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

46 Pages Posted: 16 Mar 2021

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

Kate Miller

Ariadne Labs

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

Neha Nagpal

University of Pennsylvania

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: March 16, 2021

Abstract

Major global and national vaccine allocation guidelines urge planners to allocate vaccines in ways that recognize, and ideally reduce, inequities within countries. In the US, allocation frameworks are ultimately determined by each of the CDC’s 64 jurisdictions individually (states, the District of Columbia, five cities, and territories). We analyzed whether jurisdictions have incorporated novel approaches to reduce inequity, analyzing allocation plans published by the CDC in early November 2020, and tracking updates of frameworks through to January 2021, capturing all jurisdictions.

By late January 2021, 30 jurisdictions (the majority of states, N=29) adopted a novel proposal to use a disadvantage index to allocate vaccines more equitably, compared to 19 in November 2020. Five types of uses can be distinguished: 1) to prioritize disadvantaged groups through larger shares of vaccines, 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. Among the 20 jurisdictions with large shares of disadvantaged populations—where reducing inequity would be most urgent—10 were pursuing such goals by January 2021, up from 7 who did so in November 2020.

While allocation frameworks continue to evolve, the plans we analyzed mark important historical and practical benchmarks. To ensure that equitable allocation is central, rather than peripheral, planners at the federal, state and local levels should review others’ approaches to use disadvantage indices for defining and reaching priority populations, adjusting allocations, 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 Miller, Kate and Buttenheim, Alison and Sadecki, Emily and Wu, Helen and Doiphode, Aditi and Nagpal, Neha and Gostin, Lawrence O. and Shen, Angela, Equitable Allocation of COVID-19 Vaccines: An Analysis of Allocation Plans of CDC's Jurisdictions with Implications for Disparate Impact Monitoring (March 16, 2021). Available at SSRN: https://ssrn.com/abstract=3803582 or http://dx.doi.org/10.2139/ssrn.3803582

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

Kate Miller

Ariadne Labs ( email )

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

Neha Nagpal

University of Pennsylvania ( 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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