Separate-To-Make-Equal Vaccine Queues?

“Among the 23 states that report those details, Black and Latino people received far smaller shares of the vaccine than their share of cases and deaths, and compared to their share of the states’ populations.” (more)

In other areas of life, such as jobs and schools, critics call it unfair to insist on exact race or class proportionality, as other important yet blameless factors are correlated with race and class. But with a pandemic, cases and deaths are in fact good proxies for the main outcomes of interest, as they indicate not just who is more likely to be harmed if infected, but also who has more risky contacts, and so is both more likely to catch the disease and to pass it on to others. So it makes more sense to try to make vaccine access more proportional to the cases and deaths of particular demographic groups.

Some say that race/class equity is just not possible in vaccine distribution, as poor folks and people of color have fewer cars, fewer computers, more language obstacles, less time flexibility, and worse abilities to navigate complex public health systems. But that’s all assuming that the system doesn’t explicitly consider race and class.

It would be completely possible to just have different queues for different races and classes. (And I can’t believe queue-designers were unaware of this option.) Give each person a rank within their different queue, presumably according to various risk and priority indicators. Call them to come get the vaccine when everyone below their within-queue rank has been given the chance to get it.

Under this system, if poor folk and people of color are less able to find out when they are called, or less willing or able to come in when called, then other people further down in their queue would get it. This system could insure race and class equal vaccine distribution up until the point where so few in a particular queue come for a vaccine when called that vaccines end up wasted.

This is just one example of a type of queue not tried. There is a vast space of possible queues, and many problems attributed to queues are actually only problems with particular versions of queues.

For example, many think it obvious that while queues might work to allocate vaccines of predictable availability, unpredictably available vaccines, such as leftovers at day end, must be allocated via who has the connections and time flexibility to be at the right place at the right time. But even unpredictably available vaccines could still be allocated via the same basic queues. Once you give everyone their rank in a queue, you could use those ranks to pick who gets any vaccines, from among those who are at the right place and time. And of course we should try harder to tell everyone what those places and times are, and to standardize them more.

In general, I think the covid vaccine distribution would have been more efficient if we had just let a private markets allocate them by price, perhaps giving out (and paying for) price discount vouchers to those we thought extra deserving. Not only would this have cut much of the waste and inequality of people trying to “work” the system to jump queues, but it would have allocated vaccines better by customer-perceived value. Yes, people with more money would tend to get vaccines sooner, but that money they paid could be spent on encouraging a larger and earlier supply. (And allowing early challenge trials would have helped even more.)

When choosing whether or not to intervene in markets, policy makers usually focus on the constraints that competition and uncoordinated actions impose on markets, while assuming that governments can do anything they want. Yet this case of pandemic vaccines reminds us that while governments may be able to set aside some of the constraints that bedevil markets, governments come with whole other sets of constraints of their own.

We do not have the best government allocation mechanisms that are abstractly possible, but instead have whatever seemed easy and familiar to existing government agencies. Markets tend to create much stronger incentives to search and innovate within its sphere of constraints. And just because advocates say government intervention is needed to ensure racial or class equity, that doesn’t mean that is what government intervention actually produce or promote.