key: cord-0934660-vufvtatb authors: Lemke, Michael K. title: Commercial truck drivers should be a priority population for COVID‐19 vaccinations date: 2021-01-09 journal: Am J Ind Med DOI: 10.1002/ajim.23220 sha: 01f3c03cfce31ab8d538fb22cdf8d33c674f462b doc_id: 934660 cord_uid: vufvtatb As COVID‐19 vaccines become available, supply is expected to initially fall short of demand. In response, the Advisory Committee on Immunization Practices (ACIP) has issued guidance on which groups should be prioritized to receive vaccines. For the first phase of vaccine allocation, the ACIP recommended healthcare personnel and long‐term care facility residents as recipients. This recommendation was based on risks endemic to these populations, as well as ethical principles related to benefits and harms, mitigating health inequalities, and promoting justice. Commercial truck drivers have played a vital and underappreciated role during the COVID‐19 pandemic. Despite the indispensable role that commercial drivers play in distributing vaccines, they have not been recommended for vaccine allocation in the next phase (1b) by the ACIP. However, the rationale and ethical principles cited for the first vaccine phase suggest that these workers should be recommended for inclusion. By doing so, the acquisition and transmission of COVID‐19 may be mitigated, which would benefit both these workers and the US public. Further, persistent vulnerabilities render commercial truck drivers susceptible to severe COVID‐19 infection; therefore, vaccination during the next phase is imperative to curb the exacerbation of extant health inequities. Finally, because present‐day COVID‐19 vulnerabilities in these workers have been shaped by unjust policies over the past several decades, and because COVID‐19 public health policies have excluded and potentially exacerbated the impacts of the pandemic for these workers, allocating vaccines to commercial truck drivers is a necessary step toward promoting justice. drivers have played a vital and underappreciated role during the COVID-19 pandemic. Despite the indispensable role that commercial drivers play in distributing vaccines, they have not been recommended for vaccine allocation in the next phase (1b) by the ACIP. However, the rationale and ethical principles cited for the first vaccine phase suggest that these workers should be recommended for inclusion. By doing so, the acquisition and transmission of COVID-19 may be mitigated, which would benefit both these workers and the US public. Further, persistent vulnerabilities render commercial truck drivers susceptible to severe COVID-19 infection; therefore, vaccination during the next phase is imperative to curb the exacerbation of extant health inequities. Finally, because present-day COVID-19 vulnerabilities in these workers have been shaped by unjust policies over the past several decades, and because COVID-19 public health policies have excluded and potentially exacerbated the impacts of the pandemic for these workers, allocating vaccines to commercial truck drivers is a necessary step toward promoting justice. The supply of vaccine is expected to fall short of demand during the coming months, 1 during which time COVID-19 cases are expected to continue to rise. In response, guidance has been issued by the Advisory Committee on Immunization Practices (ACIP) to advise the Centers for Disease Control and Prevention (CDC) on which population subgroups should be prioritized for vaccination, with healthcare personnel and long-term care facility residents moved to the front of the line within Phase 1a. This recommendation was grounded in the ethical principles of the ACIP, which stipulate that this decision was made to "…maximize benefits and minimize harms, promote justice, and mitigate health inequities." 1, 3 Excluded from the first round in vaccine allocation, the trucking industry has advocated for its workers to be prioritized for vaccination. 4 The course of the pandemic has certainly supported this contention as truck drivers have been essential workers who are indispensable cogs in the distribution networks that will be depended upon to deliver those vaccines that will end the pandemic. However, the ACIP has excluded transportation workers from their Phase 1b recommendation, even though their description of essential workers in this phase-who "…perform duties across critical infrastructure sectors and maintain the services and functions that US residents depend on daily" 5 -also describes truck drivers. Therefore-in addition to the essential role that these workers provide in ensuring that vaccines and other essential supplies can actually be distributed-the rationale and ethical principles that The prioritized allocation of COVID-19 vaccines to commercial truck drivers can also mitigate persistent health disparities in these workers, and by doing so, may represent the first step in reversing the longstanding policy-driven injustices. As part of the rationale for their Phase 1a recommendations, the ACIP describes long-term care facility residents as high risk for COVID-19 acquisition and severity due to their advanced age and high rates of underlying medical conditions. 1 For commercial truck drivers, the constellation of endemic cardiometabolic illness, 12 increased age compared with other working populations, 13 and stressful work conditions that have been exacerbated by the pandemic 14 renders this population similarly vulnerable. These vulnerabilities are the consequences of unjust macrostructural forces and corporate policies that have evolved over the last several decades. 14 As a result, present-day commercial truck driving is inherently obesogenic and stressogenic, with inadequate environmental supports for healthful lifestyles, 15 poor access to medical care, 16 enacting stay-at-home orders for this population may lead to catastrophic shortages in vital supplies, 7 thereby necessitating their continued presence on the road. Additionally, other prevention policies that have been enacted (e.g., closing restaurants) across various locales have been known to perpetuate the extant lack of worksite environmental supports for drivers. 24, 25 Because the organization of work for many of these drivers includes prolonged periods away from home, 26 self-quarantine efforts are difficult to implement, and drivers who do develop pronounced cases of COVID-19 illness may be far away from medical care. 25, 27, 28 Altogether, given the vital role of commercial truck drivers in protecting the US public's health-including the distribution of COVID-19 vaccines-it is imperative that these workers be prioritized for Phase 1b of vaccine allocation. This decision would align with both the rationale and the ethical principles-maximizing benefit and minimizing harm, mitigating health inequities, and promoting justice-presented by the ACIP in their recommendations for the initial allocation of vaccines. 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Commercial truck drivers should be a priority population for COVID-19 vaccinations Michael K. Lemke conceptualized and wrote the manuscript. https://orcid.org/0000-0002-5921-1473