The American media has already established that the initial wave of COVID-19 vaccines will almost immediately lead to massive inequalities between wealthy and poor nations, as well as among the wealthy and the poor within each individual society.
Given that Pfizer's vaccine is not only in limited supply, but comparatively costly due to its stringent temperature requirements for shipment and storage, some have warned that it risks becoming a "vaccine for the rich".
Now, bioethicists are saying that the likelihood that a 'black market' for the rich and famous emerging is a virtual guarantee. Because just like black-market human organs, the COVID-19 vaccines has "life-saving properties".
The worst attempts to nefariously procure a vaccine may come a few months into distribution, once vaccines are available that don’t require ultra-cold storage and local pharmacies and physician practices get allotments. “There absolutely will be a black market,” said bioethicist Arthur Caplan of New York University. “Anything that’s seen as lifesaving, life-preserving, and that’s in short supply creates black markets.”
Concierge services for wealthy clients are already being inundated with questions about when COVID vaccines will be available (even though opinion polls show many have reservations about whether the approval process has been "rushed").
At WorldClinic, which charges members $10,000 to $250,000 a year for 24/7 care, no patients have asked for special treatment and the clinic would not undermine its integrity by trying to secure vaccines unethically, said Lang, who was a White House physician during both the Bush and Clinton administrations. "The optics of trying to jump the line would be so bad, they don’t want to do that." But within the broader system, he added, some people will inevitably cut in line.
In addition to ensuring that nurses and doctors get the vaccines, members of the ACIP, a federal panel responsible for writing the rules surrounding how to distribute the vaccines has pledged to ensure that only the real "essential" workers will be prioritized to ensure that "people of color, who are often the hardest hit by the virus, get early access."
Members of the Advisory Committee on Immunization Practices (ACIP), the federal panel recommending how to distribute the vaccines, want to prioritize essential workers to help ensure people of color, who are often the hardest hit by the virus, get early access. But the predominantly white workers in the financial services industry are also considered essential, according to guidance from the Cybersecurity and Infrastructure Security Agency, which was referenced by ACIP, as well as executive orders from several states including New York, Illinois, Colorado, and California. Public-facing bank tellers face contagion risks in their work, but aren’t the only financial services employees included. “It was left a little bit nebulous but basically covered people who oil the movement of money, so exchanges, trading floors, trading operations, and people who keep money moving at the retail [banking] level,” said Lang. "They’re defined very broadly in New York and Illinois, because that’s where so many of our financial services industries are based."
Whether that will happen remains to be seen. As STAT's sources argue, it's a difficult problem fraught with complications.
Bioethicists warned that as soon as vaccines start getting doled out, there will be a rush of industries trying to claim that their workers are "essential" and deserve priority - much like we saw with the lockdowns.
Already, financial services employees - a broadly defined category that includes everything from bank tellers to investment banking analysts - are raising eyebrows and hackles from some who feel they've been unfairly classified as "essential".
The potential of industry lobbyists "redefining what an essential worker is is a very strong possibility," said Glenn Ellis, a visiting scholar at the National Center for Bioethics in Research and Health care at Tuskegee University and a narrative bioethics fellow at Harvard Medical School.
Prioritizing essential workers is intended to give early vaccine access to those who provide a critical societal function and cannot socially distance easily, the Colorado health department said in a statement that acknowledged it can be difficult to write airtight rules. “Given the thousands of different job descriptions in the state, it is impossible to come up with a complete list for every occupation for a specific vaccine phase. Vaccine providers will need to use their best judgment about which patients may qualify for vaccination during this phase.” The California health department confirmed financial services employees, including those needed to “maintain orderly market operations,” will have early access to the vaccine as essential workers, as will people in the news media, such as reporters. State health departments in New York and Illinois did not respond to requests for comment about whether those in financial services would receive a vaccine early.
On the flip side, it's nice to see the medical establishment finally acknowledge the fact that, yes, the definition of what constitutes an "essential" worker is vague, fluid and hardly an inflexible concept. Beyond nurses, doctors, other medical workers, and grocery-store clerks, there's a wide world of functions that are critical to keeping the economy humming without causing serious shortages of food or other resources (like, for example, toilet paper).
Adding some balance to the piece, STAT adds that making the early 'essential' phases of vaccine distribution completely airtight comes with its own risks. Because if government agencies get too involved checking and double-checking everything, the bureaucracy would likely slow down the process.
At a certain point, though, vigilance brings its own risks. "If you add too many inefficiencies of checking and double-checking everyone, then you put so much bureaucracy into the program, you slow things down," he added.
Plus, with the college admissions scandal still fresh in everyone's mind, people in positions of power are presently hyper-aware of the risks of being caught and called out, and what it could mean for their livelihoods. That, one bioethicist said, will probably act as an effective check on abuse - at least to a degree.
The public shame of being caught should act as a deterrent, especially if the backlash is akin to what several Hollywood celebrities and wealthy parents faced following the 2019 college admissions bribing and cheating scandal, said Bateman-House. "I can promise you, no CEO wants to be on the front page of the newspaper for giving preferential access to his college roommate," she said. "I think a few public naming and shamings would probably tamp down some activity."
The piece ends with STAT's sources claiming that the decision to supply experimental treatments to President Trump and other politicians (Ben Carson, Chris Christie) could hurt public faith in the process by creating the impression that insiders are cutting the line.
While bioethicists are at it, we would love to hear their take on the ethics of governments issuing COVID-19 'vaccine passports' or vaccine ID cards.
In the end, to create a truly effective deterrent, the public must send a message to the rich and powerful that special treatment simply won't be tolerated.
Following the vaccine rollout, the response to the wealthy and powerful cutting the line needs to be different and fierce, he said. “Everybody has to condemn them: the media, your neighbor, your boss, everybody.”
But what if all those people are the same ones who are cutting the line?