Emilie Egger //

As the effort to vaccinate Americans against COVID-19 begins, states, scholars, and editorial boards continue to deliberate as to who should receive available supply first. Most conversations coalesce around the “most vulnerable” with a few main definitions of who that includes. 

The earliest definitions of “at risk” centered on the elderly, residents of care facilities, people with pre-existing conditions, and frontline healthcare workers. More recently, some scholars have started to include a socio-racial and political analysis in their definition of vulnerable; many activists, scholars, and public health professionals have called for early vaccination of incarcerated people, people experiencing homelessness, and people who live in poverty.

However, one axis of COVID risk I have not seen discussed as frequently is consideration for those more vulnerable to violence within medical systems. This post will outline three groups of people who face higher risk of experiencing medical malpractice and neglect inside health facilities and from public health policy and could therefore possibly benefit from earlier vaccination and avoiding having to seek care for COVID-19:

  1. Racial minorities: Discussion around Black and Latinx communities’ skepticism of the United States’ vaccine rollout have rightly proliferated, as have analyses about why these communities are more at risk for deadly COVID disease. Layering these two well-documented phenomena together highlights why Black and Latinx people should be at higher priority for receiving the vaccine and could redirect efforts by the CDC and other agencies to display the efficacy and safety of the vaccines currently under emergency authorization. Many of the disproportionate risks these communities experience emerge from faulty health equipment, racist policy and research, neglect, and outright abuse; vaccination could help them avoid having to enter the medical system and experience neglect and abuse that will feed the problem of mistrust of health care and vaccinations.
  2. People who are categorized as overweight and obese: While recent studies have challenged the “not adequately disentangled” evidence that high BMI on its own causes worse COVID outcomes, it remains true that patients deemed overweight and obese are at higher risk for worse disease due to socioeconomic disparities, medical neglect, and lack of evidence-based care because their health problems are assumed to stem from weight. People with higher BMIs could be made eligible for vaccination, not because their higher body weights necessarily cause worse outcomes, but so they can avoid prejudiced care that does lead to worse outcomes
  3. Trans and non-binary people: This population faces persistent illegibility within health systems and increased mental health issues after interfacing with medical personnel. They also face increased risks associated with isolation and domestic violence. Furthermore, trans people, as well as the other two groups listed here, are at higher risks for the inability to afford acute or long-term health insurance and care due to their marginalized status. 

This list is not exhaustive; other marginalized people at high risk for medical abuse include women, sex workers, people who use drugs, and many others. This post is meant to be a starting point for widening our definition of medical risk through the addition of a framework of medical violence to discussions around how marginalization manifests inside health systems.

(Image per Corell [CC / Flickr])

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