Lack of equity among priority groups leaves most vulnerable from Covid-19 without vaccine, analysis finds

By assessing known clinical risk factors, such as obesity, as well as measures of the health effects of living environment factors, such as air quality and access to fresh food, in the As part of the recommendations of the Federal Priority Immunization Group, the company was able to more precisely identify the most vulnerable individuals in the state and counties in which they live.

According to the analysis, dozens of counties in California are lacking sufficient doses to serve the state’s most vulnerable people under federal leadership alone. Los Angeles County, for example, is said to have a shortfall of nearly 405,000 doses.

Expanding these results to the 10 largest states shows that about a third of counties would miss doses relative to the number of most vulnerable residents – and that about 5 million doses could have a deeper impact in the fight against Covid-19 if reassigned to a different county.

“Without a surgical approach to distributing the vaccine, more Americans – often in communities of color and rural areas – are at risk of being left behind,” Gary Velasquez, CEO of Cogitativo, told CNN. “The key is to use a combination of real clinical data and social determinants of health to surgically assess who is most at risk. This approach may help states avoid acute deficits in some countries.”

Equity in vaccine distribution

Experts CNN spoke to agreed that allocations should be more nuanced than the share of the population belonging to a certain priority group. For example, not all people over 65 are at the same level of risk for Covid-19, although a county with more people in that age group may receive more vaccines.

“The quickest and quickest approach to saving the most lives and ending this increasingly rapid pandemic must go hand in hand with understanding the conditions under which people live, work, are educated and more. “Dr. Kedar Mate, president of the Institute for Improved Healthcare, told CNN. Mate was not involved in the Cogitativo analysis. “The social determinants of health have a very significant effect on the trajectory of this pandemic.”

Equity is at the heart of the Biden administration’s plan to distribute vaccines through federally qualified health centers and FEMA sites, and dozens of states have adapted the federal framework for their own distribution plans. , many specifically adding elements of fairness to the equation.

But it has been a national struggle to get it right.

In the coming weeks, California specifically plans to revamp its vaccine allocation plan to address concerns about fairness in deployment.

Currently, California assigns doses to local health departments proportionately based on their share of the state’s eligible population. Along with health workers, the state extended the priority to all people aged 65 or older, so that a county with twice as many people in that age group as another would receive twice. more doses.

A new formula would assign doses directly to providers in an attempt to provide coverage to neighborhoods that need it most. The goal is to reach disproportionately affected communities that the current system is not adequately reaching, Darrel Ng, senior communications adviser for the state’s vaccine task force, told CNN.

“ Difficult to prescribe ” at the national level

Experts CNN spoke to said the federal guidelines give a good idea of ​​how to start the vaccination process.

But, they said, adjustments can be made locally as more is learned along the way, particularly focusing on groups most susceptible to the virus and performing poorly.

“It’s difficult to prescribe this nationally,” Mate told CNN. “Every state and region needs to do some personalization based on local experience.

Local health services are well aware of the pockets of populations at risk in communities, as well as the vulnerabilities in themselves and in their environment that put them at risk.

They are “ideally positioned to be the backbone of equitable distribution,” said Lori Tremmel Freeman, executive director of the National Association of County and City Health Officials.

But some local leaders say it’s hard to focus on fairness when supply is so limited.

“Without more supply, and without stable and predictable information on future supply levels, it is difficult to ensure that we can quickly and fairly immunize those most at risk,” Santa Clara County officials said. , in California.

According to Cogitativo’s analysis of counties in the 10 largest states, Santa Clara has the third largest vaccine dose deficit in the 10 largest states. Analysis suggests the county could receive up to 175,000 more doses than it would under federal leadership alone, due to its relatively large vulnerable population at risk due to weak social determinants of health. .

“In many cases, counties have too limited an supply to have a more in-depth equity strategy,” Freeman said. “We hear it all the time. Some counties are only getting 100 doses of vaccine per week and are doing their best to analyze that among the priority groups.”

Others say it can be difficult to argue for even more precise prioritization – especially when demand has so far outweighed supply – but it helps remind people of a common goal.

In Texas, the state government has rejected a plan proposed by Dallas to prioritize vaccinating people in certain zip codes. Ultimately, the state and county worked together and were able to prioritize based on socioeconomic status and the spread of cases in the community, but not for specified zip codes.

“Because of the very limited supply, we wanted to have the greatest impact with the precious amount we had,” Dr. Philip Huang, director of the Dallas County Department of Health, told CNN.

And there is a more targeted prioritization. Federal vaccination initiatives conducted in tandem with state plans can help deliver the vaccine to more people. The FEMA-run vaccination sites in Dallas target people living in the 17 zip codes that local leaders have helped prioritize.

Still, Dallas only receives about 9,000 doses of the Covid-19 vaccine each week. There are over 650,000 people on the waiting list.

“You do the math. It’s going to take a while,” Huang said. “We all want everyone to get it as soon as possible. The better we are able to show that we are reaching those most at risk of suffering, the better we will achieve this goal.”