Strategies to Ensure Equitable Access to COVID-19 Vaccines
As COVID-19 vaccination efforts roll out across the nation, how can policymakers balance reducing the complexity of vaccine priority lists with improving the ease of access? CCHRPP researchers Erika Martin, Guthrie Birkhead, and David Holtgrave tackle this problem in their recent commentary, “Maintaining a Focus on Health Equity During the COVID-19 Vaccine Rollout” in the latest issue of Journal of Public Health Management & Practice.
The initial federal vaccination guidelines called for a phase approach to first prioritize health care workers, essential workers, and persons at highest risk of infection such as long-term care facility residents. The recommendations also emphasized the importance of keeping a focus on health equity to ensure that racial and ethnic minority communities would have access to vaccines. However, by mid-January 2021, more than half of states had deviated from the national guidelines to include persons aged 65 years and older.
The authors argue, “While we support approaches to reduce the complexity of prioritization and increase the pace of the rollout, we are concerned that a heavy focus on age-based recommendations without a clearly articulated, detailed, and intentional strategy to build partnerships with and prioritize racial and ethnic minority communities fails to incorporate the National Academy of Medicine's recommendation that health inequities be considered explicitly as part of a framework for equitable allocation of COVID-19 vaccines.” They offer several pieces of evidence to support their concerns about relying exclusively on age-based prioritizations. First, because of differences in life expectancy across demographic groups, a lower percentage of Black persons will be prioritized for COVID-19 vaccination based on age criteria. Second, some communities experience higher disadvantages in the social determinants of health that relate to COVID-19 infection and the development of severe illness. Finally, prioritization rules that are strictly based on age do not consider racial and ethnic disparities in the likelihood of seeking and having access to COVID-19 vaccinations.
They conclude with a set of recommendations to ensure that health equity can continue to be emphasized during the vaccine rollout, including developing health education campaigns in collaboration with community leaders and community-based organizations to address distrust and misinformation, implementing policy strategies to ensure that racial and ethnic minority communities achieve truly equitably access to the vaccine, such as paid time off and flexible leave in the workplace to make and attend vaccine appointments, engaging community-based organizations to serve as health navigators to provide information about the vaccine and schedule appointments, improving access to telephone hotlines and mobile applications to schedule appointments, and placing Points of Dispensing vaccination sites in zip codes with high levels of social vulnerability. They also advocate for the routine collection of vaccination data by race, ethnicity, and region to allow for real-time monitoring of equitable access.
New York is now starting a new phase of vaccinations that relax the initial prioritization criteria. As of March 30, all residents ages 30 and over became eligible and beginning April 6, eligibility will be expanded to residents ages 16 and over. It is important to keep these principles in mind to ensure that vaccines are equitably allocated across communities.