How to properly allocate a COVID-19 vaccine that will be in scarce supply when it is approved has become a major question.
One potential answer in a new opinion piece in the Journal of the American Medical Association is to prioritize giving the few vaccine doses to healthcare workers, people in high-risk occupations and housing and those with high-risk conditions at the same time. This runs counter to a recommendation from the National Academies of Sciences, Engineering, and Medicine that calls for only front-line healthcare workers and those with high-risk conditions to get the initial doses.
“A COVID-19 vaccine should be allocated to prevent harm, prioritize people who are disadvantaged, and achieve equal treatment,” according to the JAMA piece led by Ezekiel Emanuel, a professor at the Perelman School of Medicine at the University of Pennsylvania and a former Obama administration healthcare adviser.
The priority populations are likely to vastly exceed the initial quantities of a vaccine. The White House’s Operation Warp Speed has started funding the manufacturing of doses of the six vaccine candidates currently in clinical trials in the U.S., but it remains unclear how many initial doses will be available.
“To the extent that a vaccine does not prevent transmission, but just reduces the severity of illness, its effect and distribution should resemble therapeutics that only protect direct recipients,” the JAMA piece said.
Any vaccine distribution needs to focus on current and future benefits, including the direct benefits to vaccinated people, indirect benefits to people protected from the spread of infection and “indirect health and socioeconomic benefits to those protected from harm as health system and societal functioning improve.”
The other authors were Govind Persun, a law professor at the University of Denver's Sturm College of Law, and University of Chicago Professor Monica Peek, M.D.
The piece looked at several ways to distribute a vaccine equally among front-line health workers; essential workers like those in the food supply, education and childcare industries; and those with medical conditions that are at increased risk of poor outcomes if they become infected.
“However, nearly 200 million individuals in the U.S. have a high-risk condition,” the JAMA article said. “Limited vaccine supplies will require prioritizing among these individuals, with attention to evolving data about how conditions affect COVID-19 risk and vaccine efficacy.”
The authors say that dividing the initial allotment of vaccine doses into priority access categories and then prioritizing people within each category was a “promising approach.”
“For instance, half of the initial allotment might be prioritized for frontline health workers, a quarter for people working or living in high-risk settings and the remainder for others,” the article said.
This approach could be better than the tiered ordering that has been previously used for influenza vaccines because it ensures several groups have access to a vaccine.
The article is the latest to weigh in on how a vaccine should be distributed in the early phases after approval.
The National Academies of Sciences, Engineering, and Medicine released a framework back in October that used existing systems across the government to ensure equitable allocation of a vaccine. The first phase would cover front-line health workers, those with underlying health conditions and adults ages 65 and older that are living in nursing homes.
The second phase would cover teachers and childcare workers as well as essential workers in areas like food supply and public transit.
America’s Health Insurance Plans, the top insurance lobbying group, sent recommendations to the academies asking about what role insurers will play in the allocation of the vaccine, including whether they will work with provider networks to ensure patients get the vaccines they need.