Framework for Equitable Allocation of COVID-19 Vaccine (2020) / Chapter Skim
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1 Introduction
1 Introduction
Pages 23-58
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This chapter presents the study charge and approach and lays out the report's organization. The chapter also examines the ways in which race and ethnicity and health equity are intertwined with the impact of COVID-19, the populations that are at increased risk of severe illness or 23
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, in partnership with the National Academy of Medicine, to convene an ad hoc committee to develop an overarching framework for COVID-19 vaccine allocation in order to assist policy makers in the domestic and global health communities. This framework could later inform the work of national health authorities and additional advisory bodies, including CDC's Advisory Committee on Immunization Practices (ACIP)
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As part of the overall study, the committee will produce a discussion draft of the framework for public comment, and hold a public workshop to solicit feedback from external stakeholders. Framework for Equitable Allocation of COVID-19 Vaccine,1 to obtain input from members of the public, especially groups disproportionately affected by COVID-19, to inform the committee's final report (see Appendix 1 See https://www.nap.edu/catalog/25914 (accessed September 15, 2020)
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The committee hosted a public listening session where more than 2,000 members of the public attended and more than 50 individuals were able to formally address the committee. During this public listening session, the committee heard from stakeholders from minority communities, state and local government representatives, health and medical professional organizations, those representing older adults, those representing occupations at risk, and stakeholders from special populations, such as those representing incarcerated individuals, as well as individuals experiencing homelessness.
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authorities in their COVID-19 vaccine allocation planning. Throughout the report, there are key terms that are routinely used in the public health field that may contain nuance or depend on the particular context and user.
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According to the World Health Organi zation, health equity "implies that ideally everyone should have a fair opportunity to attain their full health potential and that no one should be disadvantaged from achieving this potential." SOURCES: CDC, 2020g; WHO, 2020b. efit from and be informed by this report include the federal government and STLT authorities, as well as groups such as ACIP as they create and implement national and/or local guidelines for COVID-19 vaccine allocation.
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. Racial and Ethnic Equity An increasing body of evidence indicates that in the United States, certain racial and ethnic groups including Black, Hispanic or Latinx, American Indian and Alaska Native, and Native Hawaiian and Pacific Islander communities have been disproportionately affected by COVID-19 (Cohen, 2020b; Johnson and Buford, 2020)
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. American Indians and Alaska Natives also tend to have higher rates of diabetes mellitus, obesity, hypertension, and other chronic conditions compared to the White population in the United States (Adakai et al., 2018; Poudel et al., 2018)
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CDC has identified several categories of risk factors that are associated with COVID-19 illness, hospitalization, and death in racial and ethnic minority communities (CDC, 2020c)
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Discrimination in health care, hous ing, education, criminal justice, or finance can lead to chronic stress and may put some racial and ethnic minority groups at an increased risk for COVID-19. People from racial and ethnic minority groups face risks associated with health care access and utilization, as they are less likely to be insured than non-Hispanic Whites.
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. American Indian and • Compared to non-Hispanic White populations, this group has Alaska Native a case rate that is 2.8 times higher, a hospitalization rate that is 4.6 times higher, and a death rate that is 1.4 times higher (United States)
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. People who are • Group may be at an increased risk of developing severe pregnant or COVID-19 disease that requires intensive care unit admission breastfeeding and mechanical ventilation (Cohen, 2020b)
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. This risk is likely exacerbated by the fact that many elderly people have underlying health conditions or live in congregate settings, such as long-term care facilities, where transmission of SARS-CoV-2 can occur readily (Cohen, 2020b)
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The current network covers nearly 100 counties in the 10 Emerging Infections Program states, and 4 additional states through the Influenza Hospitalization Surveillance Project (14 states in total)
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. Modeling estimates suggest that roughly 20 percent of people worldwide may be at an increased risk of severe COVID-19 disease due to their underlying health conditions.
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• Sickle cell disease • Type 2 diabetes mellitus People with the following conditions might be at an increased risk for severe illness from COVID-19: • Asthma (moderate-to-severe) • Cerebrovascular disease • Cystic fibrosis • Hypertension • Immunocompromised state from blood or bone marrow transplant, im mune deficiencies, HIV, use of corticosteroids, or use of other immune weakening medicines • Liver disease • Neurologic conditions, such as dementia • Pregnancy • Pulmonary fibrosis • Smoking • Thalassemia • Type 1 diabetes mellitus SOURCE: CDC, 2020g.
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. People aged <65 years experiencing homelessness have an all-cause mortality rate that was already 5–10 times higher than that in the general population before the arrival of COVID-19; this disparity in mortality could be further widened by the pandemic (Tsai and Wilson, 2020)
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, which puts them at a higher risk of severe illness from COVID-19. In addition, some groups experience an increased risk due to the living conditions necessitated by their disability.
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, and consistent with observations previously described, children who are Black, Hispanic or Latinx, American Indian and Alaska Native, or who have certain underlying conditions (e.g., obesity, lung disease) are at increased risk of hospitalization or
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. In addition, infants born to women who are infected with SARS-CoV-2 during pregnancy appear to be at an increased risk for adverse outcomes, including preterm birth and admission to a neonatal intensive care unit (Allotey et al., 2020)
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. Developing an effective vaccine against a newly discovered viral pathogen in such a short time frame is unprecedented, but efforts around the world have now generated multiple promising candidates that are entering various stages of clinical trials.
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vaccine tracker is currently tracking 45 vaccine candidates, many of which are in Phase I–III trials and some of which are promising candidates in the preclinical stages of research and development (Craven, 2020)
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The six vaccine candidates currently supported under OWS include those being developed by: • AstraZeneca and the University of Oxford (replication-defective vector) -- OWS is providing up to $1.2 billion in support, and at least 300 million doses of vaccine are guaranteed to the U.S.
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. Adenovirus replication-defective vectored vaccine candidates use different vectors to deliver recombinant SARS-CoV-2 spike protein genes -- derived from the surface of the virus -- to human cells and induce an immune response (O'Callaghan et al., 2020)
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by merging four existing NIAID-funded clinical trial networks: the HIV Vaccine Trials Network, the HIV Prevention Trials Network, the Infectious Diseases Clinical Research Consortium, and the AIDS Clinical Trials Group. In the United States, regulatory requirements have been adjusted to expedite authorization and clinical trials, and FDA is encouraging studies on the use of COVID-19 vaccines among pregnant women as well as the enrollment of racial and ethnic minorities disproportionately affected by the disease (Chen, 2020)
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Only about 6 percent of vaccine candidates ultimately make it to market (Steenhuysen and Kelland, 2020) , and setting up a production facility in the United States can cost US$50–$500 million for a monovalent vaccine and up to US$700 million for a polyvalent vaccine (Anderson, 2020)
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. Some of this enormous financial risk is being mitigated by advance-purchase agreements with countries for promising vaccine candidates (Furlong, 2020)
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The introduction of a COVID-19 vaccine would be a valuable addition to the pandemic response, but must be a part of a multi-pronged public health response to COVID-19. CONTEXTUALIZING COVID-19 VACCINATION EFFORTS IN THE CURRENT SYSTEM In conducting its work, the committee assumed that the national COVID-19 vaccine program will build on the solid and tested national vaccine program that has existed for 65 years and has evolved and improved over the years.
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However, the vaccination program goes beyond this. States can request a CDC field assignee from the Program Operations Branch in the Immu FIGURE 1-2 Operation Warp Speed vaccine distribution process.
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2018. Health disparities among American Indians/Alaska Natives -- Arizona, 2017.
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Morbidity and Mortality Weekly Report. https://www.cdc.gov/mmwr/volumes/69/wr/mm6937e4.htm (accessed September 17, 2020)
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https://gis.cdc.gov/grasp/COVIDNet/COVID19_3.html (accessed September 15, 2020)
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Washington, DC: HHS. https://www.hhs.gov/about/news/2020/06/16/ fact-sheet-explaining-operation-warp-speed.html (accessed September 17, 2020)
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https://www.kff.org/coronavirus-covid-19/issue-brief/state-data-and-policy-actions-to address-coronavirus (accessed September 17, 2020)
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2009. Cardio metabolic health disparities in native Hawaiians and other Pacific Islanders.
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Kaiser Family Foundation. https://www.kff.org/medicaid/issue-brief/covid-19-and-workers-at risk-examining-the-long-term-care-workforce (accessed September 17, 2020)
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