Deprioritizing People With Asthma for the Covid-19 Vaccine Is a Racial Justice Issue

The CDC says the condition doesn’t put people at a greater risk for severe Covid-19, but there’s an equity argument to be made

Photo: FG Trade/Getty Images

On Monday, Massachusetts Congresswoman Ayanna Pressley tweeted that excluding asthma from the list of medical conditions eligible in phase two of the state’s vaccine rollout was “devastating for Black & Brown communities in MA with disproportionately higher rates of asthma” and “both a racial & environmental justice issue.”

Pressley was referring to well-established data showing that Black and Brown people have higher rates of asthma because they have been historically redlined into polluted areas. These communities have also been hit harder by the Covid-19 pandemic, with disproportionately high rates of severe disease and death compared to White Americans.

The U.S. Centers for Disease Control and Prevention categorizes asthma as one condition that “might be at an increased risk” for severe Covid-19. “Might be” carries a lot of weight in that sentence, as it means that asthma is not included on the list of diseases that are currently eligible for vaccination in many states. Those conditions are associated with a more certain increased risk of death from Covid-19, such as cancer, Type 2 diabetes, heart failure, and chronic obstructive pulmonary disease.

It’s hard to see how asthma, a respiratory condition that causes inflammation and dysfunction in the lungs, wouldn’t worsen people’s outcomes from Covid-19. However, a recent review paper reported that, overall, people with asthma actually do not have higher rates of Covid-19 diagnoses, hospitalizations, or deaths than people without asthma.

Individual studies echo these findings, although with a few caveats. In one study of 7,272 people with Covid-19 in Korea, there was no increased risk for severe disease or death in the 686 people with asthma, unless they had experienced a serious asthma attack in the previous year. Similarly, a study from the U.K. found that people who died from Covid-19 were not more likely to have had asthma, unless, again, they’d recently taken an oral corticosteroid to treat an acute flare-up.

The American Academy of Allergy Asthma and Immunology recently put out a statement attempting to reassure people with asthma that they were at no greater risk from Covid-19. They state: “There have been many studies looking at the relationship between COVID-19 and asthma. Thus far the vast majority of these studies have found no increased risk of COVID-19 disease severity in those with asthma. Further, there appears to be no indication that asthma is a risk factor for developing COVID-19 disease.”

Based on these conclusions, it may make sense that asthma would not be included in the prioritized list of preexisting conditions that are currently eligible for vaccination. Theoretically, vaccines are being equitably distributed in phases depending on both risk of exposure and risk of serious outcomes, and if people with asthma don’t really have a higher risk of severe disease or death, then they shouldn’t be included in an earlier phase.

But the reality is that the rollout of the vaccines — like the pandemic itself — has been anything but equitable, and Black and Brown people have disproportionately suffered. And even if asthma itself doesn’t confer a higher risk, several factors associated with it do.

In the United States, Black, Latinx, and Native American people have disproportionately high rates of asthma, in large part due to higher exposure to environmental hazards. And in addition to causing asthma, even small exposures to air pollutants is associated with a 15% increase in Covid-19 death rates.

In an article for Future Human in November, Drew Costley wrote, “Environmental and public health researchers have warned since April that long-term exposure to air pollution in Black communities in the U.S. (and the respiratory illnesses it’s been linked to) make Black people with Covid-19 more likely to die or have severe complications than white people.”

Similarly, in September Yasmin Tayag reported for Medium’s Coronavirus Blog on data released by the National Community Reinvestment Coalition that found “neighborhoods that were redlined over 80 years ago are at a higher risk of severe illness or death from Covid-19” because historically redlined neighborhoods “continue to face increased pollution, decreased access to healthy food, and widespread poverty.”

By including asthma in the vaccination phase with other preexisting conditions, people with these related risk factors — such as exposure to air pollutants and just being Black, which in and of itself is associated with a 1.5 to 3.6 times higher death rate from Covid-19 — can be better protected.

What’s more, communities of color are already being vaccinated at significantly lower rates than White Americans. Prioritizing a respiratory illness that would make more Black and Brown people eligible for the vaccine would be one way to start rectifying an unequal system.

Health and science writer • PhD in 🧠 • Words in Scientific American, STAT, The Atlantic, The Guardian • Award-winning Covid-19 coverage for Elemental

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