This month, the National Academy of Medicine’s Committee on Equitable Allocation of Vaccine for the Novel Coronavirus released its “Framework for Equitable Allocation of COVID-19 Vaccine” Report that was commissioned by the National Institute of Health and the CDC.
This report has significant implications for Black Americans and could (should) be used as a “checklist” that minority health professionals can use to advocate for, and monitor, state and local decisions and actions regarding COVID vaccine distribution.
The report offers a framework for equitable allocation of the COVID-19 vaccine that is built upon popular principles and recognizes the distinctive characteristics of COVID-19 disease, including:
The Report contains the following specific elements that will be of relevance to African American health professionals:
An unambiguous declaration of the importance of HEALTH EQUITY in framing vaccine allocation decisions.
In the United States and worldwide, the COVID-19 pandemic has shed light on the pervasive impacts of social and structural inequities in society. COVID-19 is having a disproportionate impact on people who are already disadvantaged by virtue of their race and ethnicity, age, health status, residence, occupation, socioeconomic condition, or other contributing factors.
At a moment when racial inequality and discrimination are at the center of national conversations in the United States, and a well-established source of poor health outcomes as well as the legacy of medical experimentation, these considerations must be a critical component of COVID-19 vaccine allocation.
The report further states that “current evidence has shown how COVID-19 disproportionately affects particular racial and ethnic minority groups.
CDC has compiled data by race and ethnicity on the rates of COVID-19 cases, age-adjusted hospitalizations, and death.
Compared to White, non-Hispanic person, black or African American (non-Hispanic) persons had a case rate that was 2.6 times higher, a hospitalization rate that was 4.7 times higher, and a death rate that was 2.1 times higher.
The Report highlights key lessons learned from prior mass vaccination efforts that include:
The importance of leveraging relationships with professional medical societies and other key downstream stakeholders from the outset.
Developing effective systems for tracking distribution.
Deploying limited vaccine supplies equitably and transparently using pre established, evidence-based criteria to prioritize allocation.
Using consistent, respectful, accurate communication to earn, secure, and maintain trust.
The Report highlights key foundational principles, goals, and allocation criteria to reduce severe morbidity and mortality and negative societal impact due to the transmission of SARS-CoV-2. These include:
The Report identifies four phases for disseminating COVID-19 vaccines that include the following guidance of interest to AA health professionals themselves, as well as their patients, given the frequency with which their patient populations experience multiple chronic illnesses or are employed in high risk “essential” occupations:
Phase 1a includes high-risk health workers (e.g., in hospitals or nursing homes, or providing home care)—these health professionals are involved in direct patient care.
Also included are workers who provide transportation, environmental services, and other health care facility services and who risk exposure to bodily fluids or aerosols.
Phase 1b focuses attention on two groups that are particularly vulnerable to morbidity and mortality due to COVID-19: (1) people of all ages with comorbid and underlying conditions that put them at significantly higher risk; and, (2) older adults living in congregate or overcrowded settings.
CDC currently lists the following comorbid conditions as associated with increased risk of severe COVID-19 disease: cancer, chronic kidney disease, chronic obstructive pulmonary disease (COPD), immunocompromised state from solid organ transplant, obesity (body mass index [BMI] ≥30), serious heart conditions (e.g., heart failure, coronary artery disease, cardiomyopathies), sickle cell disease, and type 2 diabetes mellitus.
Recognizing the limited initial vaccine supply, Phase 1b proposes setting a priority on individuals with two or more of these conditions, recognizing that these priorities can be refined as better evidence emerges.
This category includes administrators, environmental services staff, maintenance workers, and school bus drivers, all of whom are essential to education and face disease exposure.
Vaccinating these individuals supports their vital societal role in providing children’s education and development, while reducing their role in transmission between schools and the community and protecting their own health risks from exposure in these settings.
Includes critical workers in high-risk settings—a group of individuals whose occupations are in essential industries and who cannot avoid a high risk of exposure to COVID-19. They include workers in the food supply system, public transit, and other vital services.
Includes people of all ages with comorbid and underlying conditions that put them at moderately higher risk, which the committee defined as having one of the previously mentioned conditions and potentially some rare diseases as well.
Includes people in homeless shelters or group homes, and staff who work in those settings.
Includes young adults, children, and workers in industries that are both important to the functioning of society and pose moderately high risk of exposure.
Includes everyone residing in the United States who did not have access to the vaccine in prior phases.
This NAM report provides a very thorough and specific set of goals, actions and criteria to facilitate the opportunities for the African American community, and other communities of color, to employ proven safe and effective COVID-19 vaccines in mitigating the disastrous impact of this pandemic.
You are encouraged to use this as a “checklist” as you participate in the design of vaccine dissemination programs in your community and as you monitor and track the implementation of these programs by local officials.
You can access the full report at: www.nap.edu/vaccineframework.
To access the report, click:
https://www.nap.edu/catalog/25917/framework-for-equitable-allocation-ofcovid-19-vaccine
by Reed Tuckson, MD
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