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On March 22, Maylin Enamorado-Pinheiro’s aunt began showing signs of infection. On March 29, her mother, who along with her father serves as a pastor of a small congregation about 30 minutes north of downtown Miami, was rushed to the hospital with breathing difficulties and intubated. She spent the next month on a ventilator, clinging to life. The rest of her family, eight people in total, ultimately tested positive for the novel coronavirus. They decided it would be better to keep her grandfather, 92-year-old Pedro Enamorado, at home despite a rising temperature and coughing fits that started on April 2.

“We didn’t want to risk getting him tested and then having him end up in the hospital,” said Enamorado-Pinheiro, a writer and English as a second language teacher. “Plus we couldn’t even find him a test.”

He died the next day.

Though no one else from her family was hospitalized or died due to COVID-19, the reasons why it swept through her home have become tragically familiar as the total number of cases in the U.S. surpasses 5.4 million, with more than 169,000 lives lost.  Enamorado-Pinheiro’s mother didn’t have health care and was scared of the cost of a hospital or doctor visit. The congregation they serve comprises mostly immigrants, many of them undocumented and essential workers who continued toiling as the pandemic widened. Her parents’ home housed four generations of her family. 

Now, months after the pandemic began its spread across the world and country, there’s a surfeit of data showing how minority and particularly Black communities suffered and continue to suffer far more than similarly situated white counterparts. Researchers from the Harvard Center for Population and Development Studies found that, up until mid-June, the death toll on Black Americans and those of Hispanic or Latino origin combined to a total of 93,981 years of life lost. White Americans who perished from the disease and associated complications lost a total of 33,446 years. 

“As of June, the Centers for Disease Control and Prevention (CDC) reported that 21.8% of COVID-19 cases in the U.S. were African-Americans and 33.8% were Latinx, despite the fact that these groups comprise only 13% and 18% of the U.S. population, respectively,” researchers from the Mayo Clinic wrote in a June paper. In many states, they said, death rates for African-Americans was often twice that of whites. 

Experts say the outsize impact of the virus on minority communities is a stark reminder of the longstanding inequalities riddled throughout the United States’ social, economic, and cultural fabric. It’s a point Dr. Anthony Fauci, the director of the NIH’s National Institute of Allergy and Infectious Diseases, made to lawmakers while testifying on Capitol Hill in late June.

“Obviously the African-American community has suffered from racism for a very, very long period of time, and I cannot imagine that that has not contributed to the conditions that they find themselves in economically and otherwise,” Fauci said. 

With more than 100 vaccines currently under development—including some in late-stage trials—and governments in the midst of spending tens of billions of dollars, agencies are still trying to develop a plan to determine who will get the vaccine first, and how it will be prioritized among different communities.

As the outbreak continued to worsen and over the summer threatened the stability of health systems in places like Houston and South Florida, the vaccine emerged as a political issue, with President Donald Trump dubiously promising that one would be available around Election Day. In the days that followed, medical experts and leaders from the FDA and CDC attempted to check the president by offering promises that politics would not compromise the vaccine’s approval process.

When it comes to the longstanding disparities re-revealed amid the pandemic, George Washington University Law School Dean Dayna Bowen Matthew says their beginnings stretch back to the start of racial segregation, especially in housing. 

“If you live in a neighborhood where health care is poor, the food is mostly 7-11 and fast food joints, and you don’t have any place to exercise or recreate because there’s no green space, then you’re going to have unhealthy generation after generation after generation,” she says. The disparities led to more instances of diabetes, heart disease, obesity, and stroke, making those communities even more susceptible to the ravages of COVID-19.

While Supreme Court rulings make it unconstitutional for government agencies to prioritize one group over another for medical treatments, Harald Schmidt, an assistant professor of medical ethics and health policy at the University of Pennsylvania, tells Complex that policymakers must reckon with the longstanding injustices that led to the novel coronavirus’ explosion in minority communities and can do so by using a suite of tools that already exist to help gauge where the vaccine is most needed. 

Among them is a set of criteria the CDC issued in 2009 on how to allocate flu vaccines based on such factors as income, education, unemployment, and housing quality data ranked by neighborhood and socioeconomic status.

“We can’t pretend we’re starting from scratch here,” Schmidt says. 

“It’s really hard for me to understand how a country that goes out of its way to destroy, to shoot, and to kill to keep you in a certain place and level of standing all of the sudden is so worried about your welfare that they’re going to choose your health before theirs.” - The D.O.C.

In addition to the dozens of multinational drug companies scrambling to develop an effective vaccine, the Trump administration also launched “Operation Warp Speed,” combining private industry, the military, and government health agencies in a $10 billion effort to deliver more than 300 million vaccine doses by January 2021. President Trump earlier this month said vaccine delivery could begin ahead of Election Day, an optimistic prediction that was shown to be flawed a few days later. Meanwhile, Russian President Vladimir Putin recently claimed victory in the race for a vaccine with a treatment named Sputnik V. Pharmaceutical giant Pfizer received nearly $2 billion to deliver the first 100 million doses by the end of this year. Massachusetts-based Moderna, in partnership with the National Institutes of Health, in late July launched the third phase of a clinical trial. The British-Swedish company AstraZeneca, in partnership with the University of Oxford, has a vaccine in Phase 3 human trials in England and India, with plans to expand to South Africa and hard-hit Brazil. In all, more than 140 vaccines are in development, with 27 in clinical trials as of early August, according to the New York Times

All of this is happening against the backdrop of George Floyd’s killing, which has after decades, if not centuries, forced citizens across the country to reckon with longstanding, racial disparities. 

While thinkers, activists, and scientists called for much of the first wave of the vaccine to be directed toward those minority communities that have felt the effects of COVID-19 most severely, many recall the Tuskegee Experiments of the mid-20th century, during which hundreds of impoverished Black sharecroppers were left to suffer with untreated syphilis in order for researchers to study its impacts. 

“It’s really hard for me to understand how a country that goes out of its way to destroy, to shoot, and to kill to keep you in a certain place and level of standing all of the sudden is so worried about your welfare that they’re going to choose your health before theirs,” says rapper and activist Tracy Lynn Curry, the artist better known as the D.O.C., whose writing and rapping helped launched N.W.A and Dr. Dre to superstardom. 

Should that distrust turn into people deciding against receiving the vaccine, they could face legal, financial, or other repercussions through ad hoc mandates. New York City in 2019, for example, passed an ordinance fining those in certain neighborhoods who refused a measles vaccine for themselves or their children, like some Orthodox Jews in Brooklyn.

Who will be the leading proponent of a vaccine, or a set of vaccines, will matter, according to a recent Politico/Morning Consult poll. Only 14%  of voters said they would take a vaccine President Trump approved of, while only 20%  said they’d follow a nod from presumptive Democratic presidential nominee Joe Biden. The most credible sources were family (46%), the NIH’s Dr. Fauci (43%), and the CDC (43%).

Multiple agencies and organizations are developing recommendations for how the vaccine, whenever one is approved for widespread use, ought to be distributed. 

Since 1964, the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices (ACIP) has offered non-binding guidelines on how vaccines should be disbursed once they’re approved by the Food and Drug Administration. The panel is currently developing its recommendations, though the CDC and multiple panel members declined interview requests.

“It is our solemn obligation at [the U.S. Department of Health and Human Services (HHS)] to ensure every American has easy access to an FDA approved, safe and effective vaccine as fast as possible,” a senior HHS official writes in an email. “Subject matter experts who are seeking input from several external parties, including medical ethicists, will propose a distribution and allocation plan for HHS approval. [Operation Warp Speed] will not play a role in crafting this policy decision, but is committed to implementing the plan and distributing medical countermeasures as fast as possible.” 

A committee formed by the National Academies of Sciences, Engineering, and Medicine and the National Academy of Medicine met for the first time late last month in hopes of helping policymakers decide how to distribute what will be a limited first wave of vaccines.

While most agreed that frontline medical workers ought to be the first to receive the vaccine, neither President Trump nor former Vice President and Democratic presidential candidate Biden have laid out specific plans. 

Ezekiel J. Emanuel, vice provost of the University of Pennsylvania and a member of Biden’s public health advisory committee, in a Washington Post op-ed last month laid out the Herculean effort that will be needed to ensure all Americans receive the vaccine, for which he argued the government should pay more than $20 each. 

“[The vaccine] immediately has to go to lower-income Black and brown people.” - Maylin Enamorado-Pinheiro

Emanuel also said that research is showing the vaccine would require two doses, which in order to be administered would require 7,300 vaccination clinics providing about 30,000 doses per month. Given that many of them could be in pharmacies spread across the United States that already administer vaccines, the infrastructure seems to be in place to ensure the vaccine actually reaches the communities where it’s determined to be needed most. 

Enamorado-Pinheiro, the ESL teacher who watched her entire family fall ill with the COVID-19, tells Complex she believes it has to be “disproportionately distributed.” She agrees that medical workers should be first in line. Who should come next, she says, is obvious when she makes the 20-minute drive north from her apartment on South Beach to her parents’ house in a predominantly Black and immigrant community. 

Schmidt, of the University of Pennsylvania, says the methodology used to distribute the vaccine could mirror what cities like Chicago have done in their use of an “area deprivation index” composed of economic and demographic metrics in an effort to make public school admissions fairer. 

“This isn’t something that has to be developed, and it’s legally feasible,” he says. “This situation offers an opportunity toward valuing lives more equally than we have so far with COVID-19, and we shouldn’t pass that up.”

For people like Enamorado-Pinheiro, who’ve lived with the virus and personally felt its impact, the problem and what needs to be done become almost simple. 

“It immediately has to go to lower-income Black and brown people,” she says. “When fast food workers are second on the list behind doctors and nurses, the condition of a large number of people in this country becomes pretty obvious.”

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