In the United States, there are several plans to prioritize the distribution of the limited supply of vaccines – in December, the U.S. Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices released federal guidelines on who should be first in line To the shots, starting with primary care health workers and nursing home residents and staff, followed by other primary care essential workers and people 75 and older.
But the total number of doses delivered nationwide – more than 88 million – is barely enough to cover individuals in those groups with one injection, let alone the required second dose.
And ultimately states decide who will be first in line to get a vaccine.
Cogitativo, medical data company, analyzed thousands of health insurance claims and local California demographics to assess the most predictive and discriminatory factors that lead to poor outcomes after a Covid-19 infection.
By assessing known clinical risk factors, such as obesity, along with measures of the health effects of environmental factors, such as air quality and access to fresh food, within the recommendations of the federal vaccination priority group, the company was able to identify the most vulnerable individuals in the state. and the provinces where they live.
According to the analysis, dozens of California counties would not have sufficient doses to serve the most vulnerable people in the state under federal guidance alone. Los Angeles County, for example, is said to be short of nearly 405,000 doses.
Extending these findings to the 10 largest states shows that about a third of the counties would miss doses relative to the number of most vulnerable residents – and about 5 million doses could have a deeper impact in the fight against Covid-19 if they would be reassigned to another province.
“Without a surgical approach to distribute the vaccine, more Americans – often in communities of color and rural areas – are at risk of being left behind,” Cogitativo CEO Gary Velasquez told CNN. “The key is to use a combination of real clinical data and social health determinants to surgically assess who is most at risk. This approach can help states avoid acute deficits in certain countries.”
Equality in the distribution of vaccines
Experts with whom CNN spoke agreed that allocations should be more nuanced than the proportion of the population falling within a particular priority group. For example, not all people over 65 are at the same risk from Covid-19, although a county with more people in that age group may receive more vaccines.
“The fastest and fastest way to save the most lives and ultimately end this pandemic faster and faster must go hand in hand with understanding the conditions in which people live, work, receive education and more,” said Dr. Kedar Mate, President of the Institute. for Healthcare Improvement told CNN. Mate was not involved in the Cogitativo analysis. “Social health determinants have a very significant effect on the course of this pandemic.”
Equality is central to the Biden government’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, with many specifically adding elements of equality to the equation.
But it has been a nationwide struggle to get it right.
In the coming weeks, California specifically plans to review its vaccine allocation plan to address equality concerns in the rollout.
Currently, California allocates doses proportionally to local health departments based on their share of the state’s eligible population. Along with health care personnel, the state has expanded the prioritization to all people who are at least 65 years old, so one county with twice as many people in that age bracket as another would receive twice as many doses.
A new formula would assign doses directly to healthcare providers in an effort to provide coverage to neighborhoods that need it most. The goal is to reach disproportionately affected communities that the current system is not reaching enough for, Darrel Ng, senior communications adviser for the state’s vaccines task force, told CNN.
At a national level ‘difficult to prescribe’
Experts who spoke to CNN with said federal guidelines gave a good idea of how to start the vaccination process.
But, they said, adjustments can be made locally as more is learned, particularly targeting groups most susceptible to the virus and its poor outcomes.
“It’s hard to prescribe that nationally,” Mate told CNN. “Every state and region needs to do some customization based on local experience.
Local health departments are well versed in community groups at risk, as well as the vulnerabilities in themselves and their environment that put them at risk.
They are “uniquely positioned to be the backbone of equitable distribution,” Lori Tremmel Freeman, CEO of the National Association of County and City Health Officials.
But some local leaders say it’s hard to focus on equity when supply is so limited.
“With no more supplies, and stable and predictable information about future supply levels, it’s a challenge to ensure that we can quickly and fairly vaccinate those most at risk,” said a statement from Santa Clara County, California.
According to Cogitativo’s analysis of counties in the 10 largest states, Santa Clara has the third largest vaccine dose shortage in the 10 largest states. The analysis suggests that the province could receive up to 175,000 more doses than under federal guidance alone, due to the relatively large vulnerable population at risk from poor social health determinants.
“In many cases, counties are given too limited a supply to have a deeper strategy for dealing with stocks,” Freeman said. ‘We hear it all the time. Some provinces only receive 100 vaccine doses 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 specific prioritization – especially when demand so far exceeds supply – but it helps remind people of a common goal.
In Texas, the state government rejected a plan proposed by Dallas to prioritize the vaccination of people within certain zip codes. Ultimately, the state and county worked together, and they were able to set priorities based on socioeconomic status and distribution of community affairs, but not for specified zip codes.
“Because of the very limited supply, we wanted to make the biggest impact with the precious amount we had,” said Dr. Philip Huang, director of the Dallas County health department, to CNN.
And there is more targeted prioritization. Federal vaccination initiatives running in tandem with state plans could help get the vaccine to more people. Vaccination sites operated by FEMA in Dallas target people living in the 17 zip codes that helped local leaders prioritize.
Still, Dallas only receives about 9,000 doses of Covid-19 vaccine per week. There are more than 650,000 people on the waiting list.
‘Do the math. It will take a while, ”said Huang. “We all want everyone to get it as soon as possible. The better we can show that we reach the people most at risk of suffering, the better we will achieve that goal.”