Around the United States, there are various plans to prioritize the distribution of the limited amount of vaccines – in December, the U.S. Advisory Committee on Immunization Practices of the U.S. Centers for Disease Control and Prevention issued federal guidelines on who should be first in line for the shots, start with frontline health workers and residents and nursing homes, followed by other essential workers at the front and 75 years and older.
But the total number of doses delivered across the country – more than 88 million – is barely enough to cover individuals in the groups with one shot, let alone the required second dose.
And finally, states decide who is first in line to receive a vaccine.
Healthcare data science firm Cogitativo has analyzed thousands of claims for health insurance and local demographics in California to assess the most predictive and discriminatory factors that led to poor outcomes after Covid-19 infection.
By evaluating known clinical risk factors, such as obesity, together with measures for the health effects of environmental factors, such as air quality and access to fresh food, within the federal recommendations on vaccination of the priority group, the company was able to identify the most vulnerable individuals in the state and the provinces where they live.
According to the analysis, dozens of provinces in California would not have enough doses to serve the most vulnerable people in the state under federal leadership alone. Los Angeles County, for example, has a shortage of nearly 405,000 doses.
Extending the findings to the ten largest states shows that about a third of the provinces would be missing doses relative to the number of most vulnerable residents – and about 5 million doses could have a deeper impact in the fight against Covid-19 if it again assigned to different provinces.
“Without a surgical approach to vaccine distribution, more Americans – often in color communities and rural areas – are at risk of being left behind,” Cogitativo CEO Gary Velasquez told CNN. “The key is to use a combination of real clinical data and social determinants of health to surgically determine who is at greatest risk. This approach can help states avoid acute shortages in certain provinces.”
Fairness in the distribution of vaccines
Experts interviewed by CNN agreed that the allocation should be more nuanced than the section of the population that falls within a certain priority group. For example, not all people over 65 have the same level of risk as Covid-19, although a country with more people in that age group may receive more vaccinations.
“The fastest and fastest approach to saving most lives and eventually ending this pandemic sooner and faster must cross with understanding the circumstances in which people live, work, are educated and more,” said Dr. Kedar Mate, President of the Institute. for improving health care told CNN. Mate was not involved in the Cogitativo analysis. “Social determinants of health have a very important impact on the trajectory of this pandemic.”
Equity is central to the Biden Administration’s plan to distribute vaccines through federally qualified health centers and FEMA sites, and dozens of states have adapted the federal framework for their own distribution plans, and many have specifically added elements of equity to the comparison.
But it was a nationwide struggle to get it right.
In the coming weeks, California specifically plans to revamp its vaccine allocation plan to address concerns about equity in the deployment.
Currently, California allocates doses to local health departments proportionately based on their share of the state’s eligible population. Together with health care staff, the state has extended the priority to all people who are at least 65 years old, so a country with twice as many people in the age category will receive twice as many doses as another.
A new formula will allocate doses directly to providers in an effort to provide coverage to neighborhoods that need it most. The goal is to reach disproportionately affected communities that do not adequately reach the current system, Darrel Ng, senior communications adviser to the state’s vaccine task force, told CNN.
‘Difficult to prescribe’ at national level
Experts interviewed by CNN said federal guidelines gave a good idea of how to begin the vaccination process.
But according to them, adjustments can be made locally as more is learned along the way, especially with the focus on groups most susceptible to the virus and its poor outcomes.
“It’s hard to prescribe it nationally,” Mate told CNN. “Every state and every region has to adapt based on local experience.
Local health departments are well acquainted with the population of people at risk in communities, as well as the vulnerability in themselves and their environment that puts them at risk.
They are ‘uniquely positioned to be the backbone behind equitable distribution’, says Lori Tremmel Freeman, chief executive officer of the National Association of County and City Health Officials.
However, some local leaders find it difficult to focus on equity when supply is so limited.
“Without more supply, and consistent and predictable information on future supply levels, it is a challenge to ensure that we can vaccinate those at greatest risk quickly and fairly,” a statement from Santa Clara County, California said.
According to Cogitativo’s analysis of provinces in the ten largest states, Santa Clara has the third largest shortage of vaccine doses in the ten largest states. The analysis suggests that the province could receive up to 175,000 more doses than it would receive under federal guidance alone, due to its relatively large vulnerable population at risk due to poor social determinants of health.
“In many cases, provinces become too limited with a deeper strategy to address stocks,” Freeman said. “We hear it all the time. Some provinces only get 100 vaccine doses a week and do their best to analyze it among the priority groups.”
Others say it may be difficult to prioritize the issue for even more specific priorities – especially if demand so far outweighs supply – but it helps people remember a shared goal.
In Texas, the state government rejected a plan proposed by Dallas to prioritize people within certain zip codes. Eventually, the state and country worked together and were able to prioritize based on socio-economic status and distribution of community cases, but not for specific zip codes.
“Because of the very limited supply, we wanted to make the biggest impact with the precious quantity we had,” said Dr. Philip Huang, director of the Dallas Department of Health, told CNN.
And there is more purposeful prioritization. Federal vaccination initiatives that run alongside state plans could help get the vaccine to more people. Vaccination sites run by FEMA in Dallas target people living in the 17 zip codes that have helped prioritize local leaders.
Yet Dallas receives only about 9,000 doses of Covid-19 vaccine per week. There are more than 650,000 people on the waiting list.
“You do math. It’s going to take a while, ‘Huang said. “We all want everyone to get it as soon as possible. The better we can show that we are reaching the people who are most at risk of suffering, the better we will achieve the goal.”