The Covid-19 pandemic has made inequality – from health insurance to service careers – across different walks of life very apparent. As countries around the world have expanded their eligibility criteria in efforts to vaccinate the general population, the distribution of certain vaccine brands to less advantaged communities highlights the inequities around the role of race and class.
“The vaccines have different efficacy rates, so it does raise questions if a less efficacious dose is given to certain communities,” said Mohana Biswas, a third-year medical student at Robert Wood Johnson Medical School. “If I had to choose between the vaccine I’d go with Moderna, not Johnson & Johnson (J&J), only because of the efficacy rate. Why go for 70% when you can get 95%?”
Though public officials consider Johnson & Johnson’s shot a convenient alternative to Pfizer and Moderna, both which require two doses and freezer storage, it is perceived by some as inferior in spite of being 72% effective at guarding against Covid in the US Alternatively, Pfizer and Moderna’s shots boast 95% efficacy rates.
While J&J’s rate isn’t as high as Pfizer and Moderna’s vaccines, it is still a highly effective tool at protecting against Covid. Several developing countries, like Pakistan, not only lack access to “mainstream” vaccines such as J&J, but also privatised the distribution as a whole. So far, Pakistan has approved a handful of vaccines, including three Chinese vaccines, Russia’s Sputnik V, and the Oxford-AstraZeneca vaccine.
Pakistan’s private marketplace of vaccines raises concerns about affordability and accessibility, anchored in the nation’s deep-rooted socioeconomic inequality. The majority of private vaccine sales are in large cities, such as Karachi and Islamabad, but remain inaccessible to residents in rural and border communities.
Otherwise, many residents of Pakistan reported to CNN that they prefer the privatisation of vaccine sales rather than relying on the public health care sector to vaccinate 113 million adults. “It’s good that it’s available privately, I have no idea when our turn will come through the government,” said Anushka Jatoi 35, to CNN after receiving the vaccine with her family at a private hospital in Karachi.
While the privatisation of vaccines transparently favours certain fiscal classes, critics warn that this type of marketplace encourages companies to act out of self-interest and profit from people’s desperation. Jatoi acknowledged her privilege and said that the private hospital where she got vaccinated was “like a hotel” with croissants in the waiting area. “We’re lucky to be in this position,” she added.
Like most countries, the United States doesn’t allow private entities to distribute the vaccine. Public officials are responsible for the administration and communication with any brand of vaccine, which is why there is a greater burden of representing even-handedness across the 258-million adult population. The unforeseen issue arises out of the fact that J&J’s shot is particularly useful in hard-to-reach areas, like poorer ZIP codes in urban cities and rural communities, since it’s easily transportable and only requires a single dose.
“The media focuses on how Johnson & Johnson shows less efficacy and doesn’t have a booster yet, but they’re not considering the fact that the research is ongoing and there is less data to support it,” said Asna Khalid, a former Life Science Research Professional (LSRP) at Stanford University and a Senior Associate Scientist at Pfizer. “That’s why people think Pfizer and Moderna are the ‘better’ vaccines when there really is no better or worse.”
By sending certain vaccine brands to poorer ZIP codes in major cities and rural communities, “segregated, wealthier areas get the better vaccine and the poor, more minority areas are told, ‘just be happy,’” according to Logan Patman, a Black attorney who wrote about vaccine hesitancy in the Black community. He writes:
“In America, Black people receive second-class health care, coupled with an insurance and payment system that limits access to the weakened health-care systems in the first instance. Vaccines can’t save lives if the most vulnerable groups won’t take them.”
According to a recent report by the Kaiser Family Foundation, across 43 of the US’s 50 states, the percentage of whites who have received at least one Covid-19 vaccine dose was 1.2 times higher than the rate for Black people and Hispanic people. These groups remain less likely than their white counterparts to have received a vaccine, leaving them at increased risk, particularly as people of colour are increasingly becoming a larger percentage of the working class. Working class jobs were often considered “essential workers” during the pandemic, ranging from consumer-facing services like grocery store cashiers.
More data from states shows Blacks and Hispanics continue to make up a disproportionate share of Covid-19 fatalities, but are receiving the vaccines at significantly lower rates than white people. The questions of inequality in relation to vaccines are not limited to developing countries, like Pakistan, nor Western countries, like the United States. Farah Ramadan, a graduate of Texas A&M in Qatar, was quarantined in Doha, Qatar, during the pandemic and was turned away when requesting a Pfizer vaccine.
“At the clinic, I shared my Student ID which includes my nationality and was told that Pfizer wasn’t available to me. I researched different vaccine brands and requested Pfizer instead of Moderna,” Ramadan told The Analyst. “But later, Qatari students were given the Pfizer vaccine that non-Qatari students were told was unavailable at that same clinic.”
Ramadan noted that she can’t confirm whether Qatar – a country majorly composed of expatriates – systematically reserves Pfizer for its own citizens, but said “it did make me question why I wasn’t able to get Pfizer while others were.”
The unintended consequences of distributing certain vaccine brands to marginalized communities may pervade with the roll-out of newly-approved booster shots. Dr. Sonja Hutchins, a former CDC official, told the agency’s Advisory Committee on Immunization Practices on March 1st that such practices could further exacerbate the “level of mistrust” and “increased hesitancy.”
“The best vaccine is the one that’s available to you, and during a global pandemic, we don’t have a luxury of choosing,” Khalid, a vaccine researcher at Pfizer, told The Analyst. “There will always be changing minds and different ways to do comparisons, but vaccines are our only real tool towards ending Covid-19. We need to trust it.”
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