Comment: Vaccinations are going well, as long as you’re white

By Cathy O’Neil / Bloomberg Opinion

For all its successes, the U.S. covid-19 vaccination campaign has a troubling mix of characteristics: chaotic organization that requires significant time and effort to navigate; a wealthy elite desperate to get shots; and a vast group of front-line workers who are supposed to receive the first doses but who lack resources and have been hardest hit economically.

In other words, it has all the elements required for an inequitable and even corrupt result. And that appears to be precisely where it’s headed.

The Biden administration inherited a distribution system that its predecessor left almost entirely up to the states, with wildly divergent and haphazard results — as in New York, where Democrastic Gov. Andrew Cuomo has been openly meddling with the rules and incentives for distribution, causing plenty of confusion and changing plans. The result is a mess that puts the well-heeled and well-connected — predominantly white people — at a significant advantage.

Consider my own efforts to get an appointment for my 79-year-old mother in Massachusetts, which has been lagging the rest of the country in shots administered. I spent hours searching on multiple terrible websites that often had me waiting 45 minutes to search 30-mile-radius bubbles for appointments that had already been filled up. I ultimately scored a Saturday spot at a mall about a two-hour drive to the west, an achievement that required ample form-filling, document-scanning and quick access to reams of information. Soon afterward, my mother’s primary care doctor offered us an earlier appointment near home. We gratefully accepted, but the website where I made the first appointment didn’t have an option to cancel.

How would a low-wage nursing home worker — struggling to make ends meet, perhaps managing kids staying home from school, with no free time to search websites or access to scanning equipment — pull that off for her mom? Yet I, a relatively privileged, highly educated white woman working in academia, end up sitting on two appointments.

So even if people follow the rules, the bureaucratic complications alone pretty much ensure an unfair outcome. But to add insult to injury, not everyone follows the rules in good faith. Witness the SoulCycle instructor who assumed the status of educator to get a shot, the wealthy New Jersey hospital donors and Florida country-club members who have reportedly gained privileged access. In many places, gaming the system is surprisingly easy: A friend from Tennessee told me he didn’t need to show any identification for his shot, which he was eligible for as a high-school teacher who has been working in person for months.

In that context, I suppose I shouldn’t have been shocked to hear separately from two friends in New York City that they had been offered the chance to skip the line for $250. One of them likened the offer to scalping: The vaccines are real, the setting is official, but the tickets are for sale. My friends insist they didn’t go for the deal, and I don’t know what would have happened if they did. But it’s easy to imagine the incentives that would make such a black market possible: The people with appointments to sell are the same, disproportionately minority front-line workers who might have already fallen ill, and who might figure they need the money more than they need the vaccine.

No wonder the distribution of vaccines has been so skewed by race and income. The data are far from complete, but what’s available shows that Black people, for example, are getting shots at rates sometimes far below their share of the general population; even though they comprise an outsized share of the front-line workers who should be getting inoculated first. As of late January in New York City, where Black people make up 24 percent of the population, they had received only 11 percent of shots administered (where race was recorded). Reluctance to take the vaccine, rooted in a tragic history of medical exploitation, might explain some of the disparity, but certainly not all.

It’s hard to see an easy solution. Relaxing eligibility checks to improve access would also broaden the scope for cheating. I suppose tighter rules and hefty penalties for line-jumpers, all the way up to criminal charges, could deter some of the worst abuses. Ultimately, though, the biased distribution of lifesaving vaccines is the inevitable result of a society with a radically unequal distribution of resources. That’s a problem that only much larger policies — on the level of reparations or monumental government investment in equitable growth — can address.

Cathy O’Neil is a Bloomberg Opinion columnist. She is a mathematician who has worked as a professor, hedge-fund analyst and data scientist. She founded ORCAA, an algorithmic auditing company, and is the author of “Weapons of Math Destruction.”