Opinion: The 34 million Americans who should be among the first to access a Covid-19 vaccine


Two weeks ago, Pfizer announced that early data showed its vaccine candidate, developed in partnership with BioNTech, to be over 90% effective. Last week, the company announced that the vaccine is even more successful than it had initially stated, proving to be 95% effective upon final analysis of Phase 3 clinical trial data. Last Monday, Moderna announced that its Covid-19 vaccine candidate is 94.5% effective. And this Monday, AstraZeneca joined them, announcing that its vaccine averages 70% efficacy (90% effective in one dosing regimen and 62% effective in a second one).
With this news, a massive step was taken forward in the fight against Covid-19. And the timing could not be more critical, given that last week, more than 70,000 Americans were hospitalized with this brutal virus. Yet even when a safe and effective vaccine is released for delivery to the public, a huge challenge confronts us: There will not immediately be a large enough vaccine supply to inoculate every American. This raises serious questions about who will be prioritized for vaccination.
There is no doubt that our country must give first access to populations most at-risk for the worst of Covid-19’s complications — including 34 million Americans living with diabetes.
The Covid-19 pandemic has affected us all, but for people with diabetes, it’s proven especially dangerous. Americans with chronic health conditions, including diabetes, are hospitalized with Covid-19 six times more often as those without. For patients with diabetes and Covid-19, 1 in 10 dies within one week of hospital admission, according to a study published in the journal Diabetologia. And they now comprise a staggering 40% of Covid-19 fatalities nationwide.
Prioritizing Americans with diabetes for a vaccine means prioritizing communities where the virus is having the gravest impact. It’s well established that communities of color disproportionately suffer adverse Covid-19 outcomes than their White neighbors: African Americans, Hispanics and Native Americans are dying of the virus three times as often as the rest of the population nationwide.
These same groups also see the highest diabetes rates: African Americans and Hispanics are more than 50% as likely, and Native Americans nearly twice as likely, as their White peers to have diabetes. Overall, people of color are nearly twice as likely as White Americans to be diagnosed with chronic health conditions that make the virus more deadly.
The common denominator here is often poverty. More than 3 in 4 Americans living in poverty are people of color, and diabetes rates are inversely related to income. Thus, people with diabetes in the US are more likely to work low-wage and essential jobs where they’re less likely to have access to health insurance and more likely to face a daily risk of contracting the virus. Those facing the greatest danger also have access to the fewest resources to protect themselves.

Prioritizing vaccinations for this group could have a dramatic impact on the toll the virus is taking by interrupting this vicious cycle. Doing so would be good for everyone, not just those of us living with diabetes.

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Americans with diabetes spend nearly two and a half times more on health care than others, accounting for 25 cents of every dollar spent on health care in America. The more people with diabetes suffer the ravages of coronavirus, the more they will fill up emergency rooms and ICUs, driving up health costs while using a great deal of health system capacity.

As plans for equitable vaccine distribution are created, there are two steps policymakers should take to ensure that the communities for whom this pandemic poses the greatest threat are prioritized.

First, the Biden transition team should appoint a Covid-19 vaccine czar to oversee and coordinate the distribution process and to identify groups, like people with diabetes, who should get the vaccine early to decrease their risk of contagion, reduce the spread of Covid-19 and unburden the health care system.

Second, Congress should appropriate funding for community organizations already working in the areas where high diabetes rates, minority populations and low-income communities most often overlap.

With targeted funding, infrastructure already put in place by community health centers and nonprofit organizations could be used to get a vaccine where it’s needed most when the time comes. Legislation proposing similar measures to get Covid-19 testing into medically underserved communities was introduced in both the House and Senate earlier this year and could serve as an effective blueprint for vaccine distribution.

Thanks to the tireless efforts of our leaders in science, industry and government who are working to bring a safe and effective vaccine to market in record time, there may be a light at the end of this very dark tunnel. But we are not quite there, and if we are to reach that point once a safe, effective vaccine does — with hope — emerge, we must have a plan to administer the vaccine where it can do the most good first.



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