Racing to respond: Race and resource allocation in the COVID-19 pandemic

Dr Hazem Zohny

PI:  Dr Hazem Zohny

This project will consist of conducting two large scale online surveys, one in the UK and on in the US, to gauge public views on whether individuals from minority groups that are more at risk of COVID-19 should be prioritised when it comes to allocating scare-healthcare resources.

Funded by World Health Organization

Duration: 3.7 months

Starting date: 11 December 2020

Overview: The COVID-19 pandemic has highlighted deep and pernicious inequalities at the heart of our society.

It is all too clear that SARS-CoV2 disproportionately affects racial and ethnic minorities. In the UK, in the first phase of the pandemic, people from Black, Asian and ethnic minority (BAME) groups had a higher risk of being hospitalised from COVID-19; Black men were 4.2 times more likely to die than White. Even after taking into account other risk factors, COVID-19-related death for males and females of Black ethnicity in the UK occurred at almost double the rate of those of White ethnicity. In the US, the Centre for Disease Control reported a similar trend: Black and Hispanic people were 5 times more likely to be hospitalised from COVID-19 than White people.

Some of these disparities reflect the fact that racial and ethnic minorities are more likely to have underlying health conditions, live in multi-generational homes, crowded conditions and more densely populated areas.[3] Members of these minorities are also disproportionately represented in jobs considered essential and/or that involve interacting with the public. For instance, in the US, 25% of employed Hispanics and blacks work in the service industry, compared with 16% of whites, while blacks account for 30% of licensed nurses.

The pandemic highlights the pressing need to promote the health and well-being of racial and ethnic minorities. While all agree that this is important, there is less agreement about the right way to achieve this goal. One option would be to preferentially allocate scare healthcare resources to those disproportionately affected racial and ethnic groups. For instance, NHS England has recommended that BAME pregnant women should be fast-tracked to hospital due to their increased risk of coronavirus. Similarly, some have argued that those from ethnic minorities should be given priority access to COVID-19 vaccines. However, it has been suggested that at least in the US, explicit priority to a specific racial group would be likely to be subject to legal challenge, and that racially neutral strategies would be ethically preferable. Moreover, if critically scarce life-saving resources were preferentially allocated to members of a disadvantaged group, that might actually lead to increased overall mortality from COVID-19 (for example, because better prognosis patients would be denied access to a ventilator).

This raises an important ethical question: Should individuals from disproportionately impacted racial minorities be prioritised when allocating scare resources such as hospital beds in intensive care, mechanical ventilators and, once available, treatments and vaccines? If so, how should this be weighed against other ethical values in resource allocation, including the desire to save the most lives and the need to treat patients equally?

This large international study will be the first to gauge and evaluate the views of the general public about the role of race in resource allocation during the pandemic and its weight with competing ethical considerations. It will provide a timely, urgently needed, mechanism for involving the general community in deliberation about pandemic resource allocation, allowing the values of the wider community to be considered in development of policy and guidelines. The accompanying ethical analysis will rigorously evaluate the ethical role of race in allocation of different resources during the pandemic.

Investigators

Dr Hazem Zohny (Oxford Uehiro Centre for Practical Ethics)

Dr Andreas Kappes (City of London)

Professor Dominic Wilkinson (Director of Medical Ethics, Oxford Uehiro Centre for Practical Ethics)

Professor Walter Sinnott-Armstrong (Duke University)

Professor Julian Savulescu (Director, Oxford Uehiro Centre for Practical Ethics)