California policymakers are abandoning vaccination plans to prioritize disabled people and others with high risk health conditions.
By Holly K. Tabor
Holly K. Tabor is a bioethicist and associate professor in the Department of Medicine at Stanford University, and the parent of two sons with disabilities, firstname.lastname@example.org.
Joseph A. Stramondo, Special to CalMatters
Joseph A. Stramondo is an assistant professor of philosophy at San Diego State University who teaches and writes about bioethics, and identifies as a disabled person, email@example.com.
We must prioritize disabled people for COVID-19 vaccination. They are among the most vulnerable to COVID-19 infection, hospitalization and death. However, California’s vaccination plans are leaving them behind.
Policymakers are putting efficiency over justice and pivoting toward maximizing “shots in arms” for easier-to-access groups. In effect, they are abandoning earlier plans to prioritize those with disabilities and other high risk health conditions. These policy decisions will result in increased hospitalizations and needless deaths.
Disabled people are at higher risk of COVID-19 infection because of factors outside their control. Many need hands-on support with activities of daily living, either in facilities or at home from caregivers, so they cannot practice social distancing to prevent infection. Many staff work with several disabled clients or at multiple sites, exacerbating the potential risk of infection. While California’s plan prioritizes nursing homes, it excludes those under 65 and those who receive care in other settings.
Once infected, disabled people have a higher risk of death. A recent white paper analyzed the nation’s largest database of privately insured patients’ health care claims and found that, across all age groups, patients with developmental disorders had the highest odds, and patients with intellectual disabilities had the third highest odds, of dying from COVID-19. These are likely underestimates, since many disabled individuals have public, rather than private, health insurance and were not included in the analysis.
Disabled people also face specific access barriers to vaccination. The current vaccine distribution plan relies on access to a primary care provider, reliable transportation and complex online reservations systems – all of which belies a lack of understanding of the needs and lived experiences of many disabled Californians. This system exacerbates disparities and systematically discriminates against those who need vaccines most.
Instead, policymakers should employ a “both/and” approach that prioritizes both justice and efficiency.
First, while deploying approaches that focus on “shots in arms,” some vaccines should simultaneously be allocated to disabled people.
Second, California must expand the Center for Disease Control and Prevention’s list of high-risk conditions: while it includes Down syndrome, it does not include other intellectual and developmental disabilities.
Third, California must partner with agencies serving disabled people in the community, leveraging existing relationships to deliver vaccines.
Fourth, California should require health care institutions to proactively reach out to their disabled patients to make vaccine appointments, bypassing complex online reservation systems.
Transparency and representation are also critical.
Vaccine distribution data should be shared publicly with multiple metrics of equity on publicly available dashboards. While dashboards have been created by some counties, such as Santa Clara County, they have not included disability as a reported equity variable. Counties and institutions should be incentivized and held accountable for meeting vaccine equity targets. Moving forward, vaccine distribution committees at all levels must include members of disability communities.
In California, policymakers seem to be frozen. There has been some acknowledgement of the need to prioritize disabled people “soon,” but no visible progress on concrete timelines or actions. On Feb. 8, Gov. Gavin Newsom committed “to figure this (vaccination prioritization for disabled individuals) out, once and for all, by the end of the week,” but he did not offer any specifics. This is a stark contrast to other states, like New York, which recently announced vaccine eligibility for intellectually and developmentally disabled people starting Feb. 15, and Oregon, which recently set up a vaccination site for disabled people at the Portland airport.
Every day, more disabled people die of COVID-19. The stakes could not be higher to demonstrate we regard disabled lives as having equal value to non-disabled lives. We call on all Californians – providers, policymakers and residents – to rise to the challenge. Disability affects everyone, and prioritizing disabled Californians will benefit everyone.