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1 Introduction
Pages 23-58

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From page 23...
... 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
From page 24...
... , 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)
From page 25...
... 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)
From page 26...
... 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.
From page 27...
... 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.
From page 28...
... 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.
From page 29...
... . 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)
From page 30...
... . 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)
From page 31...
... 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)
From page 32...
... 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.
From page 33...
... . 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)
From page 34...
... . 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)
From page 35...
... . 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)
From page 36...
... 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)
From page 37...
... . 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.
From page 38...
... • 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.
From page 39...
... . 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)
From page 40...
... , 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.
From page 41...
... , 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
From page 42...
... . 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)
From page 43...
... . 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.
From page 44...
... 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)
From page 45...
... 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.
From page 46...
... . 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)
From page 47...
... 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)
From page 48...
... 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)
From page 49...
... . Some of this enormous financial risk is being mitigated by advance-purchase agreements with countries for promising vaccine candidates (Furlong, 2020)
From page 50...
... 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.
From page 51...
... 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.
From page 52...
... 2018. Health disparities among American Indians/Alaska Natives -- Arizona, 2017.
From page 53...
... Morbidity and Mortality Weekly Report. https://www.cdc.gov/mmwr/volumes/69/wr/mm6937e4.htm (accessed September 17, 2020)
From page 54...
... https://www. cdc.gov/socialdeterminants/about.html (accessed September 21, 2020)
From page 55...
... https://www.gao.gov/products/GAO-20-583SP (accessed September 17, 2020)
From page 56...
... Nature 580. https://www.nature.com/articles/d41586-020-01063-8 (accessed September 17, 2020)
From page 57...
... 2009. Cardio metabolic health disparities in native Hawaiians and other Pacific Islanders.
From page 58...
... 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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