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Michigan Officials Wrestle With How To Ethically Distribute COVID-19 Vaccines

Michigan officials are using the Centers for Disease Control's social vulnerability index to distribute COVID-19 vaccines, but some argue this is the wrong way to decide who gets to go to the front of the line.
Michigan officials are using the Centers for Disease Control's social vulnerability index to distribute COVID-19 vaccines, but some argue this is the wrong way to decide who gets to go to the front of the line.

Black residents in Michigan account for roughly 21% of the state's COVID-19 deaths despite being just 14% of the state's population. State officials want to decrease the number of deaths, so Michigan is relying on a formula recommended by the Centers for Disease Control called the Social Vulnerability Index to help guide its vaccine distribution. The index — ordinarily used by federal agencies dispensing aid after natural disasters — considers 15 different factors including minority groups, people living in multi-generational housing, age, and income.

But in recent weeks Republicans in one of the most conservative counties flanking metro Detroit and the state legislature have vocally opposed using the SVI.

Commissioners there passed a resolution calling on the governor and the state health department to rescind the SVI and replace it with a plan that "results in pro-rata uniform distribution to Michigan's most medically vulnerable population."

State Sen. Jim Runestad, a white Republican, was spitting mad about the same topic in a legislative hearing. He was incensed that residents age 65 and older in his majority white suburb of Detroit were still waiting on vaccines.

"This is the population. I don't care what race they are, I don't care what ethnicity they are, I don't care what language they speak. These are the people who are vulnerable to die. We should [be] worrying about getting this virus into the hands of the people who can preserve these people and not any other matrix," Runestad said.

In a floor speech later Runestad alleged the state was failing seniors in his district by using, "social engineering policies, not the likelihood of death."

State Sen. Erika Geiss, a Black Democrat who represents metro Detroit, fired back.

"When folks in my neck of the woods were dying and getting sick, folks in Brighton were saying, 'It's a hoax, it doesn't do anything, it doesn't matter, masks don't do anything.' And now you want to jump to the front of the line?" asked the senator.

Geiss and other Democrats argue stripping the SVI out of the state's vaccine allocation would be racist.

"It's absolutely unconscionable that while we are using a social vulnerability index to protect the very people who got the virus the most, who were the most vulnerable, who still are the most vulnerable, and it happens to be people of color. It happens to be people who are disabled. All of a sudden you want to be racially aware? It doesn't make any sense," Geiss said.

The Republican-controlled state senate eventually passed a bill barring the use of "race, gender, color, national origin, religion, sex, and socioeconomic status as factors in determining the distribution of COVID-19 vaccines." But the state House declined to pass the legislation, so the SVI remains in use.

Renee Canady heads the Michigan Public Health Institute. She compares public health professionals to firefighters — they run into the fire — wherever that fire may be.

"If this were affecting white men, we'd be running to that fire because it is our professional obligation. So, when we have seen repeated over and over again this pattern where disproportionately Black, Latino, Native American communities are suffering more it is our moral and professional responsibility to go there," Canady said.

The CDC reports that Black Americans are 1.9 times more likely to die of COVID-19 than white Americans, Latinos are 2.3 times more likely to die, and Native Americans are 2.4 times more likely to die.

That's partially why places like Wayne County, which includes Detroit, have received more vaccines than neighboring whiter, wealthier counties. Taking away the SVI would also de-prioritize some of the most impoverished counties in the state, all of which are rural and majority white.

The rush to vaccinate Detroit

The City of Detroit still trails the surrounding suburbs as roughly 11.5% of the age 16 and older population have received their first dose, but health officials in the city are trying to reach people at churches, senior centers, and via mass vaccination clinics.

In a parking garage under the TCF center in Detroit 4,700 residents are being vaccinated in one day. People in white protective suits and scrubs buzz around placing clipboards on car dashboards and jabbing people through car windows while industrial fans whir in the background.

Voletta Bonner is a Black 38-year-old teacher from Detroit. She said distributing the vaccine based only on age, or underlying health conditions doesn't make any sense to her.

"Everybody wasn't affected the same. So how can you then say, 'OK, well, now let's just open it up for everybody.' That's not fair. Nor is it smart," Bonner said. "If you want people to stop dying, then you need to address the people that are dying first. Not that you're never going to get the vaccine, but you can hold off and wait, because it's not affecting your community as harsh right now."

Eric Smith was getting his second shot. The Black 50-year-old letter carrier from Detroit argues that the SVI levels the playing field for some communities who haven't historically had access to the healthcare, so the Republican argument that the SVI shouldn't be used is a mistake.

"I would say to them, that they're on the wrong side of history, and they're gonna hurt a lot of people if they continue to fight that," Smith said.

Lawrence Gostin, director of the O'Neill Institute for National & Global Health Law at Georgetown University, agrees. Gostin says SVI is used to prioritize the most vulnerable — including racial minorities that have been disproportionately impacted.

"Nobody would say that it's that that we should outlaw CDC guidance that prioritizes nursing homes or over 75, the elderly. Why on earth would you do the same thing for equally disadvantaged, equally vulnerable populations that are protected through the social vulnerability index?" Gostin asked.

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