With the first COVID-19 vaccinations underway in the United States, 20 million Americans are expected to receive the inoculation in 2020, with general availability predicted for the second quarter of 2021. But who will get the vaccine first, and how will that be decided? ChangeLab Solutions CEO Sarah de Guia and Nicolas P. Terry of Indiana University discuss health equity and vaccine distribution in an article published by Bill of Health.
The impacts of COVID-19 have been disproportionate and unforgiving. The article states, “Black, Latinx and Native American populations have had case rates at 2.6 and 2.8 times higher than whites (respectively) and hospitalization rates that were 4.7 times higher, while Pacific Islander communities experienced mortality rates that were five times higher than their proportion to the general population.”
To address the disparities caused by coronavirus, the Framework for Equitable Allocation of the COVID-19 Vaccine was created through the National Academies of Science, Engineering, and Medicine. In this framework, distribution is governed by three ethical principles, one of which — mitigation of health inequities — considers the systemic racism that inflates risk factors for contracting COVID-19. These risk factors are “rooted in fundamental drivers of inequity, including poverty, lack of power, disparities in opportunity, structural discrimination, and societal failure to address these longstanding inequities. Wrapped into this is the additional challenge of gaining trust within Black, Indigenous and People of Color to ensure uptake of the vaccines, given the country’s long history of discrimination, inhumane practices, and lack of access to health care, generally.”
In the United States, the choices related to vaccine distribution may pit "saving the lives of elderly Americans against reducing infection by vaccinating essential workers; the latter cohort clearly encompasses large numbers of people of color and/or low-income."
The framework suggests prioritizing vaccine recipients according to the Centers for Disease Control and Prevention’s (CDC) Social Vulnerability Index or the COVID-19 Community Vulnerability Index. “Doing so would further specify that the most vulnerable within those groups are the primary recipients of the vaccine in the first waves.”
The CDC has also weighed in, noting the importance of intergovernmental coordination in the rollout of the vaccine. The CDC issued an interim playbook for vaccine distribution in October 2020, identifying critical populations at risk for COVID-19. The playbook provides a three-phase system for vaccine distribution in the remainder of 2020 and the first and second quarters of 2021. As populations are assigned to each phase, contentious decisions are being made.
In the United States, the choices related to vaccine distribution may pit "saving the lives of elderly Americans against reducing infection by vaccinating essential workers; the latter cohort clearly encompass[es] large numbers of people of color and/or low-income. . . .
“As policy makers consider the phases of vaccine distribution ahead, they must not only avoid exacerbating the conditions that led to infection, but also aggressively highlight equitable principles.”