Framework for Equitable Allocation of COVID-19 Vaccine (2020) / Chapter Skim
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4 Applying the Framework for Equitable Allocation of COVID-19 Vaccine in Various Scenarios
4 Applying the Framework for Equitable Allocation of COVID-19 Vaccine in Various Scenarios
Pages 145-156
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From page 145... ...
non-pharmaceutical interventions such as mask usage, physical distancing, hand washing, and others; (2) expanded diagnostic testing linked to contact tracing, isolation, and quarantine strategies aimed at containing transmission, suppressing outbreaks, and interrupting super-spreading events; and (3)
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From page 146... ...
. For an initial period when demand exceeds supply, the committee, in Chapter 3, recommended a phased approach, guided by evidence to maximize societal benefit by reducing morbidity and mortality caused BOX 4-1 Unknowns Affecting Vaccine Allocation • Number and timing of available vaccine doses • Vaccine efficacy (overall and in different groups)
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From page 147... ...
Again, vaccination would still follow the proposed allocation framework, but some individuals in subsequent phases would receive vaccination later. Vaccine Efficacy Trials of a number of candidate vaccines are currently under way, but at this time the likely efficacy of each COVID-19 vaccine in preventing infection or in preventing severe disease is unknown.
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From page 148... ...
As the vaccine starts to be allocated broadly in the United States, monitoring of safety through passive and active surveillance and possible adjustment of the allocation framework will be essential in order to minimize possible adverse effects in the population, while maximizing benefit by preventing deaths and severe disease. Effective and timely collection and communication of evidence regarding population effects, both efficacy and adverse events, will also be essential in order to secure and maintain the public's trust.
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From page 149... ...
That will include making special efforts to address issues related to health inequities that may reduce trust among some groups or that make health care less accessible to them. This is why it is essential that before COVID-19 vaccine candidates are approved and disseminated, enrollment of minority patients in the clinical trials for COVID-19 vaccine should be large enough to draw reasonable conclusions regarding the safety and efficacy of the vaccine candidate in these populations, thereby enabling experts and community advocates to accurately solicit vaccine acceptance.
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From page 150... ...
However, if a particular vaccine is inappropriate for use by a particular group, that group would need to wait for a new form of a vaccine, and the existing vaccine might be provided to those who otherwise are slated for a later phase. With multiple available vaccines, it is particularly important to monitor safety and effectiveness as immunization efforts progress so as to ensure that different population groups receive an appropriate vaccine.
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From page 151... ...
These legal issues include, but are not limited to, the process of vaccine approval, distribution, and reimbursement at the federal level; the potential intersection of allocation criteria with federal and state antidiscrimination laws; variability in state vaccination mandates aimed at schoolchildren and employees in certain sectors, such as patient care; professional licensing and scope of practice rules; recognition of out-of-state provider licenses when additional professionals are needed; payment and reimbursement provisions and processes for the varying public and private insurers within states; provider and manufacturer exposure to liability; and state-based surveillance and privacy protections. More generally, the need for vaccination will be affected by states' legal efforts to increase mask usage and social distancing and to decrease exposure. Once vaccine availability has increased sufficiently and vaccine safety in younger groups has been assessed, children will be offered a COVID-19 vaccine (Mello et al., 2020)
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From page 152... ...
, a number of concerns arise when vaccine supply is TABLE 4-1 Summary Table of the Application of the Committee's Framework in Various Scenarios Scenario Number and Timing of Vaccine Doses Fewer vaccine courses available than expected by Operation Warp Speed Vaccine requires two doses, rather than one Vaccine Efficacy Low vaccine efficacy among older adults or other population subgroup Vaccine Safety Unanticipated vaccine side effects Significant vaccine side effects among older adults or other population subgroups
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From page 153... ...
STLT authorities should not waver from their adherence to the proposed equitable allocation framework to satisfy the demands of private employers or institutions that are seeking or requiring vaccination of all workers. As a final example, if states do not provide free vaccine access to people without documentation of legal status, then the allocation framework is unchanged, but other sources of financial support (e.g., philanthropy, health systems, pharmaceutical companies)
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2020b. COVID-19: Social distancing: Keep a safe distance to slow the spread.
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. Allocation framework is unchanged, but such requirements could change rates of vaccine uptake, and would pose hazards for those individuals for whom the vaccine is medically contraindicated and could raise issues around discrimination against those unable to obtain the vaccine and therefore unable to work.
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2020. The Americans with Disabilities Act and healthcare employer-mandated vaccinations.
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