Corrupted: Vaccine for Me and Not for Thee

This is the last Corrupted issue of 2020. We will resume publication on Thursday, January 14, 2021. Happy holidays!

Operation Warp Speed has hit paydirt. This week, the nation’s healthcare workers and nursing home staff and residents began rolling up their sleeves for the first COVID-19 vaccine.

But we are concerned about what lies ahead as the other 300-plus million Americans line up for shots. Given what we’ve seen so far in the pandemic response, it’s not unreasonable to fear that the vaccination process will be just as badly managed and corruption-tainted as the distribution of supplies, testing, and treatments.

COVID-19 Treatments: It’s Who You Know

Last week, the New York Times published a disturbing reminder of just how inequitable access to medical care is in this country, with an update on the health status of several members of President Donald Trump’s inner circle who contracted COVID-19. Like the president, former New Jersey Governor Chris Christie, Housing and Urban Development Secretary Ben Carson, and Trump attorney Rudy Giuliani caught the virus. Despite being, as the Times put it, “not the sturdiest candidates to conquer the coronavirus,” all four men are apparently in the clear now thanks to experimental antibody treatments that are largely unavailable to the public.

Christie got access to a treatment before it received approval from the Food and Drug Administration (FDA), and Trump intervened to get Carson his treatment. The Times article also described a “prominent businessman” who got an experimental treatment after calling “friends who were hospital executives and hospital donors.”

Giuliani admitted to the Times that he got the treatment because he’s “a celebrity.” He also raved about the cocktail of experimental treatments he received, and described the disease as “treatable.” But the fact of the matter is that hospitals are having to ration these treatments that made Giuliani feel so much better.

COVID-19 Testing: Playing the Game

There has been a similar inequity with regard to access to COVID-19 testing.

Wealthy individuals and companies are able to line up private testing services and get results within hours, as the New York Times documented, while much of the rest of the country must wait in line for hours for free testing that takes much longer to produce results. Professional and college sports also resumed this year because they had the wealth and clout to contract with private labs to carry out robust testing schedules.

A recent Washington Post story lays out the stark disparity: The NFL administers tens of thousands of tests to players, coaches, and employees each week, Major League Baseball conducted 170,000 tests during its shortened season, and major college football programs conduct dozens of tests each day. But Jane Sandoval, a 58-year-old emergency room nurse in California, had not been tested once in eight months.

It’s not just healthcare workers who have been left behind. Employees in the retail, restaurant, and meatpacking industries have been pushing for more robust testing, with some seeing better results than others.

There is also a racial aspect to the testing access disparity. FiveThirtyEight and ABC News found “fewer testing sites in areas primarily inhabited by racial minorities” and that “Black and Hispanic people are more likely to experience longer wait times and understaffed testing centers.”

A Race to the Lifeboats

So, knowing how treatment and testing have proceeded, can we expect vaccine distribution to be any different?

While the Centers for Disease Control and Prevention (CDC) has issued guidance on vaccination priority, it’s ultimately up to each state to determine exactly how doses should be allocated, which seems to leave plenty of room for arm-twisting, favoritism, and line-cutting. Even the federal government is still sorting through which top officials should be prioritized for the vaccine.

Experts told STAT News that it’s likely vaccine distribution will be corrupted by the wheeling and dealing of the wealthy and well-connected. This could lead to undesirable consequences.

“There absolutely will be a black market,” warned bioethicist Arthur Caplan.

Expect powerful industries to lobby state and local governments to have their employees moved higher on the vaccine priority list, just as they lobbied to be allowed to stay open during lockdowns. And officials could easily play favorites—especially if a large campaign donation is involved.

Many workers in the financial services industry actually already have the coveted “essential worker” designation that would put them toward the top of the list. And since the definition of essential financial work is so broad, it’s possible that vaccine access could be prioritized for those who don’t need to interact with others to do their jobs.

Several industries are also actively lobbying for this priority status, including bank employees, port workers, and even zoo operators and journalists, according to The Intercept. With all this jostling, it’s possible some industries could be prioritized over others just because they were able to spend more on a pressure campaign. The National Hockey League also stirred controversy by planning to purchase vaccines for its players in January, though it seems the league soon clarified it had no plans to cut the line, as Judd Legum and Tesnim Zekeria noted in Popular Information.

In the meantime, states are petitioning for additional funding to distribute the vaccine, but a gridlocked Congress has been holding that up. One of the main culprits was Senate Majority Leader Mitch McConnell, who up until recently insisted on pandemic liability protection for companies, a measure that’s been the subject of a major lobbying campaign from a powerful business group.

Looking Ahead

Achieving the widespread immunity needed to stop the spread of the coronavirus in the U.S. will require inoculating up to 70% of the population. On top of the potential problems we’ve already laid out, there’s the additional problem that many Americans, particularly Black Americans, are skeptical of the COVID-19 vaccine. The federal government’s response to the pandemic hasn’t exactly earned the trust of many Americans. And their unease isn’t helped by the tremendous amount of pressure they see the White House putting on the FDA to green-light vaccines, including reportedly threatening to fire the FDA commissioner if he didn’t immediately approve the Pfizer vaccine last week.

If the government is going to effectively distribute vaccines, it needs to reassure the public that the process is guided by scientific considerations, when it comes to both distribution of doses and approval of the vaccines themselves. This can only be done by diligently guarding—inoculating, you might say—the process from even the hint of impropriety or corruption.

The process should be as transparent as possible, particularly if there are problems with side effects or adverse reactions caused by the vaccines. This will also require states to develop and publicize detailed rules and procedures to make sure those most vulnerable are vaccinated first, and that everyone else patiently waits their turn.