Social vulnerability matters in vaccine rollout, says international research team


A study from an international research team, co-authored by an expert in public health ethics based in London, Ont., argues that vaccine distribution plans should take into account “social” vulnerability, and not just medical vulnerability.

The study recommends an approach to COVID-19 vaccine distribution based on existing human rights law.

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Co-author Maxwell Smith, a Western University bioethicist and assistant professor, says “even relatively innocuous criteria” like age should be balanced with factors like income or access to health care.

“We know if you’re older, you are at greater risk of dying or having severe disease. But we know that if we said everyone over the age of 70 can get the vaccine at this point, that we might actually be disadvantaging some groups,” said Smith, who is also a member of Ontario’s COVID-19 Vaccine Distribution Task Force.

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“We know that some populations — like Black and racialized populations, low-income populations and those with disabilities — tend to be at a similar risk at lower age levels due to things that negatively affect their health, like low income or worse access to health care or other forms of discrimination or oppression.”

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For example, the study found that in an intersectional model looking at age and socioeconomic status (SES), the increase in prioritization from age 50 to 60 would be greater for those of low SES because being older has a bigger impact on a lower SES person than a higher SES person.

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“A low SES person is likely to have a lower life expectancy and is effectively aged beyond their years, due to their relatively greater deprivation, worse access to health care, and so on,” the study claims.

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The researchers, led by Sharifah Sekalala, a law professor at the University of Warwick in the United Kingdom, reviewed existing national approaches from the U.K., U.S., Israel, Canada and Russia as well as four proposed global approaches before outlining how they believe human rights principles can inform vaccine allocation in pandemic conditions.

“There are three fundamental human rights which need to be reflected in any vaccine distribution program – the right to life, the right to health, and the right to benefit from scientific progress,” she said.

“If there aren’t enough vaccines available, then they should be given as a priority to people who are more likely to contract COVID-19, to those whose health is at higher risk of being compromised as a result of coming down with COVID-19, and to those who are most likely to transmit the virus.”

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Under a human rights approach, Smith explains, the idea is that “certain legal obligations must be met to ensure that vaccine allocation doesn’t discriminate against people.”

“And actually that we take additional steps to prevent COVID-19 among the most vulnerable groups,” he added.

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Smith said that while there is a desire for the rollout to be straightforward and easily understood by the public, it’s also important that groups that might be harder to get to aren’t neglected or ignored. He pointed to vaccinations at long-term care homes as an example.

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“It would be much simpler, of course, to simply open up massive arenas and do mass vaccination clinics. We can do that and we will do that for large swaths of the population, but that doesn’t mean that we still don’t have to go in and get to those hard to reach or more vulnerable populations.”

An Intersectional Human-Rights Approach to Prioritizing Access to COVID-19 Vaccines was published Wednesday by BMJ.

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