With limited doses, many question Oregon’s plans to send teachers to the front of the vaccine line

Oregon Gov. Kate Brown wants as many schools as possible to resume in-person learning by Feb. 15 while the COVID-19 pandemic continues. To make that happen, she plans to vaccinate all of Oregon’s 100,000 or so school employees in the next few weeks — in the process putting them at the front of the line ahead of the elderly, people with pre-existing health conditions and other groups of non-medical frontline workers.

That decision has sparked controversy in Oregon. After other states seeking to prioritize teacher vaccinations reversed or altered those plans following public backlash, Oregon remains the sole holdout.

The Centers for Disease Control and Prevention recommends vaccinating older people, people with pre-existing health conditions, and people at a very high risk of exposure first. Brown’s decision directly contradicts those guidelines. Some critics argue that vaccinating teachers ahead of more vulnerable groups violates principles of medical ethics. Others — including teachers — say that vaccinating teachers is not enough by itself to open schools safely.

”Our schools are safe when our community is safe,” said Elizabeth Thiel, president of the Portland Association of Teachers. “Our educators and our students come in and out of schools and go home to families. You can’t have safe schools without safe communities.”

But Brown defended her position in a heated press conference last Friday, saying that the cost of keeping schools closed was too great, due to the impact of school closures on the economy, children’s learning and students’ health and well being.

Brown insisted it will be safe to reopen schools in February, despite a slight increase in COVID-19 cases in January.

“The good news is, Oregonians have worked very hard to adhere to our safety guidelines,” she said when pressed on school safety. “We’re watching the numbers very closely.”

For a brief period, it looked as if Oregon seniors would receive their vaccines at the same time as teachers. But when it became clear the federal government was not going to deliver a promised vaccine shipment, the conflict over teacher vaccinations surged back to the forefront.

But it’s not as simple as a contest pitting teachers against seniors in the priority rankings for vaccinations. Gov. Brown emphasized the importance of school to young adults and children, so they’re a part of this story, too. Courtney Campbell, a medical ethicist at Oregon State University, said the families and communities of those students and teachers are a part of the story, as well. And so are other essential workers that will need to wait to get the vaccine.

”Oregon is going in the right direction by stressing health equity as a governing ethics principle for vaccine allocation,” Campbell said. But “health equity does not support prioritizing teachers and K-12 staff.”

In an emailed statement, Charles Boyle, a spokesperson in the governor’s office, pushed back on the idea that prioritizing teachers is inequitable.

“There are also equity-centered reasons to prioritize vaccinating teachers, educators, and child care providers,” he wrote. “Working parents from low-income families are particularly burdened when school buildings are closed by the need to find safe and reliable child care for students learning from home.”

An issue of equity

The Oregon Health Authority gave strict instructions to Oregon’s Vaccine Advisory Committee. The panel is tasked with determining what groups will be vaccinated after health care workers, seniors, and teachers, and in what order. Committee members were presented with information on health disparities, racism and COVID-19, and were told to place Oregon’s hardest-hit communities at the forefront of their plan.

That left some observers wondering: why wasn’t equity a part of the decision to vaccinate school workers, too? Daniel Lopez-Cevallos, a public health researcher at Oregon State University, sees clear bias in the decision to vaccinate teachers and other school employees first.

While he understands that access to education is an important equity issue, it hasn’t escaped his notice that teachers — most currently working from home — are now getting the vaccine ahead of other high-risk essential workers, “who are already being exposed day in and day out.”

“About 13% of Oregon’s population is Latino or Latinx,” López-Cevallos said, “but I believe they make up about 37% of cases, last I checked.” In the most recent weekly report, the Oregon Health Authority said that 36% of Oregon’s COVID-19 cases identify as Hispanic.

“I believe this is due to exposure,” López-Cevallos said. Latino and Black Americans, and other marginalized communities are much more likely to work in high-risk frontline jobs. Oregon has seen frequent outbreaks associated with food processing facilities, farm work, and other high-contact frontline jobs. “We label them essential workers, but what are we doing to support them?”

The CDC recommends vaccinating essential workers in places with a high risk of outbreaks. Vaccinating essential workers can help stop the transmission of COVID-19 from workplaces to communities, and then back again. Frontline workers from communities of color do get a priority ranking under the Vaccine Advisory Committee’s recommendation. But no timetable has been set yet by the state for when these and others in what’s known as Phase 1b can be vaccinated.

López-Cevallos says this decision to vaccinate teachers and other school employees ahead of other, more diverse occupations, is part of a trend Oregon has faced throughout the pandemic.

“These people are continually being asked to make the sacrifice. But when it comes to getting them PPE and testing, and now vaccines, we are lagging behind,” he said.

That inequity has not been missed by Oregon teachers, some of whom are speaking out against the governor’s vaccination and school reopening plans.

”Educators have been working from home, and we can continue working from home,” said Thiel of the Portland Association of Teachers. “It feels like the decision to put teachers on the vaccine list ahead of the elderly, of BIPOC communities, and of essential workers who can’t work from home wasn’t thought through.”

BIPOC is an acronym that refers to Black Americans, Indigenous peoples and people of color.

“I want to be clear. This timeline is not coming from teachers.” Thiel said.

Beyoung Yu teaches English as a second language at Rosa Parks Elementary School in Portland. He would also see other essential workers get vaccinated before teachers.

”My personal feeling is that seniors and frontline workers who are being exposed should get those vaccines,” Yu said. “I know that digital learning is not as effective as in-person learning. That’s not a debate. But by doing this right now, we are doing it at a risk to the populations we serve.”

And while Yu acknowledges that students of color have been hurt the most by distance learning, and their families the most hurt economically, he doesn’t see vaccinating teachers as the solution.

”If that’s their argument, I would like to see them reach out to those communities,” Yu said. “I don’t see enough of that being done. People are making decisions about Black and Brown lives without involving those Black and Brown lives without including those Black and Brown lives at the table.”

From school to home

There’s another reason Yu doesn’t want to return to in-person learning yet: kids and their communities. Yu said that many Portland-area schools are outdated and lack proper ventilation, putting students at risk.

“Teachers are not the only people in schools, and the vaccine is not approved for children,” López-Cevallos said.

Although other countries have shown that schools can be reopened safely if COVID-19 cases are low, many communities in Oregon still have high levels of the COVID-19 virus circulating.

Students return to their homes after school, and go back to their communities. Although children are less likely to get severe COVID-19 and less likely to spread it, the chance is still very real — and it gets worse as case rates increase. It’s also possible that already-vaccinated teachers could transmit the virus to unvaccinated family and community members, particularly if immunity from the vaccine fades with time, as it does with other coronaviruses.

“I think teachers are made out to be a certain way. But my job as a teacher is to serve the community I work for,” Yu said, “How can I be of service to this community if by coming back to school I am making decisions that put those families at risk?”

That’s not just students’ families, but the families of unvaccinated essential workers, as well.

Here, too, the governor’s plan to vaccinate teachers and reopen schools runs into equity issues. López-Cevallos said that because of decades of institutionalized racism, people of color are more likely to have pre-existing conditions that put them at risk for severe COVID-19.

The families of well-off white children, on the other hand, are more likely to have access to medical care. At the same time, less-well-off white Oregonians also face barriers to healthcare.

That means that the risk each family faces by sending their children to school is different, and that burden is disproportionately born by people of color.

It is also disproportionately born by seniors, particularly seniors of color.

The number of elderly people living with family increased during the pandemic, as concerned adult children pulled parents out of nursing homes and assisted living facilities that appeared to be hotbeds for infection.

While this is a recent trend for some demographics, multigenerational households have long been an important part of life in communities of color. For financial and cultural reasons, young people of color are much more likely to live in homes with more than one generation, or more than one family.

“Returning more students to the classroom can also help reduce COVID-19 risks for grandparents who have been caregivers for their grandchildren during the school day,” said Boyle, the governor’s spokesperson.

But epidemiologists and teachers say that’s exactly the problem: if a student catches COVID-19 at school, even if they are asymptomatic, it’s possible to bring the virus home.

‘Like living with a COVID-19 gun to my head’

For all that everyone’s worlds shrunk during the pandemic, seniors shrunk the most of all. Grandparents met grandchildren through window glass, and celebrated anniversaries separated from loved ones.

Chet Liebs, a 75-year-old Portland resident, hasn’t entered a grocery store in almost a year: a friend goes shopping for him once a month.

Liebs knows the risks. He knows that at his age, a COVID-19 diagnosis could be a death sentence.

Since March, “My life has gotten … stressful,” Liebs said. He understands the importance of schools, and felt that vaccinating teachers and seniors at the same time was a fair solution to the vaccine shortage.

Liebs and many of his friends were relieved when they heard they’d be vaccinated sooner, like they had some glimmer of certainty in a confusing year.

So when he learned seniors had again been sent further back in line, he was disappointed. Getting a vaccine would open up doors for him, but more than that, it would do wonders for his mental health.

“I won’t feel like I have a COVID-19 gun to my head. That’s a really big deal for everybody,” Liebs said, “I’m not gonna go run around hugging people, that would be irrational. But I won’t have a gun to my head anymore.

Liebs said once he gets vaccinated, being able to live without that fear will be the biggest change: even more so than going to stores again.

Liebs’ concerns about COVID-19 are well-founded: People over the age of 65 make up about 16% of the U.S. population, but 80% of all COVID-19 deaths. 91% of all deaths in Oregon have been in those 60 and older, despite making up just a quarter of the state’s population.

Between the coronavirus’ propensity for attacking the elderly and those with pre-existing conditions, for some seniors, taking a step out of their home is an exercise in bravery.

If vaccinations for seniors are delayed, it will result in more deaths. Using Oregon’s own demographics and mortality data, it is possible to estimate how many Oregonians in each age group might contract COVID-19, and eventually die.

Oregon reported 8,150 new cases of COVID-19 the week of Jan. 4.

If transmission doesn’t change, it’s possible that 1,400 adults over 60 could be infected each week that vaccines are delayed, and around 89 of those people will eventually pass away.

Since announcing her decision to start vaccinating school employees two weeks before seniors, Brown and the Oregon Health Authority have both expressed regret over the potential loss of life. Brown also expressed concerns about an increase in youth suicides due to the pandemic: something often talked about, but that is not necessarily supported by data.

“Did the governor actually say that?” asked OSU medical ethicist Courtney Campbell. “[Adolescent suicide] is not an inconsequential matter to be sure, but it’s unclear to me just how sending vaccinated teachers into not a regular classroom setting but a trauma-charged classroom is exactly going to promote student safety.”

It’s a particularly perplexing decision, said Campbell, since there are ways to reopen schools safely: by using social distancing measures to reduce transmission, so that public health officials can test, contact trace, and quarantine new cases.

“It would surely be an irresponsible use of scarce resources to use a vaccine for a fatal disease that has killed 400,000-plus Americans, mostly elderly and disproportionately BIPOC, as the means to solve the problem of adolescent suicide attempts,” Campbell said.

“We need to ensure that when schools are reopened, it is safe for everyone,” he said, adding that school should “be a haven for education, not for trauma-informed classroom settings.”

Officials have given several other explanations for their decision: In a press conference Friday, Gov. Brown and OHA officials said one reason to prioritize teachers is that vaccinating them should be relatively easy. There’s already an infrastructure in place, and school staff are a fairly small group. But vaccinating 700,000 seniors will be more difficult.

Chet Liebs isn’t so sure about that.

”Maybe the state doesn’t have the organization it would take to make vaccinating seniors work, but I don’t know. I grew up in an age when we trusted vaccines,” Liebs said.

If Oregon opened mass vaccination clinics for seniors, he thinks they would jump at the chance. “There’s hundreds of seniors raring to go!”

Clarification: Jan. 21, 2021. An earlier version of this story did not clearly describe Gov. Kate Brown’s Feb. 15 goals for in-person learning.