In the United States, there are several plans in place to prioritize the distribution of limited vaccine supplies – in December, the US Disease Control and Prevention Centers Advisory Committee on Immunization Practices issued federal guidance on who should be first in line. to receive photos, starting with frontline health professionals and nursing home residents and employees, followed by other essential frontline workers and those aged 75 and over.
But the total number of doses distributed across the country – more than 88 million – is barely enough to cover individuals in these groups with an injection, let alone the second dose needed.
Ultimately, states decide who is first in line to receive the vaccine.
Health data science company Cogitativo analyzed thousands of health insurance claims and local demographic data in California to assess the most predictive and discriminative factors that lead to poor results after Covid-19 infection.
In assessing known clinical risk factors, such as obesity, along with measures of the health effects of living environment factors, such as air quality and access to fresh food, within the recommendations of the federal priority vaccination group, the company was able to more accurately identify the most vulnerable individuals in the state and counties where they live.
According to the analysis, dozens of California counties would lack sufficient doses to serve the most vulnerable people in the state only under federal guidance. Los Angeles County, for example, would have a deficit of almost 405,000 doses.
Expanding these findings to the top 10 states shows that about a third of counties would not have doses in relation to the number of most vulnerable residents – and about 5 million doses could have a deeper impact in the fight against Covid-19 relocated to a different county.
“Without a surgical approach to delivering the vaccine, more Americans – usually 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 determinants of health to surgically assess who is most at risk. This approach can help states avoid acute deficits in certain counties. ”
Equity in vaccine distribution
The experts CNN spoke with agreed that allocations should be more differentiated than the portion of the population that falls into a particular priority group. For example, not all people over 65 face the same level of risk as Covid-19, although a county with more people in that age group may receive more vaccines.
“The quickest and fastest approach to saving the most lives and ultimately ending this pandemic faster and faster has to come with understanding the conditions in which people are living, working, being educated and more” , Dr. Kedar Mate, president of the Institute for Healthcare Improvement told CNN. Mate was not involved in the analysis of Cogitativo. “The social determinants of health have a very significant effect on the path of this pandemic.”
Equity is central to the Biden government’s plan to distribute vaccines through federally qualified and local FEMA health centers, and dozens of states have adapted the federal structure to their own distribution plans, many specifically adding elements of equity to the equation.
But it has been a national struggle to get it right.
In the coming weeks, California specifically plans to overhaul its vaccine allocation plan to address concerns about equity in implementation.
California currently allocates doses to local health departments proportionally based on their share of the state’s eligible population. Along with health personnel, the state has expanded prioritization to all people at least 65 years of age, so a county with twice as many people in this age group as another would receive twice as many doses.
A new formula would allocate doses directly to providers, in an attempt to bring coverage to the neighborhoods that need it most. The goal is to reach affected communities disproportionately that the current system is not reaching adequately, said Darrel Ng, senior communications advisor to the state’s vaccine task force.
‘Difficult to prescribe’ at national level
CNN experts spoke with federal guidelines that 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, especially with a focus on groups that are most susceptible to the virus and poor results with it.
“It is difficult to prescribe this at the national level,” Mate told CNN. “Each state and region has to do some customization based on local experience.
Local health departments are well informed about the pockets of populations at risk in the communities, as well as the vulnerabilities within them and their surroundings that put them at risk.
They are “uniquely positioned to be the backbone behind equitable distribution,” Lori Tremmel Freeman, executive director of the National Association of County and City Health Officials.
But some local leaders say it is difficult to focus on equity when the supply is so limited.
“Without more supply and constant and predictable information about future supply levels, it is a challenge to ensure that we can vaccinate those who are most at risk quickly and equitably,” said Santa Clara County, California officials.
According to the analysis of the Cogitativo of the municipalities in the 10 largest states, Santa Clara has the third largest vaccine dose deficit among the 10 largest states. The analysis suggests that the county could receive up to 175,000 more doses than it would receive under federal guidance alone, due to its relatively large vulnerable population at risk due to poor social determinants of health.
“In many cases, counties are getting a very limited offer to have a deeper equity strategy,” said Freeman. “We are hearing this all the time. Some counties are receiving only 100 doses of vaccine a week and are doing their best to separate this among the priority groups.”
Others say that advocating even more specific prioritization can be difficult – especially when demand so far outstrips supply – but it helps to remind people of a common goal.
In Texas, the state government rejected a plan proposed by Dallas to prioritize vaccinating people within certain zip codes. Ultimately, the state and county worked together and were able to prioritize based on the community’s socioeconomic status and case distribution, but not for specified postal codes.
“Because of the very limited supply, we wanted to make the biggest impact with the precious quantity we had,” Dr. Philip Huang, director of the Dallas County health department, told CNN.
And there is more targeted prioritization going on. Federal vaccination initiatives running in conjunction with state plans can help bring the vaccine to more people. Vaccination sites administered by FEMA in Dallas target people living in the 17 CEPs that local leaders have helped to prioritize.
Still, Dallas receives only about 9,000 doses of the Covid-19 vaccine per week. There are more than 650,000 people on the waiting list.
“You do the math. It will take some time,” said Huang. “We all want everyone to achieve this as quickly as possible. The better we can show that we are reaching people at greater risk of suffering, the better we will achieve that goal.”