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On Monday, I received a text message from my health care provider, NYU Langone Health Medical Center in New York, with the cheerful message: “The Covid-19 vaccine will be available in early 2021. We will contact you as soon as we get there. will have information on who can get it when. “
But there was a caveat: since doctors at NYU Langone Health have no idea when this “info” might arrive, the text also urged me not to contact them – yet.
Even if these requests were mostly from well-worried people, many healthcare providers in New York City (and other areas) would face a barrage of requests from the wealthy and powerful, desperate to access health care. the first round of vaccines. Indeed, the question of how to get vaccinated quickly sparks rumors in the golden circles.
The more ethical medical groups try to hold the line, to implement any distribution plan that emerges as fairly as possible – even as uncertainty and anxiety increase. “It will be chaos, or close to chaos,” William Haseltine, one of America’s leading medical experts, admitted to me this week. Or as Arthur Caplan, a bioethicist at New York University, told the STAT medical journal: “There will absolutely be a black market. Anything that is considered to be lifesaving and vital, and that is in short supply, creates black markets. “
This problem is not unique to the United States. However, the ethics here are particularly tortured and emotional for at least two reasons. One is the lack of a single-payer health care system. It is a country, after all, where 29 million people under the age of 65 have no health insurance, but where the well-to-do have access to advanced treatment, concierge services and are able to increase their access to the best doctors by taking their place on hospital advice.
The other problem is fragmentation. The UK can roll out a plan because there is only one body in charge: the NHS. In the United States, the vaccine will initially be distributed to states based on their share of the national population, and state officials will then decide how to manage immunization programs. In some areas, such as New York City, Mississippi and Kentucky, local officials have said they will delegate deployment decisions to health experts. In many other areas, local towns should take matters into their own hands.
This makes sense, given the lack of resources – and expertise – of most state governments. But this fragmentation means that there could be wide variations in the tactics used, not least because federal guidelines are vague. The Advisory Committee on Immunization Practices, for example, said last week that the first round of vaccines should go to residents and caregivers of nursing homes, followed by essential workers and those who are vulnerable due to pre-existing conditions.
However, definitions of “pre-existing conditions” may vary. As does the concept of “essential worker”. In states like New York and Illinois, for example, financiers and bankers were defined as essential workers during Covid-19 (which gave them the right to enter the office). Journalists too. The net result, then, will be many loopholes that could be exploited – or, to use Wall Street parlance, subject to arbitrage.
This is all the more likely given that the White House itself has given cultural signals that seem to sanction the idea that the rich and powerful may get better access than others. When Donald Trump got the Covid-19, he proudly said he had taken experimental drugs that were not available to most ordinary Americans.
Will rich Americans use their economic and social capital to cut the line? Some say no. A financier in his forties who sits on the board of directors of a major New York hospital told me this week that he “absolutely won’t.” Another New York luminary in his 50s, who also sits on a hospital board, said he was so appalled by the idea that anyone who did should be “named and humiliated.” Meanwhile, Haseltine scoffs at the idea as not only “totally unethical” but also “dangerous” if there is a black market for untested vaccines.
However, hardly anyone I spoke to about it officially spoke about it – precisely because the question is so moving. “A lot of people will try to get it early – even if no one admits it,” one real estate developer told me.
Could President-elect Biden’s incoming administration change that? Maybe: those like Haseltine are begging them to create a centralized plan with clear advice. Some people around Biden are also urging him to adopt the “name and shame” tactic.
But don’t hold your breath as Team Biden can fix the problem. Regardless of the fact that they won’t be in office until the end of January, they face a system in which deep health inequalities have not only taken root, but also culturally normalized. In other words, the only thing unusual about the impending vaccine row is that it could reveal these inequities with surprising clarity – and in a way that could cause a feeling of unease and alarm even among rich.
Follow Gillian on Twitter @gilliantett and send him an email at gillian.tett@ft.com
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