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The Social Vulnerability Index, COVID-19 vaccines, and why it makes some Republicans mad

a man wearing a mask receives a covid-19 vaccine
C/O Spectrum Health

There’s been a lot of recent discussion about a tool the state of Michigan is using to help decide where to send COVID-19 vaccines -- something called the Social Vulnerability Index (SVI). It’s a formula that’s one factor the state uses in allocating vaccine doses throughout Michigan.

Some elected officials, mostly Republicans, are upset about it. They say the state has no business using a tool like SVI--which takes into account a series of demographic characteristics to determine how vulnerable a population is—in the vaccine-allocation process.

State Sen. Jim Runestad (R-Oakland County) raged about the SVI on the Senate floor this week. He said vaccine distribution should boil down to just two factors: population size and age.

Almost 90 percent of COVID deaths are those over 60 years of age,” fumed Runestad. “And this isn’t enough for us to target that population, and not use how much money you make, or what kind of apartment you live in?”

Here are some facts about the SVI, how the state is using it, and why the issue has become hotly politicized.

What is the Social Vulnerability Index?

The SVI is a tool developed and used by the U.S. Centers for Disease Control and other federal agencies to determine, essentially, how vulnerable a population is to an emergency situation—anything ranging from a hurricane, to a pandemic disease like COVID-19.

The SVI takes into account 15 variables about populations at the county and census tract-level:

  • Below Poverty Level
  • Unemployed
  • Income
  • No High School Diploma
  • Aged 65 or Older
  • Aged 17 or Younger
  • Older Than Age 5 with a Disability
  • Single-Parent Households
  • Minority
  • Speak English "Less Than Well"
  • Multi-Unit Structures
  • Mobile Homes
  • Crowding
  • No Vehicle
  • Group Quarters

A formula then weighs that data to give each county (or census tract) a score to indicate how socially vulnerable it is—with 0 being the lowest (least vulnerable) possible score, and 1 the highest.

Credit Michigan Department of Health and Human Services
Michigan Department of Health and Human Services

This formula isn’t something Michigan created or uses on its own. Nor is it the sole factor the state uses for vaccine allocation. The state also takes into account population size, and the percentage of a population that serves so-called priority groups—groups the state has designated as “first in line” to get the COVID vaccine. Those include people 65 and older, the number of frontline essential workers, educators, and corrections officers (this applies to local public health entities like county health departments, and to hospital systems based on the populations they serve).

The SVI data is then combined with those factors to make vaccine distribution decisions, said Linda Vail, Health Officer for Ingham County. “It’s kind of a multiplier factor,” she said. “So the higher your social vulnerability index, there’s a little bit of a bump up in vaccine based on that.”

Vail supports using the SVI for this purpose. She said public health is all about targeting and serving the most vulnerable populations, and it wouldn’t make sense to ignore this kind of data.

It allows us to say we really need to make sure that we target these populations, knowing where they are based on the social vulnerability index in our communities, so that we don't leave the most vulnerable behind in a situation where oftentimes access is based on privilege,” Vail said.

Vail said we know that certain groups, ranging from people of color to people with disabilities, are more likely to suffer bad outcomes from COVID-19. “We really have to look at the fact that we cannot roll out a system with a vaccine like this, where you have certain populations that are definitely more vulnerable, without taking that into account,” she said.

The pushback

But some elected officials, particularly Republicans, are enraged that the state is using SVI this way.

Senator Runestad made his objections very clear on the Senate floor this week. His basic premise is that less-vulnerable communities, like affluent Oakland County, are being shorted on vaccines, while communities like Detroit have been able to expand access because SVI gives them so many more vaccine doses to work with.

Runestad contends that many seniors in Oakland County are “furious” because they can’t get vaccine appointments, while a hypothetical 40-year-old Detroiter with a disability can. He dismissed objections from some Democratic colleagues pointing out that Oakland County has actually vaccinated a larger percentage of its population than Detroit has, saying: “The number of people who declined to be vaccinated is not the point.” He also claimed that Detroit is receiving a larger sheer number of vaccine doses than Oakland County, when in fact Oakland County has consistently administered more shots than Detroit for the past four weeks.

Nonetheless, the state’s use of SVI does tilt things somewhat in Detroit’s favor, proportionally. And that had Runestad literally spitting mad. He posited that age is the single-largest risk factor for COVID-19 death, and vaccine allocation should be a simple proposition based on that factor.

“The state of Michigan is failing [seniors] with their social engineering policies,” Runestad said.

There should be nothing controversial in preventing the state from using race, gender and socioeconomic factors instead of the real harm, the possible death, [in] deciding to distribute this vaccine.”

It’s important to note that while race and poverty are SVI variables, they’re not the sole ones—and the formula doesn’t necessarily favor urban areas over rural ones. Wayne County, home to Detroit, does have a high SVI score. But so do some rural, mostly-white counties such as Oceana County, Lake County, and Clare County.

Making SVI a political bargaining chip

State Republican lawmakers did more than loudly complain about SVI’s role in vaccine distribution this week. They added a related amendment to a key piece of legislation, and it blew up into a firestorm.

That legislation would divvy up some of the billions of dollars the federal government has advocated to Michigan for COVID-19 relief, including to help distribute vaccines. Republicans had been sitting on the money in an effort to force Governor Gretchen Whitmer to give up some of her powers.

The amendment would forbid the state from using SVI as a factor in vaccine allocation, banning the use of demographic characteristics like “race, gender, color, national origin, religion, sex or socioeconomic status.”

The amendment was approved by the Republican majority along party lines, with senators such as Runestad saying it was about simple fairness and not letting people “jump the line” ahead of vulnerable seniors. Some Democrats pointed out that SVI in fact favors many poorer rural areas, and State Senator Erika Geiss (D-Taylor) called Republican objections to SVI “racist bullsh*t.”

Some local governments have also taken aim at SVI. Livingston County commissioners passed a toothless resolution criticizing it, noting: "Had the State of Michigan elected to fairly and objectively and uniformly distribute vaccine based on a county’s population of its most at risk—e.g. its senior citizens—Livingston County should be prioritized as the 11th highest, rather than the lowest or 83rd." (Livingston County has Michigan’s lowest SVI score).

But other local government officials have praised it.

“The state of Michigan seems to be taking an equity-based approach toward vaccine distribution,” Evan Bonsall, a Marquette city commissioner, said at a meeting this week. “Which I think actually treats northern Michigan and the U.P. very fairly. The U.P., and the rest of northern Michigan, actually fared very well, I think, compared to the rest of the state, according to those equity metrics.”

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