Current CDC proposals for allocating COVID-19 vaccines will lead to thousands of easily preventable deaths. Using both age and race/ethnicity to prioritize who gets the first doses of vaccine will save more lives than current plans, which only consider age.
To minimize death, the CDC recommends giving higher vaccine priority to those at high risk of mortality from COVID-19: The elderly (first those 75 and older, in a later phase those 65 and older) and those with serious medical conditions that make COVID-19 more deadly. (Health workers and those in nursing homes are of an even higher priority.) Focusing on age makes sense: death rates roughly double moving from ages 50-64 to 65-74, and then double again moving to ages 75-84, and yet again moving to ages 85 and over (Figure 1).
At the same time, age alone does not perfectly predict the risk of dying from COVID-19. Race is also a strong predictor. Death rates for African Americans and Hispanics are far higher than for non-Hispanic whites of a similar age (Figure 1).
Death rates per 100,000 people for African Americans (158) and Hispanics (135) ages 50-64 are similar to death rates for whites ages 65-74 (144) – but only the white group (due to their age) is a high priority in the CDC guidelines. Unless three white people aged 65 are of more valuable to society than five Hispanics aged 64, the younger Hispanics should receive the vaccine first. Blacks and Hispanics ages 55-64 have higher death rates than whites 65-69. It is complex to add race and ethnicity to the priority criteria. At the same time, in terms of saving lives, prioritizing the minorities ages 55-64 year would be as useful as finding 50% more vaccine doses.
Accounting for race as well as age when determining vaccine priority will also reduce crowding in our hospitals. This effect will benefit people of all ages, races and ethnicities.
The CDC claims it wants to both save lives and reduce health disparities. Fortunately, California determines its own rules. Prioritizing vaccination partly based on race will help achieve both of the CDC’s important goals.