I’ve been a physician assistant at a metro area hospital for nearly eight years, most of that time practicing cardiology. I have been disheartened to see our most vulnerable Minnesotans fall behind in access to the COVID-19 vaccine.
Since last March we’ve put signs in our yards thanking workers. We’ve heard local, state and national leaders call groups “essential” and say they should be prioritized for vaccinations. And yet, a vaccination lottery does not achieve this intention.
I wrote many of our legislators on January 22, and their responses that homeless, incarcerated and essential workers are being “prioritized” has not been realized, as we continue to vaccinate any Minnesotan 65 and over without considering the significant risk for our more vulnerable populations.
I’d like to introduce you to some of my patients who don’t have the luxury of time, technology, transportation or trust — all things they need for a chance to get a vaccine through the lottery.
Mr. W. is a 72-year-old homeless man with heart failure who uses his 100 phone minutes each month to arrange medical rides, receive calls about lab work and medication adjustments, and connect with his daughter. He lives in a shelter and doesn’t have extra phone minutes or internet access to register for the lottery, or a car to drive to a vaccination site.
Mrs. A. is a 53-year-old mother of three with breast cancer. Her treatment has caused her heart to fail, making COVID-19 especially dangerous to her. She works 32 hours per week at a local fast food chain, on top of coming for weekly provider visits and helping her children navigate online education.
Mr. B is a 63-year old delivery worker who has heart disease, high blood pressure and diabetes. He brings food and other essentials to his community, often on a whim, right to their door, making it possible for his neighbors to stay at home.
Ms. L. is a 52-year old woman with heart disease and is currently incarcerated. She has seen COVID-19 blaze through the prison, lost friends and seen others struggle with COVID-19 effects. She can wear a mask, but she can’t fully isolate.
These Minnesotans’ living circumstances, medical conditions and professions make them at high risk for exposure to and complications of COVID-19 infection. Shouldn’t their situations and risk of complications from the coronavirus give them priority for vaccinations?
It is our ethical duty to decrease spread and infection. To do this, we need to identify who is at risk and who needs protecting. Age is not the only indicator of risk. Risk is determined by circumstances. With a lottery, we have lost our ability to prioritize those who are at greatest risk and those who need the greatest protection.
The federal Centers for Disease Control and Prevention has recommended prioritization of our essential workers — independent health care workers, transit workers, grocery store workers, postal workers and manufacturing workers — as phase 1b or 1c.
They recommend homeless and incarcerated populations be vaccinated as phase 1b, as these populations face higher risk of coronavirus. Despite these recommendations, there is no clear plan or consistent communication regarding vaccinating these high-risk groups throughout Minnesota.
Let’s be clear: Our choice to open up the vaccination lottery to all residents 65 years and older prior to vaccinating our most vulnerable community members is perpetuating systemic, economic, social and racial inequalities.
A lottery that seems like it gives everyone an equal chance doesn’t give help to those who need it most. In other words, in this critical moment, we have chosen equality but not equity.
Our Minnesota Department of Health has risen to the challenge of COVID-19 thus far, and I’m confident they are up to the challenge of pointing us toward a more equitable approach to distribution that prioritizes those who are at greatest risk.
We have an opportunity to learn from this process, so that in future challenges those in the most need are cared for first.