’re almost certainly finished. If we get it and die, even if we don’t pass it to them, their quality of life and life expectancy will be severely impacted.

My mother, who also is an immigrant from Japan had an experience more in line with expectations of a superpower nation. She was on a waiting list that was accessed by one of the pop-up sites operated by Amazon. She was alerted by email and my father was able to sign her up for an appointment. Before she arrived, she was texted a QR code which was scanned at every station, even one where the booster shot was scheduled.

Because he was accompanying my mother, my father also was offered a vaccine. He declined because, being a veteran, he had an appointment at the Veterans Administration Hospital. He opted for keeping his commitment and not potentially tossing a little disorder into an already chaotic situation. Go figure. 

Trump and Republican denialism aside, I don’t think it was asking too much for something more orderly and efficient to have been assembled while vaccine allocation phases were being devised. It seems reasonable to have had some sense of supply flow and, as each phase was due to be implemented, for the qualifications and timing of inoculations to be widely promulgated in as many languages as imaginable. 

We have 78 languages spoken in my zip code, 98118, and that seems like a logical minimum.

In this scenario, as each phase unfolded, qualifiers would register on websites and toll-free, multilingual lines, then would be contacted with scheduling options for first and second doses. In addition, there would be squads hunting down vulnerable people poised to fall through cracks. That would be accomplished by community networking and simply asking during scheduling calls or digital interactions if anyone in a given circle is known to be qualified but unlikely to have responded.

It always sounds expensive to be proactive. Yet we’ve been discussing $1,400 in additional stimulus checks. Yes, they are needed, but the vaccine has to be a higher priority. Scientists are saying we need to vaccinate upwards of 85% of the U.S. population to develop herd immunity — and we’re in a race against the coronavirus’ further mutation. Yes, there is a widespread distrust in centralization (unless, of course, we’re talking about the accelerated monopolization of big business), but such coordination is preferable to leaving distribution to institutions like Overlake or having about-to-spoil vaccines offered to those better networked with elite insiders.

Besides, there is one truth that can’t be denied: 

You can’t spend your stimulus payment if you’re dead.

Glenn Nelson is a Japanese American journalist and lifetime South Seattle resident who founded trailposse.com and has won numerous national and regional awards for his writings about race. Follow him: @trailposse on Twitter or @thetrailposse on Instagram.

Featured image by Alex Garland

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