Equitable Allocation of COVID-19 Vaccines: An Analysis of Allocation Plans of CDC's Jurisdictions with Implications for Disparate Impact Monitoring

Abstract

Major global and national vaccine allocation guidelines urge planners to allocate vaccines in ways that recognize, and ideally reduce, inequities within countries. In the US, allocation frameworks are ultimately determined by each of the CDC’s 64 jurisdictions individually (states, the District of Columbia, five cities, and territories). We analyzed whether jurisdictions have incorporated novel approaches to reduce inequity, analyzing allocation plans published by the CDC in early November 2020, and tracking updates of frameworks through to January 2021, capturing all jurisdictions.

By late January 2021, 30 jurisdictions (the majority of states, N=29) adopted a novel proposal to use a disadvantage index to allocate vaccines more equitably, compared to 19 in November 2020. Five types of uses can be distinguished: 1) to prioritize disadvantaged groups through larger shares of vaccines, 2) to define priority groups in phased systems, 3) to plan tailored outreach and communication, 4) to plan the location of dispensing sites and 5) to monitor uptake. Among the 20 jurisdictions with large shares of disadvantaged populations—where reducing inequity would be most urgent—10 were pursuing such goals by January 2021, up from 7 who did so in November 2020.

While allocation frameworks continue to evolve, the plans we analyzed mark important historical and practical benchmarks. To ensure that equitable allocation is central, rather than peripheral, planners at the federal, state and local levels should review others’ approaches to use disadvantage indices for defining and reaching priority populations, adjusting allocations, and monitoring uptake

Keywords: COVID-19, vaccine, rationing, scarcity, vaccine, health policy, ethics, equity

JEL Classification: I14, I18, I3