Oni Blackstock is a primary care and HIV physician and founder and executive director of Health Justice. Uché Blackstock is an emergency physician and founder and chief executive of Advancing Health Equity.

In the 1970s, epidemiologist Sherman James described the phenomenon of “John Henryism,” whereby Black Americans must invest immense effort to cope with the chronic stress of racism, leading to poor health and early death.

That’s still the case today, especially during the pandemic. In the first half of 2020, Black Americans’ life expectancy declined almost three years to an average of 72 years, compared with a loss of almost one year for White Americans (now 78 years). Meanwhile, Black Americans are not only twice as likely to die of covid-19 as White Americans but also dying at rates similar to those of White Americans who are 10 years older. Moreover, racial inequities are most striking at younger ages; for example, Black people ages 45 to 54 are seven times more likely to die of covid-19 than similarly aged White Americans.

Why, then, are Black Americans subject to the same age cutoff for vaccination prioritization?

For Phase 1b of the vaccine rollout, 14 states followed recommendations from the Centers for Disease Control and Prevention prioritizing people age 75 years and older. Twenty-three lowered their cutoffs, all but one to people 65 and older. But in every case, Black people, though they consistently carry a disproportionate burden of the disease at younger ages, must follow the same age requirements. Health officials would do better to get rid of these fixed age cutoffs.

Many factors contribute to the diminished life expectancy of Black Americans. For example, occupational segregation has concentrated Black Americans in low-paying jobs with limited or no health insurance. Meanwhile, redlining and other discriminatory housing practices have left many Black communities impoverished, polluted, and with limited availability of healthy foods and green space.

Public health researcher Arline Geronimus refers to the physiologic effect of these persistent social and environmental stressors as “weathering,” building on the John Henryism concept from James. In other words, repeated experiences of discrimination and cumulative exposure to socioeconomic disadvantage have a wear-and-tear effect on the body.

Weathering is associated with accelerated aging of the body and is thought to be one of the reasons that Black Americans develop certain chronic medical conditions at much younger ages than their White counterparts. Studies have also found that the average Black American, compared with their White peers, has a much higher “allostatic load,” which is a measurement for lifelong cumulative stress on the body.

Using data from a National Health and Nutrition Examination Survey collected from 1999 to 2002, Geronimus found that when measuring the allostatic load of Americans, the score “for Black Americans was roughly comparable to that for Whites who were 10 years older.” These social and economic stressors associated with structural racism seem to contribute to differences in cardiovascular and diabetes-related mortality between Black and White Americans, which is notable given that high blood pressure and diabetes are known to lead to worse covid-19 outcomes.

It only makes sense for vaccine allocation to acknowledge these health inequities. Other countries have approached such inequity head-on. Australia has adjusted its age cutoffs such that Indigenous Australians age 55 and older were prioritized for Phase 1b of the country’s rollout, along with non-Indigenous Australians age 70 and older. Canada’s National Advisory Committee on Immunization looked at factors such as “belonging to a racialized population” and explicitly recommended that provinces and territories prioritize Indigenous communities in the first phase of the rollout. As a result, the country is seeing higher vaccination rates in Indigenous communities as compared with the general population.

With Black Americans representing only 5 percent of Americans vaccinated so far, yet representing 13 percent of the population and 15 percent of covid-19 deaths, bold action must be taken to ensure that they are not further left out of the vaccine rollout. While much focus has been on vaccine hesitancy as a cause of racial inequities in coronavirus vaccine uptake, access to the vaccine has been a key barrier for Black communities.

As we have previously contended, Black Americans should be prioritized for the coronavirus vaccine given the pandemic’s disproportionate impact on Black communities. Removing or lowering age cutoffs for Black Americans could go a long way toward increasing access to one of the most impacted communities and accounting for structural racism’s toll on Black lives.

Read more: