Vaccination Allocation & Equity

This will be another big week for vaccine policy, law, and ethics.

Johnson and Johnson’s Emergency Use Authorization application for its one-dose vaccine will be reviewed this week by the Food and Drug Administration (they also have submitted their vaccine for emergency authorization review to the World Health Organization). While the Biden Administration announced earlier in February that it has purchased 600 million doses of the Pfizer and Moderna vaccine (which would be delivered in regular increments through late July 2021), J&J’s one-shot vaccine could be a game changer for increasing access of the public to protection against Covid-related severe cases and hospitalization. However, in the near term, it appears that demand for the vaccine will significantly outstrip supply, as the vaccine manufacturer has only readied “a few million” doses of their vaccine at this time. In related vaccine logistics news, late last week, Pfizer submitted a request to the FDA to allow its vaccines to be stored in higher temperature freezers for up to two weeks.

Interested in examining the variations in vaccine allocation plans? The National Academy of State Health Policy has a fantastic map that allows the reader to make comparisons across jurisdictions.

As we’ve been tracking here on the blog, equity remains one of the most prominent ongoing concerns during the vaccine rollout. Public health authorities and their partners continue to work to identify and address the disparities between the vaccine uptake rates of non-white and white community members and health care workers. As noted previously on this blog, narrowing the gap on Covid-related health disparities will require addressing structural determinants of health, including reducing local barriers to access to health services, and community outreach to ensure access to reliable information and assistance with appointment-making.

As noted in this Urban Institute commentary, such efforts also will require improvements in the quality of disparities-related data collected. Policymakers can improve the equity of vaccine allocation through:

• Collecting complete, high-quality race and ethnicity data when administering vaccinations. According to the authors, “as shown in Urban’s COVID-19 resource tracker, there is substantial variation in how states are tracking COVID-19 across populations and sectors. A federal mandate to improve data collection last summer increased race and ethnicity reporting for COVID-19 cases and deaths. But the federal demographic data collection requirement does not extend to COVID-19 vaccinations; as of early February, only 23 states report race and ethnicity data for vaccinations. Even when states report data, the share missing race data can be high, and the share missing ethnicity information is far higher.”
• Increasing vaccine availability in hard-hit communities. In addition to using frameworks such as the Social Vulnerability Index, some public health ethics and law experts recommend the use of the Area Deprivation Index, which, in addition to offering block-level data, might also be less likely to be challenged as discriminatory.
• Addressing vaccine hesitancy among populations at high-risk for exposure. The Los Angeles Times published a piece last week discussing the efforts undertaken by black physicians at Penn Medicine to improve outreach and uptake by black health care workers in their health system. Their multi-modal approach included:
  • Developing a one-page printed handout featuring photos of their system’s black physicians receiving Covid-19 vaccines and addressing vaccine rumors they heard from their staff. Print flyers also helped them overcome barriers such as the lack of staff email addresses.
  • Broadcasting rolling PowerPoint presentations debunking Covid myths in high traffic staff areas
  • Getting pairs of physicians (at least one of which was always black) to hold daily huddles with staff groups with a high proportion of Black employees.

Covid-19 Vaccines for Children

While children have not suffered the same level of Covid-19-related morbidity and mortality as adults, approximately 2 million cases, 8000 hospitalizations, and several hundred Covid-19-related deaths have occurred in children in the U.S. during the pandemic. While only one of the Covid-19 vaccines currently available has been approved for use by older adolescents, children ages 12-16 are being enrolled in Covid-19 vaccine safety and efficacy trials, and it is expected that later this year the FDA will approve emergency use of the vaccine for younger populations. Late last year, I co-authored a Journal of Pediatrics piece on Covid-19, vaccination trials and vaccination plans and children with colleagues Greg Zimet and Dennis Fortenberry.

Earlier this month, authors from the National Academy for State Health Policy discussed ways some states were beginning to plan for children in their vaccination distribution plans, including:

• Incorporating child health agency representatives in COVID-19 vaccination planning teams;
• Designating roles for child health programs and providers to facilitate distribution; and
• Prioritizing children or subpopulations of children for when the vaccine is authorized.

The piece offers a graphic listing states that have reported taking such steps in their planning. According to that article, Indiana has not yet reported having adopted any of the above three measures.

Diseases of Despair

Deaths from so-called “Diseases of Despair,” including overdoses, suicides, and alcohol poisoning, continue to skyrocket. While levels of non-cannabis drug use have stabilized or declined in recent years, CDC researchers writing in JAMA state, “As illicitly manufactured fentanyl became more ubiquitous, drug overdose death rates increased in all age groups, among both sexes, across most races and ethnicities, within all urbanization levels, and in the majority of US states.”

A rule change pushed through in the final days of the Trump Administration loosening rules for providers to qualify to prescribe buprenorphine as an Opioid Agonist Treatment (OAT) were clawed back by the Biden Administration late last month, as the Department of Health and Human Services did not have authority to make such regulatory changes.

A new report from the Network for Public Health Law identifies barriers to OAT access and potential solutions to improve OAT uptake in eight sectors: health care, the criminal legal system, family law, housing, zoning, transportation, education and youth, and employment. According to the authors, “In identifying areas of overlap among different sectors, the paper will serve as a guide for professionals who may be experts in areas other than OAT but who want to improve public health and reduce the individual and societal burdens of opioid use disorder.”

Webinar: On February 25, 2021 from 1:00-2:30pm ET, the Network will hold a webinar “Increasing Access to Opioid Agonist Treatment: An Innovative, Cross-Sector Approach” featuring some of the report authors. You can register for the event here.