The Star Tribune Editorial Board recently argued that "scrutiny is needed right now to ensure that the current [COVID-19] vaccine stock is being given promptly" ("State puts heat on vaccine providers," Jan. 28). I support the call for transparency about the state's pandemic response plans, and agree that "[t]he vaccine doesn't protect anyone if it's still in the vial." However, the focus on the speed with which vaccine is administered must be balanced against other considerations if the state's vaccine allocation plan is to be ethical.
Established ethics guidance for emergency response in Minnesota requires that the state balance three moral objectives: to reduce rates of sickness and death; to respect individuals and groups; and to promote fairness and equity.
Vaccinating people quickly will help to reduce illness and death. However, a dominant focus on speed will predictably mean that we vaccinate populations that are easy to reach, in order to meet the timeliness benchmarks endorsed by the Editorial Board.
Unfortunately, the populations who are at greatest risk from COVID-19 do not tend to be easy to reach with vaccination programs.
Risks of death are not equal among age groups. Minnesotans aged 75 and over represent 6% of COVID-19 cases and 73% of deaths. Those 65-74 are 7% of cases and 16% of deaths. Both age groups face elevated risks, certainly, but they are meaningfully different.
Absent specific priorities for those with health conditions that place them at higher risk of hospitalization and death, allowing those 65-74 to be prioritized at the same level as those 75 and up is not equitable because risk of hospitalization and death is much, much higher for those 75 and older than for younger seniors.
The picture is further complicated when considering the consequences of structural racism, which means Black, Indigenous, and Latino Minnesotans are dying at even higher rates, even younger.
Targeting vaccines for specific groups complicates — and so may to some extent slow — vaccine allocation, especially given that higher-risk groups tend to face higher hurdles to accessing care. These challenges include, for example: lack of technology or internet service to make appointments, transportation difficulties, language barriers and mistrust of health providers due to a history of unequal treatment. These types of challenges must be overcome to meet the needs of high-risk populations.
It is easier — and therefore faster — to vaccinate people with more privileged access to care. But doing so compromises our moral commitments. Reducing rates of serious illness and death requires more than vaccinating people quickly; it requires giving higher priority to those at greater risk.
Respect requires that we honor our commitments to protect the vulnerable. Fairness and equity require that we address access challenges and respond effectively to overwhelming evidence of profound disparities in COVID-19 risk. These are not academic concepts; they are the core values that should guide Minnesota's response to the pandemic. We should honor them, even when it's hard to do so.
Vaccinating speedily is not the same as vaccinating ethically. I call on the media, and our state leadership, to shift the narrative away from a predominant focus on speed, to a public discussion about the need to balance the complex considerations that must be taken into account for Minnesota's vaccine allocation plan to be ethical.
A highly efficient but inequitable allocation plan is unacceptable. It is possible to do better. To do so, we need to characterize our success in vaccination in terms of risk reduction, respect, fairness and equity, not speed alone.
Debra DeBruin is interim director of the Center for Bioethics at the University of Minnesota. She is a member of the Minnesota Department of Health's Vaccine Allocation Advisory Group.