Distribution of the COVID-19 vaccine: Let’s stop inequality before it happens. Again.

WASHINGTON — When it comes to distributing the COVID-19 vaccine — with initial doses to be in short supply — the monumental challenge will be to not increase the gaping inequality gaps the pandemic exposed.

The existing disparities in health care — access, quality, affordability — guaranteed that low-income Black and Brown communities with high numbers of frontline essential workers would be hit the hardest when coronavirus cases started to climb in the spring.

As COVID-19 cases soar to record numbers in Illinois and the rest of the nation, the task now is turning vaccines into vaccinations.

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The federal government, the state of Illinois and the city of Chicago are organizing massive campaigns involving everything from figuring out who gets the initial limited number of doses, to training an army of people to give the shots, to insuring that cold and ultra-cold storage standards are met, to keeping tracking records.

And once this is done — everything has to be repeated if it’s a two-dose vaccine a person gets. That’s right. Twice.

That’s because two doses of a COVID-19 vaccine, taken a few weeks apart, are needed for immunity.

“The state has not undertaken anything of this scale, ever,” Jordan Abudayyeh, Gov. J.B. Pritzker’s press secretary told me Monday.

“It is a Herculean task, and it is especially challenging, given that we’re still in the middle of a pandemic,” Katherine Baicker, the dean of the University of Chicago Harris School of Public Policy said when we talked Monday.

Baicker, a health economist, added, “The same health care system that needs to be treating people and helping to prevent the spread of the disease is also supposed to be tracking the distribution of this logistically challenging set of vaccines.”

Is it possible to install a vaccination distribution system to stop more inequality from taking place?

“There are so many different dimensions of ‘inequality,’ Baicker said. “When you say, ‘Let’s stop inequality before it starts in access to care’ … in some ways, we’re not going to be able to undo all of the inequalities that are already so tragically manifested in who’s bearing the burden of this disease.”

Equity is of vital importance.

“But does that mean starting with underserved communities? Does it mean starting with the people who are at the greatest health risk? Does it mean starting with the health care workers who are taking care of those people?” Baicker said.

“Does it mean starting with the teachers who would be able to keep kids in school for people who can’t work at home?

“There are all these economic inequalities too. And so the pandemic has laid bare inequalities on multiple dimensions,” said Baicker.

The state at first will get about 109,000 doses; about 23,000 will go directly to Chicago with some 86,000 doses for the rest of Illinois. The state and city will each develop its own plans.

If the federal Food and Drug Administration grants emergency use authorization for vaccines made by Pfizer and Moderna at its Thursday meeting, the first shipment of the drug could arrive in Illinois in a matter of days.

Based on federal guidelines from the federal Advisory Committee on Immunization Practices, in Illinois, frontline health care workers and long-term care facility residents will be at the front of the line in “phase 1a.” The populations next in line in subsequent phases have not been decided.

It’s likely that essential frontline workers will be in the second phase; that will address, in an indirect way, equity issues since so many of those workers are Black or Brown.

A Trump administration official at a Monday briefing said, “No American will have to pay a penny out of his or her pocket to get vaccinated. There will be absolutely no co-pays, deductibles, or coinsurance associated with this.” The official also said, “We’ll have sufficient number of doses to vaccinate all Americans who desire one before the end of the second quarter of 2021.”

President-elect Joe Biden is going to have a COVID-19 Equity Task Force, and on Monday he named its chair: Dr. Marcella Nunez-Smith, the founding director of Yale’s Equity Research and Innovation Center. She is a specialist in health equity issues.

The COVID-19 baton will soon be passed to the Biden White House — and a president who will be making equity a priority, with vaccine distribution the first test.