A new study from the US Centers for Disease Control and Prevention (CDC) suggests that risk-based vaccine prioritization strategies could have the greatest effectiveness on reducing COVID-19–related deaths and household transmissions while ensuring equitable vaccine distribution. The study looked at the association of different vaccine allocation strategies with COVID-19–related morbidity and mortality and their distribution by racial and ethnic groups across time. The results were published in JAMA.
In this decision analytical model, the use of risk-based, age-based, phased vaccine allocation strategies was simulated. Risk-based strategies were associated with the largest estimated reductions in nonelective hospitalizations, death and household transmissions compared with the CDC- and age-based strategies, with a similar proportion of Hispanic and Black patients being vaccinated early in the process compared with the CDC strategy.
The study findings suggest that risk-based vaccine prioritization strategies could have the greatest effectiveness on reducing COVID-19–related deaths and household transmissions while ensuring equitable vaccine distribution. Also, identifying the most efficient COVID-19 vaccine allocation strategy may substantially reduce hospitalizations and save lives while ensuring an equitable vaccine distribution.
To simulate the association of different vaccine allocation strategies with COVID-19–associated morbidity and mortality and their distribution across racial and ethnic groups the researchers developed and internally validated the risk of COVID-19 infection and risk of hospitalization models on randomly split training and validation data sets.
These were used in a computer simulation study of vaccine prioritization among adult health plan members who were drawn from an integrated healthcare delivery system. The study was conducted from January 3, 2021, to June 1, 2021, in Oakland, California, and the data were analyzed during the same period.
Given the limitations in vaccine supply in early 2021, the Advisory Committee on Immunization Practices (ACIP) recommended phased COVID-19 vaccine allocation in the US. While the ACIP allocation hierarchy sought to balance exposure risk factors, morbidity and mortality along with social and equity priorities, implementing this strategy proved challenging, with many states pivoting to alternate approaches like age-based stratification.
A key limitation has been the availability of data needed to implement the ACIP guidelines. While routine electronic health record (EHR) data could be used to inform vaccination, to our knowledge few studies have evaluated their potential role in improving allocation, particularly under inadequate vaccine supply constraints. In this study, we used EHR data from an integrated health care delivery system to simulate the potential association of different vaccine allocation strategies with estimated COVID-19–related morbidity, mortality, household transmission and racial and ethnic group vaccine distribution.
The report citation: Kipnis P, Soltesz L, Escobar GJ, Myers L, Liu VX. Evaluation of Vaccination Strategies to Compare Efficient and Equitable Vaccine Allocation by Race and Ethnicity Across Time. JAMA Health Forum. 2021;2(8):e212095. doi:10.1001/jamahealthforum.2021.2095
