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With the coronavirus pandemic surging and initial vaccine supplies limited, the United States faces a hard choice: Should the country’s immunization program focus in the early months on the elderly and people with serious medical conditions, who are dying of the virus at the highest rates, or on essential workers, an expansive category encompassing Americans who have borne the greatest risk of infection?

Health care workers and the frailest of the elderly — residents of long-term-care facilities — will almost certainly get the first shots, under guidelines the Centers for Disease Control and Prevention issued on Thursday. But with vaccination expected to start this month, the debate among federal and state health officials about who goes next, and lobbying from outside groups to be included, is growing more urgent.

It’s a question increasingly guided by concerns over the inequities laid bare by the pandemic, from disproportionately high rates of infection and death among poor people and people of color to disparate access to testing, child care and technology for online schooling.

“It’s damnable that we are even being placed in this position that we have to make these choices,” said the Rev. William J. Barber II, a co-chairman of the Poor People’s Campaign, a national coalition that calls attention to the challenges of the working poor. “But if we have to make the choice, we cannot once again leave poor and low-wealth essential workers to be last.”

Ultimately, the choice comes down to whether preventing death or curbing the spread of the virus and returning to some semblance of normalcy is the highest priority. “If your goal is to maximize the preservation of human life, then you would bias the vaccine toward older Americans,” Dr. Scott Gottlieb, the former Food and Drug Administration commissioner, said recently. “If your goal is to reduce the rate of infection, then you would prioritize essential workers. So it depends what impact you’re trying to achieve.”

The trade-off between the two is muddied by the fact that the definition of “essential workers” used by the C.D.C. comprises nearly 70 percent of the American work force, sweeping in not just grocery store clerks and emergency responders, but tugboat operators, exterminators and nuclear energy workers. Some labor economists and public health officials consider the category overbroad and say it should be narrowed to only those who interact in person with the public.

An independent committee of medical experts that advises the C.D.C. on immunization practices will soon vote on whom to recommend for the second phase of vaccination — “Phase 1b.” In a meeting last month, all voting members of the committee indicated support for putting essential workers ahead of people 65 and older and those with high-risk health conditions.

Historically, the committee relied on scientific evidence to inform its decisions. But now the members are weighing social justice concerns as well, noted Lisa A. Prosser, a professor of health policy and decision sciences at the University of Michigan.

“To me the issue of ethics is very significant, very important for this country,” Dr. Peter Szilagyi, a committee member and a pediatrics professor at the University of California, Los Angeles, said at the time, “and clearly favors the essential worker group because of the high proportion of minority, low-income and low-education workers among essential workers.”

That position runs counter to frameworks proposed by the World Health Organization, the National Academies of Sciences, Engineering, and Medicine, and many countries, which say that reducing deaths should be the unequivocal priority and that older and sicker people should thus go before the workers, a view shared by many in public health and medicine.

Dr. Robert Redfield, the C.D.C. director and the nation’s top public health official, reminded the advisory committee of the importance of older people, saying in a statement on Thursday that he looked forward to “future recommendations that, based on vaccine availability, demonstrate that we as a nation also prioritize the elderly.”

Once the committee votes, Dr. Redfield will decide whether to accept its recommendations as the official guidance of the agency. Only rarely does a C.D.C. director reject a recommendation from the committee, whose 14 members are selected by the Health and Human Services secretary, serve four-and-a-half-year terms and have never confronted a task as high in profile as this one.

But ultimately, the decision will be up to governors and state and local health officials. They are not required to follow C.D.C. guidelines, though historically they have done so.

There are about 90 million essential workers nationwide, as defined by a division of the Department of Homeland Security that compiled a roster of jobs that help maintain critical infrastructure during a pandemic. That list is long, and because there won’t be enough doses to reach everyone at first, states are preparing to make tough decisions: Louisiana’s preliminary plan, for example, puts prison guards and food processing workers ahead of teachers and grocery employees. Nevada’s prioritizes education and public transit workers over those in retail and food processing.

At this early point, many state plans put at least some people who are older and live independently, or people who have medical conditions, ahead of most essential workers, though that could change after the C.D.C. committee makes a formal recommendation on the next phase.

One occupation whose priority is being hotly debated is teaching. The C.D.C. includes educators as essential workers. But not everyone agrees with that designation.

Marc Lipsitch, an infectious-disease epidemiologist at Harvard’s T.H. Chan School of Public Health, argued that teachers should not be included as essential workers, if a central goal of the committee is to reduce health inequities.

“Teachers have middle-class salaries, are very often white, and they have college degrees,” he said. “Of course they should be treated better, but they are not among the most mistreated of workers.”

Elise Gould, a senior economist at the Economic Policy Institute, disagreed. Teachers not only ensure that children don’t fall further behind in their education, she said, but are also critical to the work force at large.

“When you talk about disproportionate impact and you’re concerned about people getting back into the labor force, many are mothers, and they will have a harder time if their children don’t have a reliable place to go,” she said. “And if you think generally about people who have jobs where they can’t telework, they are disproportionately Black and brown. They’ll have more of a challenge when child care is an issue.”

In September, academic researchers analyzed the Department of Homeland Security’s list of essential workers and found that it broadly mirrored the demographics of the American labor force. The researchers proposed a narrower, more vulnerable category — “frontline workers,” such as food deliverers, cashiers and emergency medical technicians, who must work face to face with others and are thus at greater risk of contracting the virus.

By this definition, said Francine D. Blau, a labor economist at Cornell University and an author of the study, teachers belong in the larger category of essential workers. However, when they work in classrooms rather than remotely, she said, they would fit into the “frontline” group. Individual states categorize teachers differently.

Dr. Blau said that if supplies are short, frontline workers should be emphasized. “These are a subset of essential workers who, given the nature of their jobs, must provide their labor in person. Prioritizing them makes sense given the heightened risk that they face.”

The analysis, a working paper for the National Bureau of Economic Research, is in line with other critics, who say that the list of essential workers is too wide-ranging.

“If groups are too large, then you’re not really focusing on priorities,” said Saad B. Omer, director of the Yale Institute for Global Health, who worked on the vaccination frameworks for the W.H.O. and the National Academies.

The essential workers on the federal list make up nearly 70 percent of the American labor force, the researchers said, compared with 42 percent for the frontline workers. Women made up 39 percent of frontline workers and, in certain occupations, far more. Frontline workers’ education levels are lower, as are their wages — on average, just under $22 an hour. The proportion of Black and Hispanic workers is higher than in the broader category of essential workers.

Some health policy experts said that to prioritize preventing deaths rather than reducing virus transmission was simply a pragmatic choice, because there won’t be enough vaccine initially available to make a meaningful dent in contagion. A more effective use of limited quantities, they say, is to save the lives of the most frail.

Moreover, vaccine trial results so far show only that the shots can protect the individuals who receive them. The trials have not yet demonstrated that a vaccinated person would not infect others. Though scientists believe that is likely to be the case, it has yet to be proved.

Harald Schmidt, an expert in ethics and health policy at the University of Pennsylvania, said that it is reasonable to put essential workers ahead of older adults, given their risks, and that they are disproportionately minorities. “Older populations are whiter, ” Dr. Schmidt said. “Society is structured in a way that enables them to live longer. Instead of giving additional health benefits to those who already had more of them, we can start to level the playing field a bit.”

But to protect older people more at risk, he called on the C.D.C. committee to also integrate the agency’s own “social vulnerability index.”

The index includes 15 measures derived from the census, such as overcrowded housing, lack of vehicle access and poverty, to determine how urgently a community needs health support, with the goal of reducing inequities.

In a new analysis of the states’ preliminary vaccine plans, Dr. Schmidt found that at least 18 states intended to apply the index. Tennessee, for one, has indicated that it will reserve some of its early allotments for disadvantaged communities.

Still, some people believe it is wrong to give racial and socioeconomic equity more weight than who is most likely to die.

“They need to have bombproof, fact-based, public-health-based reasons for why one group goes ahead of another,” said Chuck Ludlam, a former Senate aide and biotech industry lobbyist who protested putting essential workers ahead of older people in comments to the committee. “They have provided no explanation here that will withstand public scrutiny.”

Further complicating matters, the different priority groups discussed by the C.D.C. committee are overlapping — many essential workers have high-risk conditions, and some are older than 65. Some states have suggested that they will prioritize only essential workers who come face to face with the public, while others have not prioritized them at all.

Even some people whose allegiance lies with one group have made the case that others should have an earlier claim on the vaccine. Marc Perrone, president of the United Food and Commercial Workers Union, which represents 1.3 million grocery and food processing workers, said that despite the high rate of infection among his members, he thought that older adults should go first.

Charles Richard Drew (June 3, 1904 – April 1, 1950) was an American surgeon and medical researcher. He researched in the field of blood transfusions, developing improved techniques for blood storage, and applied his expert knowledge to developing large-scale blood banks early in World War II. This allowed medics to save thousands of lives of the Allied forces. As the most prominent African American in the field, Drew protested against the practice of racial segregation in the donation of blood, as it lacked scientific foundation, and resigned his position with the American Red Cross, which maintained the policy until 1950.

Early life and education

Drew was born in 1904 into an African-American middle-class family in Washington, D.C. His father, Richard, was a carpet layer and his mother, Nora Burrell, trained as a teacher. Drew and three of his four younger siblings grew up in Washington's largely middle-class and interracial Foggy Bottom neighborhood. From 1920 until his marriage in 1939, Drew's permanent address was in Arlington County, Virginia, although he graduated from Washington's Dunbar High School in 1922 and usually resided elsewhere during that period of time.

Drew won an athletics scholarship to Amherst College in Massachusetts, from which he graduated in 1926. An outstanding athlete at Amherst, Drew also joined Omega Psi Phi fraternity as an off-campus member; Amherst fraternities did not admit blacks at that time. After college, Drew spent two years (1926–1928) as a professor of chemistry and biology, the first athletic director, and football coach at the historically black private Morgan College in Baltimore, Maryland, to earn the money to pay for medical school.

Drew attended medical school at McGill University in Montreal, Quebec, Canada, where he achieved membership in Alpha Omega Alpha, a scholastic honor society for medical students, ranked second in his graduating class of 127 students, and received the standard Doctor of Medicine and Master of Surgery degree awarded by the McGill University Faculty of Medicine in 1933.

Drew's first appointment as a faculty instructor was for pathology at Howard University from 1935 to 1936. He then joined Freedman's Hospital, a federally operated facility associated with Howard University, as an instructor in surgery and an assistant surgeon. In 1938, Drew began graduate work at Columbia University in New York City on the award of a two-year Rockefeller fellowship in surgery. He then began postgraduate work, earning his Doctor of Science in Surgery at Columbia University. He spent time doing research at Columbia's Presbyterian Hospital and gave a doctoral thesis, "Banked Blood," based on an exhaustive study of blood preservation techniques. He earned a Doctor of Science in Medicine degree in 1940, becoming the first African American to do so.

Blood for Britain

In late 1940, before the U.S. entered World War II and just after earning his doctorate, Drew was recruited by John Scudder to help set up and administer an early prototype program for blood storage and preservation. He was to collect, test, and transport large quantities of blood plasma for distribution in the United Kingdom. Drew went to New York City as the medical director of the United States' Blood for Britain project. The Blood for Britain project was a project to aid British soldiers and civilians by giving U.S. blood to the United Kingdom.

Drew started what would be later known as bloodmobiles, which were trucks containing refrigerators of stored blood; this allowed for greater mobility in terms of transportation as well as prospective donations.

Drew created a central location for the blood collection process where donors could go to give blood. He made sure all blood plasma was tested before it was shipped out. He ensured that only skilled personnel handled blood plasma to avoid the possibility of contamination. The Blood for Britain program operated successfully for five months, with total collections of almost 15,000 people donating blood, and with over 5,500 vials of blood plasma. As a result, the Blood Transfusion Betterment Association applauded Drew for his work.

American Red Cross Blood Bank

Out of Drew's work, he was appointed director of the first American Red Cross Blood Bank in February 1941. The blood bank being in charge of blood for use by the U.S. Army and Navy, he disagreed with the exclusion of the blood of African-Americans from plasma-supply networks. In 1942, Drew resigned from his posts after the armed forces ruled that the blood of African-Americans would be accepted but would have to be stored separately from that of whites.

Academic career

In 1941, Drew's distinction in his profession was recognized when he became the first African-American surgeon selected to serve as an examiner on the American Board of Surgery.

Drew had a lengthy research and teaching career, returning to Freedman's Hospital and Howard University as a surgeon and professor of medicine in 1942. He was awarded the Spingarn Medal by the NAACP in 1944 for his work on the British and American projects. He was given an honorary doctor of science degree, first by Virginia State College in 1945 then by Amherst in 1947.

Personal life

In 1939, Drew married Minnie Lenore Robbins, a professor of home economics at Spelman College in Atlanta, Georgia, whom he had met earlier during that year. They had three daughters and a son. His daughter Charlene Drew Jarvis served on Council of the District of Columbia from 1979 to 2000, was the president of Southeastern University from 1996 until 2009 and was a president of the District of Columbia Chamber of Commerce.

Death

Beginning in 1939, Drew traveled to Tuskegee, Alabama to attend the annual free clinic at the John A. Andrew Memorial Hospital. For the 1950 Tuskegee clinic, Drew drove along with three other black physicians. Drew was driving around 8 a.m. on April 1. Still fatigued from spending the night before in the operating theater, he lost control of the vehicle. After careening into a field, the car somersaulted three times. The three other physicians suffered minor injuries. Drew was trapped with serious wounds; his foot had become wedged beneath the brake pedal. When reached by emergency technicians, he was in shock and barely alive due to severe leg injuries.

Drew was taken to Alamance General Hospital in Burlington, North Carolina. He was pronounced dead a half hour after he first received medical attention. Drew's funeral was held on April 5, 1950, at the Nineteenth Street Baptist Church in Washington, D.C.

Despite a popular myth to the contrary, once repeated on an episode ("Dear Dad... Three") of the hit TV series M*A*S*H, Drew's death was not the result of his having been refused a blood transfusion because of his skin color. This myth spread very quickly since during his time it was very common for blacks to be refused treatment because there were not enough "Negro beds" available or the nearest hospital only serviced whites. In truth, according to one of the passengers in Drew's car, John Ford, Drew's injuries were so severe that virtually nothing could have been done to save him. Ford added that a blood transfusion might have actually killed Drew sooner.

Legacy

In 1976, the National Park Service designated the Charles Richard Drew House in Arlington County, Virginia, as a National Historic Landmark in response to a nomination by the Afro-American Bicentennial Corporation.

In 1981, the United States Postal Service issued a 35¢ postage stamp in its Great Americans series to honor Drew.

Charles Richard Drew Memorial Bridge, spanning the Edgewood and Brookland neighborhoods in Washington, D.C.

USNS Charles Drew, a dry cargo ship of the United States Navy

Parc Charles-Drew, in Le Sud-Ouest, Montreal, Quebec, Canada

In 2002, scholar Molefi Kete Asante listed Drew as one of the 100 Greatest African Americans.

Numerous schools and health-related facilities, as well as other institutions, have been named in honor of Dr. Drew.

Medical and higher education

In 1966, the Charles R. Drew Postgraduate Medical School was incorporated in California and was named in his honor. This later became the Charles R. Drew University of Medicine and Science.

Charles Drew Health Center, Omaha, Nebraska

Charles Drew Science Enrichment Laboratory, Michigan State University, East Lansing, Michigan

Charles Drew Health Foundation, East Palo Alto, California, 1960s-2000, was the community's only clinic for decades.

Charles Drew Community Health Center, located in Burlington, NC near the site of the old Alamance County hospital.

Charles Drew Pre-Health Society, University of Rochester

Charles R Drew Wellness Center in Columbia, South Carolina

Charles R. Drew Hall, an all-male freshman dorm at Howard University, Washington D.C.

Charles Drew Memorial Cultural House, residence at Amherst College, his alma mater

Charles Drew Premedical Society at Columbia University, New York

K-12 schools

Charles R. Drew Middle School & Magnet school for the gifted, opened 1966 Los Angeles Unified School District https://drew-lausd-ca.schoolloop.com/

Charles R. Drew Middle School Lincoln Alabama operated by Talladega County Schools

Charles R. Drew Junior High School, Detroit, Michigan

Dr. Charles R. Drew Science Magnet School, Buffalo, NY

Charles R. Drew Elementary School, Miami Beach and Pompano Beach, Florida

Bluford Drew Jemison S.T.E.M Academy, Baltimore (closed in 2013)

Bluford Drew Jemison STEM Academy West, a Middle/High School in Baltimore, Maryland

Dr. Charles R. Drew Elementary School, Colesville, Maryland

Charles Drew Elementary School, Washington, DC

Charles R. Drew Elementary School, Arlington, Virginia

Dr. Charles Drew Elementary School, New Orleans, LA

Charles R. Drew Charter School opened in August 2000 as the first charter school in Atlanta, Georgia. This is the setting for the 2015 Movie Project Almanac.

Dr. Charles Drew Academy, Ecorse, MI

Charles R. Drew Intermediate School, Crosby, Texas

Dr. Charles Drew Elementary School, San Francisco, Ca.