Framework for equitable COVID-19 vaccine allocation released for industry adoption

The National Academies of Sciences, Engineering, and Medicine released the final report of a consensus study recommending a four-phased equitable allocation framework that the authors say the U.S. Department of Health and Human Services (HHS) and state, tribal, local, and territorial (STLT) authorities should adopt in the development of national and local guidelines for novel coronavirus (COVID-19) vaccine allocation, according to an announcement made by the academy.

The report recommends using existing systems across all levels of government to provide necessary resources to ensure equitable allocation, distribution, and administration of COVID-19 vaccine; launching a COVID-19 vaccine promotion campaign and risk communication and engagement program; and supporting equitable allocation globally.

In response to the COVID-19 pandemic, the U.S. and international communities have invested billions of dollars and immense amounts of human resources to develop a safe and effective vaccine in an unprecedented time frame, the report says. There are nearly 190 COVID-19 vaccines either in preclinical development or undergoing clinical trials in the U.S., Europe, and China. However, even if one or more safe and effective COVID-19 vaccine is authorized for use, it is very unlikely that sufficient quantities will be immediately available to vaccinate large portions of the U.S. population.

For the initial period when vaccine demand exceeds supply, the committee that conducted the study and wrote the report recommended a four-phased approach to allocation built on widely accepted foundational principles and guided by evidence to maximize societal benefit by reducing morbidity and mortality caused by the transmission of SARS-CoV-2.

Phase 1a covers approximately 5 percent of the population and includes front-line healthcare workers, workers who provide healthcare facility services such as transportation and environmental services who also risk exposure to bodily fluids or aerosols, and first responders. Phase 1b covers approximately 10 percent of the population and includes people of all ages with comorbid and underlying conditions that put them at significantly higher risk of severe COVID-19 disease or death. Also included in this phase are older adults age 65 years and over living in congregate or overcrowded settings including nursing homes, long-term care facilities, homeless shelters, group homes, prisons, or jails.

Phase 2 covers approximately 30 percent to 35 percent of the population and includes K-12 teachers and school staff including administrators, environmental services and maintenance workers, and bus drivers, and childcare workers. Also included are critical workers in high-risk settings who cannot avoid a high risk of exposure to COVID-19, such as workers in the food supply system and public transit.

Phase 3 covers approximately 40 percent to 45 percent of the population, and includes young adults, children, and workers in industries such as colleges and universities, hotels, banks, exercise facilities, and factories that are both important to the functioning of society and pose moderately high risk of exposure because there are likely to be some protective measures implemented in these work settings.

Phase 4 covers everyone residing in the U.S. who did not have access to the vaccine in prior phases.

For each group included in each phase, the committee recommended that STLTs ensure that special efforts are made to deliver vaccine to residents of high-vulnerability areas by using a specific index, such as the COVID-19 Community Vulnerability Index. This would incorporate the variables that the committee believes are most linked to the disproportionate impact of COVID-19 on people of color, the authors said.

When individuals fit into multiple categorizations, the report notes, the higher phase should take precedence, the report says. This framework can also inform the decisions of other groups, such as the Advisory Committee on Immunization Practices, and other recommendations for the HHS.

“Inequities in health have always existed, but at this moment there is an awakening to the power of racism, poverty, and bias in amplifying the health and economic pain and hardship imposed by this pandemic," said Helene Gayle, committee co-chair and president and CEO of the Chicago Community Trust, in a statement. “We saw our work as one way to address these wrongs and do our part to work toward a new commitment to promoting health equity.”

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