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Pages 1-22

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From page 1...
... Vaccination against this novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) , offers the possibility of significantly reducing severe morbidity and mortality and transmission when deployed alongside other public health strategies (e.g., non-pharmaceutical interventions and better diagnostic tests)
From page 2...
... If we have learned anything from this pandemic, it is that we are inevitably all in this together. Current evidence has shown how COVID-19 disproportionately affects particular racial and ethnic minority groups, including Black, Hispanic or Latinx, American Indian and Alaska Native, and Native Hawaiian and Pacific Islander communities.
From page 3...
... . 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 4...
... reported to the Centers for Disease Control and Prevention between mid-February and the end of July 2020 were people from Black, Hispanic and Latinx, or American Indian and Native Alaskan communities. 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.
From page 5...
... A FRAMEWORK FOR EQUITABLE ALLOCATION OF COVID-19 VACCINE Foundational Principles, Goal, and Allocation Criteria The committee based its framework for equitable allocation of COVID-19 vaccine on current evidence, recognizing its uncertainties and the need for flexibility as evidence emerges and medical realities change. The framework's foundational principles guide its goal, allocation criteria, and allocation phases (see Figure S-1)
From page 6...
... transmitting SARS-CoV-2 infection to others Foundational Principles Ethical Principles: Maximum Benefit; Equal Concern; Mitigation of Health Inequities Procedural Principles: Fairness; Transparency; Evidence-Based FIGURE S-1 Major elements of the framework for equitable allocation of COVID-19 vaccine. To ensure that the allocation framework is equitable and can be seen as equitable, the committee designed its framework so that it (1)
From page 7...
... Guided by these foundational principles, the goal of the committee's framework for equitable allocation of COVID-19 vaccine is to: Reduce severe morbidity and mortality and negative societal impact due to the transmission of SARS-CoV-2. The framework pursues that goal while mitigating health inequities, showing equal concern for all, being fair and transparent, and building on the best available evidence.
From page 8...
... Chapter 4 describes how the allocation process can adapt to plausible scenarios involving these factors. Allocation Phases In light of the foundational principles, goal, and allocation criteria, the committee recommends a four-phased approach to equitable COVID-19 vaccine allocation (see Figure S-2 and described in detail in Chapter 3)
From page 9...
... . The evidence clearly shows that people of color -- specifically Black, Hispanic or Latinx, American Indian and Alaska Native, and Native Hawaiian and Pacific Islander -- have been disproportionately impacted by COVID-19, with higher rates of severe morbidity, mortality, and transmission.
From page 10...
... 10 Phase 1 Phase 2 Phase 3 Phase 4 Phase 1a "Jumpstart Phase" • K–12 teachers and school staff and • Young adults • Everyone residing • High-risk health child care workers • Children in the United States workers • Critical workers in high-risk who did not have • Workers in industries access to the • First responders settings -- workers who are in and occupations vaccine in previous industries essential to the function Phase 1b important to the phases ing of society and at substantially • People of all ages functioning of society higher risk of exposure with comorbid and and at increased risk of underlying conditions that • People of all ages with comorbid and exposure not included put them at underlying conditions that put them in Phase 1 or 2 significantly higher risk at moderately higher risk • People in homeless shelters or • Older adults living in group homes for individuals with congregate or overcrowd disabilities, including serious mental ed settings illness, developmental and intellec tual disabilities, and physical disabilities or in recovery, and staff who work in such settings • People in prisons, jails, detention centers, and similar facilities, and staff who work in such settings • All older adults not included in Phase 1 Equity is a In each population group, vaccine access should be prioritized crosscutting for geographic areas identified through CDC's Social Vulnerability consideration: Index or another more specific index. FIGURE S-2 A phased approach to vaccine allocation for COVID-19.
From page 11...
... older adults living in congregate or overcrowded settings. CDC currently lists the following comorbid conditions as associated with increased risk of severe COVID-19 disease: cancer, chronic kidney disease, chronic obstructive pulmonary disease, immunocompromised state from solid organ transplant, obesity (body mass index ≥30)
From page 12...
... It would be useful for public health agencies, including CDC, the Occupational Safety and Health Administration, the Mine Safety and Health Administration, and state and local public health agencies, to provide additional guidance in the designation of jobs or tasks involved as well as occupational codes or job titles in this group. Phase 2 includes people of all ages with comorbid and underlying conditions that put them at moderately higher risk, which the committee defined as having one of the previously mentioned conditions and potentially some rare diseases as well.
From page 13...
... authorities should adopt the eq uitable allocation framework set out in the committee's report in the development of national and local guidelines for COVID-19 vaccine allocation. The guidelines should adhere to the foundational principles, goal, allocation criteria, and allocation phases described in the com mittee's report and seek to maximize benefit, mitigate health inequities, manifest equal regard for all, be fair and transparent, and build on the best current evidence.
From page 14...
... Food and Drug Administration, NIH, the Health Resources and Services Administration, and the Centers for Medicare & Medicaid Services. Secure vaccine storage, transport, and safe, efficient, and equitable vaccine distribution are critical to a successful national COVID-19 vaccination program, especially given the potential vaccine ultracold chain requirements and a multi-dose vaccine regimen.
From page 15...
... public health mass vaccination clinics are federally supported and funded to provide vaccinations at no cost to individuals being vaccinated, which is particularly important for reaching popula tions that do not have insurance. Specific action steps to implement this recommendation are as follows: •  Apply Patient Protection and Affordable Care Act regulations re garding no cost sharing for preventive services for COVID-19 vac cinations for insured individuals, while addressing instances where these regulations fail to protect the beneficiary from out-of-pocket costs.
From page 16...
... Employers and unions could support improved access by providing work-site clinics and by covering costs for employees. As part of community engagement, the ethical principles, implementation processes, expected outcomes, and how well the program has achieved equitable allocation of safe and effective COVID-19 vaccine actual performance must be transparently communicated.
From page 17...
... The program should: •  Ensure public understanding of the foundational principles, proce dures, expected outcomes, and performance of vaccination efforts, including changes in response to research, experience, and public input. •  informed by the concerns and beliefs, as revealed by surveys, Be news media, public discourse, and social media channels, with spe cial attention to information gaps and misinformation.
From page 18...
... •  Partner with diverse stakeholders (e.g., health care providers, His torically Black Colleges and Universities research centers, Hispanic Association of Colleges and Universities, Tribal Colleges and Univer sities research centers, social marketing firms and other groups with specific expertise reaching underserved communities) and prioritize promoting the vaccine to Black, Hispanic or Latinx, American In dian and Alaska Native, Hawaiian Native and Pacific Islander, and other communities in which vaccine hesitancy and skepticism have been documented.  •  Engage thought and opinion leaders, such as celebrities, to help promote COVID-19 vaccination acceptance and uptake.
From page 19...
... Specific action steps to implement this recommendation include: •  Support innovation in vaccine promotion at the state, tribal, local, and territorial levels and among community-based organizations through existing and expanded program grant mechanisms, with an emphasis on supporting existing entities, programs, and infrastruc ture with community knowledge and expertise; and on expanding CDC's existing Vaccinate with Confidence programs. •  Support a new rapid response research grant mechanism to advance the science of COVID-19 vaccine acceptance through grants that: °  and community-basedresearch entities, public health agen Foster partnership among cies, organizations; Evaluate existing or novel theory-driven strategies and inter ° ventions to decrease COVID-19 vaccine hesitancy, increase COVID-19 vaccine uptake, and eliminate social, cultural, logis tic, and legal barriers to COVID-19 vaccination in focal popula tions; and ° Support approaches, with anin diverse on novel approaches and  research grounded theoretical and method ological emphasis data sources.
From page 20...
... A total of 156 economies, representing more than two-thirds of the global population, are now either committed to or eligible for the COVAX Facility -- with more to expected to follow. Although the United States is not currently among those countries, the report discusses the reasons favoring its participation, including COVAX serving as an insurance policy to OWS, should the vaccine that it is supporting prove less effective or less available than hoped; the recognition that infectious disease threats do not respect international boundaries; the need for domestic preparedness and national security; and the moral duty to support it.
From page 21...
... • Provide and administer COVID-19 vaccine with no out-of-pocket costs for those being vaccinated. • Create and appropriately fund a COVID-19 vaccine risk communication and community engagement program.


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