Rewriting the Vaccine Distribution Algorithm
Keeping health care workers in the loop
While health care workers are among those receiving priority for the vaccine, the hierarchy of hospitals can obscure and hide the many faces, occupations, and roles that workers play in fighting the COVID-19 pandemic. These same values that structure hospital hierarchies are also implicitly programmed into algorithms that are being used to determine priority for the vaccine, raising questions about visibility, value of work, and equity. These blog posts center the experiences of critical workers in the hospital ecosystem who are often less visible. — Aiha Nguyen, Data & Society Labor Futures program director
In December 2020, frontline workers at Stanford Medical Center found out that few of them would be prioritized to receive the COVID-19 vaccine, despite risking their lives everyday to treat infected patients. Blame lay in the hospital’s algorithm that, by its flawed design, sent them to the back of the vaccination line, behind hospital administrators who work remotely and don’t treat any patients. Stanford’s algorithm, it turns out, weighed too much on age and theoretical risk of infection and not enough on job duties, direct contact with the virus, and actual risk of infection, injury, illness, and death. Beyond Stanford, however, the entire hospital industry is poised to make similar mistakes.
[Hospitals] operate under a hierarchy defined by occupation, race, class, money, and power.
Hospitals use algorithms to execute their daily operations, including the allocation of resources such as the Moderna and Pfizer-BionTech vaccines to their workforces. They also operate under a hierarchy defined by occupation, race, class, money, and power. At the top typically sit administrators, followed by doctors, then nurses, and finally, at the very bottom, nurse assistants, janitors, and cooks. This hierarchy is likely to create more flawed algorithms and vaccination plans that feed the cycle of inequities. COVID-19 has already ravaged poor and communities of color the most. But just as frontline workers forced Stanford to create a more equitable algorithm and corresponding vaccination plan, we too can help ensure we do the same for the entire industry and beyond. Here I propose a vaccination plan that 1) allows all healthcare workers equal access to vaccination, 2) allows for a choice on vaccination and a say in creating the vaccination line, and 3) is affordable to all. I use the example of nurses and nurse assistants, relying on insights and experiences from a decade-and-a-half of service in labor and community organizing, education, and research.
Equal Access: Equal Protection for Equal Risk
Nurse assistants and nurses work as part of a team that performs direct-patient care, which exposes them equally to COVID-19. When treating patients, they perform tasks ranging from delivering proper medication and treatment to feeding, bathing, and dressing them. They might also help them execute their daily recovery regimen and discharge. Or if the patient succumbs to the virus, they, with the help of a patient transporter, help prepare to move the expired patient’s body from a care room to the hospital morgue (or, if over capacity, a frozen meat truck in a parking lot).
We have a moral responsibility to roll out a national vaccination plan that allows all health care workers to have equal access to the vaccine.
Regardless of what type of patient they care for, nurse assistants and nurses assume equal risk by working in a hospital: a small, tight-knit community on the frontlines of the COVID-19 pandemic. In California, hospitals are stretched to the limit, at or dangerously close to running out of bed capacity. Some adjust by converting traditional care units to COVID-19 ones. Others install makeshift units by erecting tents in parking lots.
Despite taking on similar responsibilities, and as a result, risk, labor law creates seemingly arbitrary exclusions and divisions. In California, the Department of Health Care Services Title 22 protects nurses by establishing a nurse-to-patient ratio ranging from 1 to 8, depending on patient care needs. But it does not afford similar protections for nurse assistants. As a union representative and organizer in health care, I regularly see nurse assistants with up to 32 patients. This outrageous double standard under state labor law fits within a larger national pattern of racist, classist, and exclusionary labor laws. A prime example of this ugly legacy is the National Labor Relations Act (NLRA) of 1935, which to this day continues to exclude agricultural and domestic workers from collective bargaining rights and a democratic voice in their workplaces.
We have a moral responsibility to roll out a national vaccination plan that allows all health care workers to have equal access to the vaccine. Doing so will help correct the blatant exclusionary policies inherent in Title 22 and the NLRA, and avoid more suffering to communities that have already suffered enough.
Workers Voices: Workplace Democracy
Instead of leaving it entirely up to an algorithm, health care workers should be the decision makers on whether to vaccinate and what the vaccination line should look like. This can strengthen worker democracy and worker power. In years past, as union and community organizers, we have helped workers increase worker power and their workplace democracy here in California. In 2014, we helped airport service workers create a new union at Los Angeles International Airport. In 2016, we helped nurses win greater protections against workplace violence under California Occupational Safety and Health (Cal/OSHA) regulations. Currently, we are helping health care workers decide for themselves whether or not to get the vaccine, and figure out the best place for them and their colleagues in the vaccination line at each of their hospitals.
A choice on vaccination and a say on the vaccination line is fundamental to correcting this gross inequity.
But sadly, these are the exceptions rather than the rules. In the majority of our workplaces, workers have very little power and employers too much of it, judging by union density, which is at an all-time low of 10.8%. The decline in union density and workplace democracy helped create the structural conditions that created this disaster in the first place. COVID-19 has made poor people poorer and the rich richer. A prime example of this tragic situation is at Amazon. There, warehouse workers labor in highly dangerous conditions and high risk of exposure to COVID-19, processing shipments that doubled Amazon owner Jeff Bezos’ net worth from $113 billion to $203 billion, without him having to step foot in any of his warehouses. A choice on vaccination and a say on the vaccination line is fundamental to correcting this gross inequity.
Affordability: Equity
Lastly, distribution of the vaccine should follow an occupational health and safety framework to analyze the benefits of COVID-19 vaccine and its potential cost to healthcare workers. Under this framework, the coronavirus is treated as an occupational hazard. Health care workers are exposed to this lethal occupational hazard, the vaccine is a control mechanism for the hazard, and thus, the employer is responsible for administering the vaccine in order to maintain the healthiest and safest workplace possible. Just as health care workers don’t have to pay for the security guards that help eliminate workplace violence (another type of occupational hazard), they should not have to pay for the COVID-19 vaccine. The Center for Disease Control and Prevention (CDC) has made this recommendation already. Given it’s influence, it’s a good and needed measure to ensure that all health care workers get a free COVID-19 vaccine—not just the rich and privileged.
As we take a look back at 2020 and assess the effects of the COVID-19 virus on all of us, it is important to highlight the profound effect on low-income individuals and communities of color — a segment of the population that includes many health care workers. By ensuring that all health care workers have equal access to the vaccine regardless of occupation and zip code, receive it free of charge, and have a voice in whether or not to vaccinate, we can start to build an equitable path toward preventing further harm, rebuilding from destruction, and continuing the fight for justice and fairness for us all.
Jorge A. Cabrera is a community and union organizer, educator, and researcher. Long live tacos and tamales.
Stay tuned for a forthcoming post, in which Data & Society Labor Futures Program Director Aiha Nguyen and Digital Content Associate Natalie Kerby interview a wifi engineer who has to traverse nearly all areas of a hospital but few people see him as a healthcare worker.
