Listen: Who Gets the Next Shot?

And a lot of the people who really need the vaccine right now are not positioned to be able to figure out how to check every two seconds on a website or wait forever for a phone call or navigate the system in a language they don’t know. We have a lot of equity challenges buried in the details. And then we have the equity challenges that come from the justified distrust of communities of color and poor people with respect to institutions generally and public-health programs in particular.

Hamblin: We had a question from a listener asking about if and how it’s being kept track of who’s been vaccinated and who has not. Is there any discussion about the ethics of having a registry of who has and hasn’t been vaccinated?

Faden: It’s a great question. There are two pieces to this. One: Absolutely, as a public-health matter, we have to keep track. That’s nonnegotiable. Now, the question is: What other data do you collect? Age, ethnicity, location? There’s that issue. And then there’s this issue of: Should any perks result from the fact that you’ve been fully vaccinated? And that’s the conversation about “vaccination passports” or “vaccination passes” of some kind.

Hamblin: Like that you might not have to wear a mask if you’ve been vaccinated? Or something like that that could actually incentivize people to get the vaccine?

Faden: Or maybe you have to wear a mask, but if you have been exposed and ordinarily you would be a contact and have to quarantine for two weeks, you would get a quarantine pass, for example. I don’t think anybody is going to say you don’t have to wear a mask. We don’t know enough about that yet.

Hamblin: Yeah, we don’t know yet, but just in terms of the idea of what kind of things it might eventually be …

Faden: Yeah, it could be something like that. And that’s a kind of calculated gamble too. No one is proposing that in the U.S.

Higgins: If you could prove you were vaccinated, could you travel to another country, for instance?

Faden: From a global point of view, it’s a complete structural-injustice mess. Because if we’re going to start privileging people—which makes a lot of sense, depending on what we learn about onward transmission and these vaccines, which we don’t know enough about yet … If we start basically saying that if you’ve been fully vaccinated, then you can start traveling globally. And we have a context in which a very tiny percentage of the world’s population outside of high-income countries gets access to the vaccine, who’s going to be able to travel globally?

It’s an awful picture. The director-general of the WHO gave an address [recently], and he made a stunning point. There were 39 million doses of vaccine administered in 49 high-income countries as of [a few] days ago. Can you guess how many doses have been administered so far in a lowest-income country?

Twenty-five total. Against 39 million. So I don’t think people have begun to get their heads around how wide the disparity is and how urgent it is to try to do something about this. We’re concerned about what to do because this doctor gave it to his family. I mean, there are definitely ethical issues there, and I don’t mean to dismiss them, but we have to put that in perspective as well.

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