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Symposium: Vaccine Allocation and Social Justice

Ariadne Labs and partners hosted the first part of a multi-part online symposium, “Vaccine Allocation and Social Justice,” on Dec. 4 to explore concrete steps that public health leaders can take to dramatically improve the chances of equitable COVID-19 vaccine allocation. The symposium, which featured experts in public health policy, economics, medical ethics and epidemiology, underscored how “good equity starts with good facts.” 

Learn more about the speakers and see a video of the Dec. 4 session here.

Michelle A. Williams, dean of Harvard’s T.H. Chan School of Public Health, introduced the symposium by noting the good news about the rapid development of COVID-19 vaccines but stressed that we must start grappling with logistical issues and identifying “how to distribute in ways that reduce inequality as opposed to exacerbating inequalities.” 

Rebecca Weintraub, MD, who leads Ariadne Labs Vaccine Delivery initiative and is Director of Ariadne Labs’ Better Evidence program, helped organize the symposium; she has worked with the Surgo Foundation on the Vaccine Allocation Planner for COVID-19. 

Ariadne Labs Chair Atul Gawande, MD, MPH, opened the third and final session of the day, “How leaders are preparing systems for equitable vaccine allocation,” and singled out public health and front-line workers for praise during the COVD-19 pandemic. “If we are going to demonstrate a working and equitable vaccine allocation — where the bus driver is prioritized ahead of bankers — we need a fair system and one simple enough for the public to understand,” Gawande said. 

Kate Miller, PhD, MPH, a senior scientist at Ariadne Labs spoke during this session on “States and other jurisdictions’ initial vaccine allocation plans.”  In her talk, Miller described how the research team reviewed each of the 50 states’ vaccine allocation plans with two questions in mind. First: Will states use a vulnerability index, which indicates populations at risk from factors like age, race, and economic status, to plan vaccine allocation? The findings: 19 states indicated they will use an index, while 34 states didn’t mention one, Miller said. 

The second question was: What groups will states vaccinate and in what order? Researchers found “there is a real variety of how people are thinking about this,” Miller said. Some states relied heavily on the CDC playbook. Four states specifically cite racial and ethnic minorities in their plans. Different states sub-prioritize within that first category of health care workers, Miller said. For example, New Mexico would prioritize vaccinators, those who vaccinate others, before other  health workers. 

This information may help health officials collaborate on their approaches, Miller said. She also noticed that plans may have changed, and Ariadne plans on doing another round of reviews. A paper on the research was co-authored by Weintraub, Williams, and colleagues. 

Highlights of the session on “How leaders are preparing systems for equitable vaccine allocation” included:

  • Erica Pan, California acting state health officer, stressed that science alone will not resolve vaccine hesitancy. Health officials may have to play a role as a “trusted messenger.”
  • Michelle D. Fiscus, medical director of Tennessee’s Vaccine-Preventable Diseases and Immunization Program, described strategies for reaching remote rural communities now experiencing a sharp rise in COVID-19 infections. This includes navigating the challenges posed by the requirement some vaccines need to be kept at extremely cold temperatures. About 85 percent of the deaths from COVID-19 are in those over 65 so older people will be prioritized, Fiscus said. 
  • Heidi Clark, chief of the Illinois Division of Infectious Diseases, Office of Health Protection, said her state will model COVID-19 response on lessons learned from a hepatitis A outbreak. We must “meet people where they are” and “utilize trusted providers,” she said. “We can’t plan to just drop into the community and expect them to come to us.”

These presentations were three excellent “examples of adaptive leadership,” said Dr. Weintraub. 

“Vaccine Allocation and Social Justice” is co-hosted by Ariadne Labs, Boston College, the Harvard Chan School of Public Health, the International Society for Priorities in Health, MIT, O’Neil Institute/Georgetown, the University of Pennsylvania’s Department of Medical Ethics and Health Policy, and the Leonard Davis Institute of Health Economics. Part four of the symposium will be held Dec. 9 on “Social justice and domestic vaccine allocation: perspectives from a global advisory body, low- middle- and high-income countries, and a funding agency.” 

The symposium was supported by the Patrick J. McGovern Foundation.

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