Equitable Allocation of COVID-19 Vaccines: An Analysis of the Initial Allocation Plans of CDC's Jurisdictions with Implications for Disparate Impact Monitoring

64 Pages Posted: 3 Dec 2020

See all articles by Harald Schmidt

Harald Schmidt

University of Pennsylvania

Rebecca Weintraub

Harvard University - T.H. Chan School of Public Health; Brigham and Women's Hospital

Michelle A. Williams

Harvard University - T.H. Chan School of Public Health

Alison Buttenheim

University of Pennsylvania

Emily Sadecki

University of Pennsylvania - Department of Medical Ethics and Health Policy

Helen Wu

University of Pennsylvania - School of Arts & Sciences

Aditi Doiphode

University of Pennsylvania - School of Arts & Sciences

Lawrence O. Gostin

Georgetown University - Law Center - O'Neill Institute for National and Global Health Law

Angela Shen

Children’s Hospital of Philadelphia - Vaccine Education Center

Date Written: December 1, 2020

Abstract

Major global and national vaccine allocation guidelines urge planners to allocate vaccines in ways that recognize, and ideally reduce, existing societal inequities within countries. However, allocation plans of the US will be determined individually by each of the CDC’s 64 jurisdictions (states, the District of Columbia, five cities, and territories). We analyzed whether jurisdictions have incorporated novel approaches to reduce inequity, based on plans published by the CDC in early November 2020 (63 summaries [98% of all jurisdictions] and 47 full guidance documents [73% of all, including all 50 states]).

Eighteen states adopted a novel proposal to use a disadvantage index to allocate vaccines more equitably, for five types of equity goals: 1) to prioritize disadvantaged groups directly, 2) to define priority groups in phased systems, 3) to plan tailored outreach and communication, 4) to plan the location of dispensing sites and 5) to monitor uptake. Yet just over a third of all states, and only half of the 16 states with the largest shares of disadvantaged populations—where reducing inequity would be most urgent—pursue such goals.

While allocation frameworks are still evolving, the plans we analyzed mark important historical and practical benchmarks, and could become firm policy when COVID-19 vaccines are authorized and delivered. Vaccine roll-out poses unprecedented logistical and practical challenges. To minimize the risk that ethics and social justice falls by the wayside in the busy months to come, planners at the federal, state and local levels should carefully consider on what grounds they decline to adopt equity measures that other planners deem important and feasible for defining priority populations, designing allocation quotas, and just as critical, enabling, and monitoring, uptake.

Keywords: COVID-19, vaccine, rationing, scarcity, vaccine, health policy, ethics, equity

JEL Classification: I14, I18, I3

Suggested Citation

Schmidt, Harald and Weintraub, Rebecca and Williams, Michelle A. and Buttenheim, Alison and Sadecki, Emily and Wu, Helen and Doiphode, Aditi and Gostin, Lawrence O. and Shen, Angela, Equitable Allocation of COVID-19 Vaccines: An Analysis of the Initial Allocation Plans of CDC's Jurisdictions with Implications for Disparate Impact Monitoring (December 1, 2020). Available at SSRN: https://ssrn.com/abstract=3740041 or http://dx.doi.org/10.2139/ssrn.3740041

Harald Schmidt (Contact Author)

University of Pennsylvania ( email )

Philadelphia, PA 19104
United States

Rebecca Weintraub

Harvard University - T.H. Chan School of Public Health ( email )

677 Huntington Avenue
Boston, MA MA 02115
United States

HOME PAGE: http://https://ghsm.hms.harvard.edu/faculty-staff/rebecca-weintraub

Brigham and Women's Hospital ( email )

United States

HOME PAGE: http://https://ghsm.hms.harvard.edu/faculty-staff/rebecca-weintraub

Michelle A. Williams

Harvard University - T.H. Chan School of Public Health ( email )

677 Huntington Avenue
Boston, MA MA 02115
United States

Alison Buttenheim

University of Pennsylvania

Philadelphia, PA 19104
United States

Emily Sadecki

University of Pennsylvania - Department of Medical Ethics and Health Policy ( email )

423 Guardian Dr
Philadelphia, PA 19104
United States

Helen Wu

University of Pennsylvania - School of Arts & Sciences ( email )

Philadelphia, PA 19104
United States

Aditi Doiphode

University of Pennsylvania - School of Arts & Sciences ( email )

Philadelphia, PA 19104
United States

Lawrence O. Gostin

Georgetown University - Law Center - O'Neill Institute for National and Global Health Law ( email )

600 New Jersey Avenue, NW
Washington, DC 20001
United States
202-662-9038 (Phone)
202-662-9055 (Fax)

Angela Shen

Children’s Hospital of Philadelphia - Vaccine Education Center ( email )

3401 Civic Center Blvd.
Philadelphia, PA 19104
United States

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