Public health: Assessing the equitable distribution of COVID-19 vaccinations in the United States

A study of whether jurisdictions across the United States are promoting the equitable distribution of vaccines against COVID-19 is published this week in Nature Medicine.

Achieving herd immunity in the United States will rely on an equitable allocation of vaccines against COVID-19, particularly in underserved communities. However, the United States continues to face an unprecedented public-health, logistical and social-justice challenge in doing so. One way to address this is by identifying priority groups, determined by incorporating place-based disadvantage indices such as the US Centers for Disease Control and Prevention’s Social Vulnerability Index (SVI). Such indices can identify population groups for whom the protection offered by vaccines is both more necessary and more valuable. For example, certain groups may be more dependent on a regular income, less able to socially distance, and more likely to contract and spread the virus.

To evaluate the distribution of vaccines against COVID-19 in the United States, Harald Schmidt and colleagues analyzed vaccine-allocation plans published by 8 November 2020, and tracked updates to these plans until 30 March 2021. The authors found that by 20 March 2021, 14 jurisdictions (out of 64 jurisdictions in the United States, which include 50 states, the District of Columbia, 5 cities and 8 territories) had prioritized specific zip codes, in combination with metrics such as COVID-19 incidence, for vaccine allocation. 37 jurisdictions (including 34 states) had adopted disadvantage indices, compared with only 19 jurisdictions in November 2020. Among jurisdictions with the largest disadvantaged communities, the use of disadvantage indices to allocate vaccines doubled from 7 to 14.

The authors also found that certain states increased the share of vaccine appointments for people from more disadvantaged areas. For example, Tennessee reserves 5% of its Moderna vaccines for areas with a high SVI. Massachusetts allocates an additional 20% vaccines to communities with a disproportionately large COVID-19 burden and high SVI. North Carolina reserves 30% of vaccines for purposes that include equitable access for racial and ethnic minorities, and requests that 40% of daily vaccinations be reserved for people from historically marginalized populations first.