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Considerations in Ensuring Equitable COVID-19 Vaccine Administration

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On January 21, the Biden administration released its National Strategy for the COVID-19 Response and Pandemic Preparedness. The plan highlights numerous actions that the administration intends to implement as it assumes responsibility in the fight against COVID-19.

According to the president’s plan, strategies in the administration’s goal of mounting a safe, effective, and comprehensive vaccination campaign include the following:

  • “Accelerate getting shots into arms and get vaccines to the communities that need them most” and “Focus on hard-to-reach and high-risk populations”; that is, prioritize vaccine administration for high-risk populations.
  • “Create as many venues as needed for people to be vaccinated”; encourage partnerships between federal, state, local, and private stakeholders to vaccinate en masse.
  • “Drive equity throughout the vaccination campaign and broader pandemic response” via the establishment of the COVID-19 Health Equity Task Force and more robust data collection across various social groups.
  • “Bolster data systems and transparency for vaccinations”; improve communication and tracking capability across federal, state, and local governments, as well as between patients and providers.

When looking to implement the actions included in President Biden’s plan, federal, state, and local stakeholders may consider the following.

Emerging Data Suggest Potential for Inequity

The Biden administration has included equity as a key pillar of its vaccination campaign, highlighting the importance of demographic data in identifying the communities that are most in need of protection. The plan outlines the establishment of the COVID-19 Health Equity Task Force, intended to provide recommendations that reduce health inequities in the response to COVID-19.

Demographic information on COVID-19 vaccine administration faces limitations. A Morbidity and Mortality Weekly Report (MMWR) recently published by the Centers for Disease Control highlights demographic characteristics of individuals having been vaccinated within the first month of vaccine administration (December 14, 2020–January 14, 2021). This report acknowledges several limitations in the initial data available. Initial reports of vaccination among priority groups did not always contain consistent information on racial/ethnic groups or correlating priority group category. Race or ethnicity was not known for roughly 50% of the population initially vaccinated during the first month. Among persons with available demographic characteristics who received a vaccine:

  • 60.4% were White, non-Hispanic
  • 5.4% were Black non-Hispanic
  • 11.5% were Hispanic/Latino
  • 6.0% were Asian, non-Hispanic
  • 14.4% identified across multiple/other races or ethnicities (non-Hispanic)

In reference to the 2019 American Community Survey, the MMWR reports that in 2019, 60% of healthcare workers were white, 16% were black, 13% were Hispanic, and 7% were Asian. While restrictions in available data may limit the ability to generalize these findings broadly, initial discrepancies across individuals who would likely be recommended to receive initial vaccination and those who received vaccination indicate potential for inequity.

The Biden administration has acknowledged that collection of more robust, state-level demographic information will be vital in ensuring greater equity in vaccine administration. However, decision-makers at the state and local level may currently face opportunities to prevent further exacerbation of these inequities via equal access to vaccination. As the broader vaccination campaign begins, state-level decision-makers may consider prioritizing cities, neighborhoods, and communities that have faced historical health inequity or have been considerably impacted by the COVID-19 pandemic.

The Need for Diversification of Vaccine Registration Tools

Federal, state, and local governments may also seek to diversify the modes of communication used to publicize, register, and schedule for vaccinations. Relying solely on communication and registration practices that require an Internet connection may serve as a barrier to certain populations without consistent Internet access or proficiency, and may further exacerbate the inequity already observed in vaccine administration:

  • In 2019, roughly 30% of individuals over age 65 in the US did not use the Internet, and more than 40% of individuals in that age range did not have access to broadband service at home.
  • These trends continue when examining race and ethnicity. In 2019, 8% of White US adults did not use the Internet, while 14% and 15% of Hispanic and Black adults did not use the Internet, respectively. When looking at access, 21% of White adults in the US were not home broadband users, while 34% and 39% of Black and Hispanic adults were not home broadband users, respectively.

These divergences in Internet access across age and racial and ethnic groups indicate the potential for disparate access to vaccine registration across prioritized groups. Other potential methods of vaccine outreach to consider include outbound calling to eligible vaccinees based on state- and community-level data, mail-in registration, and partnership with local community centers that interface with eligible vaccinees regularly.

The Potential for Impact via Mass Immunization

The COVID-19 pandemic has impacted care delivery and administration of vaccines broadly, as over 80% of payers in a recent survey cited decreases in child and adult immunization since the start of the pandemic. The Biden administration indicated its intention to create additional venues for individuals to become vaccinated, through partnership with state and local communities. This initiative includes the establishment of community vaccination centers and mass-vaccination events.

Mass-vaccination events allow for large quantities of vaccines to be administered in shorter periods of time in a centralized location. Some states, such as Oregon, have already conducted mass-vaccination events leading to the administration of over 10,000 immunizations.

The Biden administration also acknowledged that privately owned venues such as stadiums and conference centers may also serve as venues for mass vaccination. Recently, music-industry conglomerates such as Live Nation that have seen significant impact to their business due to COVID-19 have offered to leverage their venues to assist with vaccine distribution and mass-vaccination events, which may help move the needle toward greater vaccine administration countrywide. Additional innovative strategies for mass vaccination, such as mobile vaccination units suggested in President Biden’s plan, may increase the ability to administer vaccines to a wider spread of individuals. Additionally, stakeholders may look to coordinate efforts with the Federal Retail Pharmacy Program, under which approximately 1 million vaccines will be distributed directly to select pharmacies each week, starting February 11. The head of President Biden’s Coronavirus Taskforce, Jeff Zients, indicated that vaccine distribution under the program will prioritize communities that have been underserved or significantly impacted by the pandemic.

Lessons Moving Forward

When seeking to leverage the guidance and instruction laid out by the Biden administration in order to bridge the gap between vaccine supply, demand, and administration, decision-makers at federal, state, and local levels may consider the following:

  • Invest greater resources to ensure collection of robust, state-level demographic data. This will be critical in ensuring that vaccine supply is administered equitably across all individuals considered to be high risk. State-level decision-makers may look to the guidance of the COVID-19 Health Equity Task Force to ensure they are taking all the proper actions in ensuring equitable vaccination opportunity and access.
  • Diversify methods of communication so that vaccine information and registration is accessible to all populations. Consider differences in access to broadband Internet across high-risk populations and provide easier methods of registration for vaccination that is cohesive across multiple sites of care.
  • Consider expanding mass-immunization events, created through multi-stakeholder partnerships that may include public health officials, local providers, community organizations, the National Guard, and even private music or live entertainment venues.

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