Rationing Safe and Effective COVID-19 Vaccines: Allocating to States Proportionate to Population May Undermine Commitments to Mitigating Health Disparities

Abstract

A central goal in the National Academies of Science, Engineering and Medicine’s (NASEM) framework for equitable COVID-19 vaccine allocation is to mitigate existing inequities, particularly those affecting economically worse-off racial and ethnic minorities. The Advisory Committee on Immunization Practice (ACIP) likewise notes that equity demands to “reduce, rather than increase, health disparities in each phase of vaccine distribution”. A crucial question in this regard is how vaccines should be distributed to states. The default is to allocate proportionate to population size. However, this approach risks increasing scarcity for worse-off populations in states where they represent above-average shares. To avoid lower odds of receiving a vaccine for worse-off groups, more vaccines could be given to states with larger shares of worse-off populations, and fewer to ones with smaller shares. We show here the consequences of allocating by these two different approaches.