Insights from top U.S. vaccine policy experts
Insights from top U.S. vaccine policy experts
February 24, 2021
Alison Buttenheim, Harald Schmidt
As the rollout of the U.S. COVID-19 vaccine program continues and questions remain about how allocation can simultaneously reduce risk and inequity, Penn LDI is convening a new series, COVID Vaccine Equity Research Dialogues (CoVEReD)Hosted by LDI Senior Fellows and vaccine policy experts Alison Buttenheim, PhD, MBA and Harald Schmidt, PhD, MA, the series will bring together top experts to discuss equitable vaccine distribution.
Susan Goold
In the first edition of CoVEReD, Alison and Harald speak with Susan Goold, MD, MHSA, MA of the Institute for Healthcare Policy and Innovation at the University of Michigan about federal guidelines on equitable vaccine distribution. They also review Michigan’s vaccine roll-out, and dig through a recent paper linking the CDC’s Social Vulnerability Index (SVI) to COVID-19 incidence and mortality. 
Please view their video discussion below, along with a brief episode summary. We hope you find this new series informative, and encourage you to share it with your colleagues.
Rachel M. Werner, MD, PhD
Executive Director, Penn LDI

CoVEReD Video
CoVEReD Episode Summary
Our first dialogue reviews emerging disparities in vaccine distribution: African Americans, Hispanic/Latinos, and other minority groups, all of whom have been disproportionately affected by COVID-19, have the lowest vaccination rates. Wealthier areas with lower COVID-19 rates have received the vaccine more easily. Schmidt explains that ACIP’s guidelines to prioritize groups like health care workers and long-term care residents are non-binding and have been adopted to varying degrees by states. Identifying those most in need – particularly the disadvantaged – is essential. Various models have been proposed to identify such groups, including the Social Vulnerability Index and the Area Deprivation Index.
The National Academies of Sciences, Engineering, and Medicine, which drafted the framework for equitable allocation of the vaccine upon which the CDC’s guidance is based, recommended use of a measure like the SVI as a means of prioritizing racial and ethnic minority groups that are likely to face disparities in vaccine access as a result of structural inequalities. Schmidt notes that addressing equity through an index that measures a generalized concept of disadvantage helps directly address the situation of worse-off populations but is not limited to race-based justice. As such, it can avoid legal challenges and recognizes that disadvantage can take many different forms that matter independently. 
Use of vulnerability measures to allocate vaccine doses – as Michigan is currently doing, at least within priority phase – raises questions about the ultimate policy goal: social justice or risk mitigation? While this framing may carry political weight, it is likely a false dichotomy. Social status and COVID risk are, unfortunately, inextricably linked in this country. Goold’s conclusion: we still have a long way to go in this vaccination campaign, and while efficiency is important, it is imperative that we continue to assess and make changes to our distribution strategy as we go to ensure that we are protecting the most vulnerable among us.  
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