It has been six years since the start of the COVID-19 pandemic, but one question remains relevant: who should be first in line when vaccines are scarce? Wageningen researchers Nazli Gul and Sander de Leeuw propose prioritising socioeconomically vulnerable groups.
When COVID-19 vaccines first became available, supply was limited and governments had to make difficult choices. In most countries, priority was based on medical risk. Older people, healthcare workers and those with underlying conditions were vaccinated first.
New research by Wageningen University & Research experts Nazli Gul and Sander de Leeuw revisits this approach. They ask whether it was not only effective, but also fair, and whether incorporating social inequality into vaccine allocation could have saved more lives.
Health risks are not evenly distributed
The pandemic did not affect everyone equally. People living in poverty, crowded housing or insecure jobs faced higher exposure to the virus and more severe outcomes. This pattern was observed across countries, including the UK, the United States and Brazil.
As Gul explains, “The pandemic did not create inequality. It revealed what was already there.” She adds that even outside crisis situations, “when resources are limited, the most deprived are the least likely to benefit.” This suggests that social vulnerability should play a role in allocation decisions more broadly, not only during pandemics.
Despite this, most vaccination strategies focused narrowly on medical vulnerability. Socioeconomic factors were rarely included in formal allocation models.
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