The Importance of COVID Vaccination for the Economically Underprivileged

This essay assumes that vaccination for COVID-19 is effective, and that it is safe for most people. It does not address the specific types of SARS-Cov-2 vaccines.

My Proposal

The demand for SARS-Cov-2 vaccines still outweighs the supply in many US states (1), and therefore, legislation is required to orchestrate the distribution of these vaccines. Policymakers must divide the population into groups, and then decide the order in which these groups should be vaccinated.

Most people can agree it’s common sense that the SARS-Cov-2 vaccines should be first administered to healthcare workers who are exposed to a wide variety of patients (and therefore potential carriers), every day. Among healthcare workers, those who are most frequently exposed to the most contagious patients, should be given utmost vaccination priority.
But after the healthcare workers, then who should be vaccinated? I propose that wealth should be an important factor taken into account when dividing populations into groups, and that individuals with the least amount of wealth should be given significant vaccination priority. My proposal remains valid in any future pandemic or epidemic.

The Correlation Between Wealth and Viral Exposure

The less wealthy you are, the more likely it is that you will become infected through reasons outside your control.
A study done in Barcelona, published by the National Institute of Health, found that “the lower the mean income, the higher the COVID-19 incidence… Specifically, the district with the lowest income had 2.5 times greater incidence of the disease, compared with the highest-income district”2 The study also mentioned New York: “The Bronx — the borough with the highest proportion of racial/ethnic minorities, the most persons living in poverty and the lowest levels of educational attainment — had higher rates of hospitalization and death related to COVID-19.”(2) Furthermore, similar results were found in the UK by a group called Biobank.(2)

The CDC confirms that “Limiting close face-to-face contact with others is the best way to reduce the spread of coronavirus disease 2019 (COVID-19),” but it’s difficult for the economically disadvantaged to maintain social distancing. According to The Brookings Institute, a report by the Economic Policy Institute analyzed data from the U.S. Bureau of Labor Statistics, and found that “Low-wage workers are six times less likely to be able to work from home than high-income workers.”(6,4)

Several studies have also found that BIPOC individuals are at a higher risk of becoming infected than white people.(2,11,6) However, this is likely not due to an inherent physiological difference, but rather to differences in wealth.(5) According to an article published by CNN Politics on June 3, 2020, “The median net worth of white households is about 10 times the median net worth of black households.” However, the date of the article’s publishing apparently doesn’t matter — since according to a study published by the Federal Reserve Bank of Minneapolis, “no progress has been made in reducing income and wealth inequalities between black and white households over the past 70 years.”(7) Researchers have explained the importance of taking into account racial — and therefore, economic inequalities, when drafting vaccination sequencing plans, so that COVID-19 does not contribute to the perpetuation of already growing inequalities.(2)

When you’re unemployed, there’s a high amount of pressure to get back to work, and you are more likely to end up doing jobs you wouldn’t have done otherwise, just to pay your bills. Which explains why the Economic Policy Institute also found that black people were more likely to be essential workers than white people.(4)

Essential workers are often not very wealthy. Another study by the Economic Policy Institute found that “nearly 70% of essential workers do not have a college degree,”(8) and those who have graduated college make earn more than those who haven’t. US Department of Education data shows that college graduates with a bachelor’s degree typically earn 66 percent more than those with only a high school diploma.(9)

A New York Times analysis used a combination of US Census data and federal essential worker guidelines to find that “Nonwhite women are more likely to be doing essential jobs than anyone else.”(10) According to a 2021 analysis by Business.org, the US Census also shows that “women make 18% less in their yearly earnings than men.” in total across the US. On average, women make [significantly] less than men in every single state. “ Even in the state with the smallest wage gap, women still earned almost 10% less than men.(11) It’s also worth mentioning that “women account for 73 percent of the U.S. health care workers who have been infected since the outbreak began.”(10)

The economically disadvantaged are therefore more likely to be exposed to the virus through their work. They are more likely to be working jobs that cause them to be exposed, and they will need to work these jobs for longer hours since the pay tends to be quite low. Since people with less wealth live with more people per household, and are more likely to be living in mulitgenerational households,(4) even if they are not working a dangerous job themselves, they are still more likely to be exposed. It’s also worth mentioning that according to the Center for Disease Control, “People who are infected but do not show symptoms can [still] spread the virus to others.”(12) It makes sense to place high vaccination priority on the people who are exposed the most, because they will inevitably spread it the most, infecting more people who may have worse symptoms.

Why the Poor Suffer Greatly if Infected — And Why it Matters

A higher exposure rate due to reasons outside their control makes the economically underprivileged greater spreaders of SARS-Cov-2, but it isn’t the only reason they’ve suffered to a greater extent during the COVID-19 pandemic. There are three other reasons for this:

1. A combination of environmental factors and lack of medical care, makes it more likely that they will have pre-existing health conditions, causing their symptoms to be worse if they contract COVID.2
2. They seek out less treatment when they get the virus.
3. During the pandemic, unemployment rose to unprecedented levels. The economically underprivileged tend to work in industries which saw greater unemployment levels. The unwealthy also suffered more financial damage due lack of lack of savings.

The CDC has created a list of conditions that put people at “increased risk of severe illness from the virus that causes COVID-19.” These include:
• Cancer
• Chronic kidney disease
• COPD (chronic obstructive pulmonary disease)
• Down Syndrome
• Heart conditions
• Immunocompromised state (weakened immune system) from solid organ transplant
• Obesity and Type 2 diabetes mellitus
• Pregnancy
• Sickle cell disease
• Smoking

Individuals with less wealth suffer from all these conditions more than wealthier people, except down syndrome and immunocomprimission due to organ transplants. They have both a higher incidence of cancer, and worse outcomes, (13) they tend to have worse nutrition which results worse outcomes for chronic kidney disease,(14) they tend to smoke more due to a combination of structural reasons,(15,16) they have a higher incidence of heart conditions and obesity,(17) they are more likely to be Black, Indigenous, and People of Color (BIPOC)(18,19), and therefore more likely to have sickle cell disease(20), and finally,they are more likely to be exposed to irritating gases or particulate matter due to air pollution, (21,22) “due to their proximity to particulate-matter-emitting facilities”(4) and therefore are more likely to suffer from chronic obstructive pulmonary disease.

While it is true that the Coronavirus Aid, Relief, and Economic Security (CARES) Act makes it so that those without health insurance do not have to pay their medical bills if they become infected with SARS-Cov-2, if their healthcare provider submitted a claim to the Health Resources & Services Administration Uninsured Program, many people were never informed of this by their hospitals or the government, and so they rejected medical treatment for fear of bills they won’t be able to pay off.(23)In fact, many people who were uninsured received medical bills in error.

People who were raised in families that were wealth-deprived end up going to college at lower rates. As discussed earlier, there is a direct positive correlation between education and wealth. Low-skilled workers were more likely to work in service industry jobs, which saw the highest unemployment rates last year. If these people got vaccinated, they could get back to work sooner and end up boosting the economy.

Concluding Thoughts

The socio-economically disadvantaged is a large group of people, which encapsulates and intersects with many other categories: BIPOC, essential workers, those with pre-existing health conditions, and single mothers. And within each of those categories, the people who have the least wealth are usually exposed at the highest rates, the greatest spreaders, suffer the worst health effects, and would benefit the most financially by getting a vaccine which would allow them to get back to work, helping the economy in the process.

Separating people by wealth will also be popular among a wider variety of individuals with different backgrounds and biases. For example, income inequality is a less politically divisive topic than racial inequality, and focusing on it will end up tackling racial inequalities, even if that is not the explicit purpose.

To summarize, lack of wealth is the root cause of a lot of the suffering that occurred, and is still occurring during the COVID-19 pandemic, and giving vaccination priority to the economically underprivileged will begin to fix this problem.

Works Cited

1. Feb 15 SS| NR| CN|, 2021. COVID-19 vaccine in high demand across US, but supply limited. CIDRAP. Accessed March 10, 2021. https://www.cidrap.umn.edu/news-perspective/2021/02/covid-19-vaccine-high-demand-across-us- supply-limited

2. Baena-Díez JM, Barroso M, Cordeiro-Coelho SI, Díaz JL, Grau M. Impact of COVID-19 outbreak by income: hitting hardest the most deprived. J Public Health Oxf Engl. 2020;42(4):698- 703. doi:10.1093/pubmed/fdaa136

3. Ross MK and M. Reopening America: Low-wage workers have suffered badly from COVID-19 so policymakers should focus on equity. Brookings. Published June 23, 2020. Accessed March 16, 2021. https://www.brookings.edu/research/reopening-america-low-wage-workers-have-suffered- badly-from-covid-19-so-policymakers-should-focus-on-equity/

4. Black workers face two of the most lethal preexisting conditions for coronavirus — racism and economic inequality. Economic Policy Institute. Accessed March 15, 2021. https://www.epi.org/publication/black-workers-covid/

5. Race and Income Shape COVID-19 Risk | SPH. Accessed March 10, 2021. https://www.bu.edu/sph/news/articles/2020/race-and-income-shape-covid-19-risk/

6. Raifman MA, Raifman JR. Disparities in the Population at Risk of Severe Illness From COVID- 19 by Race/Ethnicity and Income. Am J Prev Med. 2020;59(1):137–139. doi:10.1016/j.amepre.2020.04.003

7. Income and Wealth Inequality in America, 1949–2016 | Opportunity & Inclusive Growth Institute. Accessed March 12, 2021. https://www.minneapolisfed.org:443/research/institute-working- papers/income-and-wealth-inequality-in-america-1949–2016

8. Who are essential workers?: A comprehensive look at their wages, demographics, and unionization rates. Economic Policy Institute. Accessed March 13, 2021. https://www.epi.org/blog/who-are-essential-workers-a-comprehensive-look-at-their-wages- demographics-and-unionization-rates/

9. Fact Sheet: Focusing Higher Education on Student Success | U.S. Department of Education. Accessed March 15, 2021. https://www.ed.gov/news/press-releases/fact-sheet-focusing-higher- education-student-success#_ftn1

10. Robertson C, Gebeloff R. How Millions of Women Became the Most Essential Workers in America. The New York Times. https://www.nytimes.com/2020/04/18/us/coronavirus-women- essential-workers.html. Published April 18, 2020. Accessed March 14, 2021.

11. The Gender Pay Gap Across the US in 2021. Business.org. Published March 1, 2021. Accessed March 14, 2021. https://www.business.org/hr/benefits/gender-pay-gap/

12. CDC. Community, Work, and School. Centers for Disease Control and Prevention. Published February 11, 2020. Accessed March 9, 2021. https://www.cdc.gov/coronavirus/2019-ncov/community/health-equity/racial-ethnic-disparities/ increased-risk-exposure.html

13. Wilkes G, Freeman H, Prout M. Cancer and poverty: breaking the cycle. Semin Oncol Nurs. 1994;10(2):79–88. doi:10.1016/s0749–2081(05)80061–0

14. Gutiérrez OM. Contextual poverty, nutrition, and chronic kidney disease. Adv Chronic Kidney Dis. 2015;22(1):31–38. doi:10.1053/j.ackd.2014.05.005

15. Americans Are Smoking Less, But the Poorest People Still Suffer from Addiction. Global Citizen. Accessed March 13, 2021. https://www.globalcitizen.org/en/content/poverty-smoking-inequality- america/

16. CDCTobaccoFree. Cigarette and Tobacco Use Among People of Low Socioeconomic Status. Centers for Disease Control and Prevention. Published March 26, 2019. Accessed March 13, 2021. https://www.cdc.gov/tobacco/disparities/low-ses/index.htm

17. Żukiewicz-Sobczak W, Wróblewska P, Zwoliński J, et al. Obesity and poverty paradox in developed countries. Ann Agric Environ Med AAEM. 2014;21(3):590–594. doi:10.5604/12321966.1120608

18. Hansen S. Here’s What The Racial Wealth Gap In America Looks Like Today. Forbes. Accessed March 12, 2021. https://www.forbes.com/sites/sarahhansen/2020/06/05/heres-what-the-racial- wealth-gap-in-america-looks-like-today/

19. CNN TL. US black-white inequality in 6 stark charts. CNN. Accessed March 12, 2021. https://www.cnn.com/2020/06/03/politics/black-white-us-financial-inequality/index.html

20. Lee L, Smith-Whitley K, Banks S, Puckrein G. Reducing Health Care Disparities in Sickle Cell Disease: A Review. Public Health Rep Wash DC 1974. 2019;134(6):599–607. doi:10.1177/0033354919881438

21. News CK Environmental Health. People in Poor Neighborhoods Breathe More Hazardous Particles. Scientific American. Accessed March 12, 2021. https://www.scientificamerican.com/article/people-poor-neighborhoods-breate-more-hazardous- particles/

22. Inequitable Exposure to Air Pollution from Vehicles in California (2019) | Union of Concerned Scientists. Accessed March 12, 2021. https://www.ucsusa.org/resources/inequitable-exposure-air- pollution-vehicles-california-2019

23. Hospital Bills For Uninsured COVID-19 Patients Are Covered, But No One Tells Them. NPR.org. Accessed March 13, 2021. https://www.npr.org/sections/health-shots/2020/10/22/925942412/hospital-bills-for-uninsured- covid-19-patients-are-covered-but-no-one-tells-them