COVID-19 Vaccine Allocation and the Social Vulnerability Index

As the nation readies itself for the vaccine, distribution remains a challenge.

COVID-19 has been with us for almost a year. There is light at the end of the tunnel, through vaccinations anticipated to start over the next month. But how to accomplish this, and more vitally, to whom the vaccinations will be administered, remains the big challenge.

Public health experts question what lessons were learned from rampant spread of the virus across populations facing longstanding health disparities: persons of color, marginalized groups (older adults and persons with disabilities, for example), and working-class immigrant communities across urban, suburban, and rural regions of the country. A recent issue brief from the Kaiser Family Foundation digs deep into this topic. The brief, Addressing Racial Equity in Vaccine Distribution, provides an overview of barriers to vaccination that disproportionately affect people of color, and discusses how current national recommendations and state vaccine allocation plans address racial equity.

Among the barriers for consideration are the following:

• Concern for populations more prone to health disparities receiving the vaccine:
  • Historically, people of color are less likely to be vaccinated, compared to their white counterparts; 39 and 37 percent for Black and Latinx persons, respectively, versus 49 percent for whites.
  • Other barriers cited include:
    • Lack of insurance
    • Lack of trust by Black and Latinx patients of providers and organizations; patients often were refused tests, treatment, or pain medication provided to other populations.

The National Academies of Medicine (NAM) issued a framework for equitable coronavirus vaccine allocation and distribution that accounts for population health disparities; persons at higher risk due to health status, occupation, or living conditions; and geographic distribution of active virus spread.

The framework identifies mitigating health inequities as an underlying ethical principle, and prioritizes allocation to areas identified using the Centers for Disease Control and Prevention (CDC) Social Vulnerability Index (SVI). Ths rating system rates an area’s social vulnerability based on factors that weaken a community’s ability to prevent human suffering and financial loss in a disaster:

• Poverty
• Employment
• Income
• Education
• Population over 65 years of age
• Population under 17 years of age
• Presence of a disability
• Single-parent households
• Identified as a minority
• Language literacy
• Quality/type of housing
• Crowding
• Group quarters
• Lack of housing
• Lack of access to transportation

States have the final word on how to distribute vaccines to their citizens. Yet despite the rigor put into the development of these plans, concerns exist. How will each state balance equitable access of the vaccine while avoiding repetition of outbreaks that create further waves of contagion? This week’s Monitor Mondays Listeners Survey asked how confident listeners are of their state’s plan to fairly and equitably distribute the vaccine. The responses appear here.

Programming Note: Ellen Fink-Samnick is a permanent panelist on Monitor Mondays. Listen to her live reporting when Monitor Mondays returns on Monday, Jan. 11, 2021, 10 a.m. EST.