National Academies Committee Considers Equitable Allocation of COVID-19 Vaccine

An ad hoc committee of the National Academies of Sciences, Engineering, and Medicine has issued a discussion draft of plans for equitable allocation of vaccines for COVID-19, to serve as a basis for public comment and facilitate plan development and implementation.

The Committee on Equitable Allocation of Vaccine for the Novel Coronavirus, co-sponsored by the CDC and NIH, indicates that the draft provides only a preliminary framework for allocation planning, and that the final report will address such elements as risk communication, mitigation of vaccine hesitancy and global considerations.

The committee is co-chaired by William Foege, MD, MPH, Emeritus Distinguished Professor of International Health, Rollins School of Public Health, Emory University, Atlanta, GA, and Helene Gayle, MD, MPH, president and CEO, The Chicago Community Trust, Chicago, IL.

“Even if one or more safe and effective COVID-19 vaccines under development are tested and quickly approved for use, they are unlikely to be available immediately in amounts sufficient to vaccinate the whole population, despite plans to begin large-scale production of promising vaccines even before trials are completed. As a result, at the outset and in the months to follow, vaccines will almost certainly be available only in limited supplies,” the committee explains.

“In this context, a scarce vaccine or vaccines will need to be allocated in ways that reduce virus transmission and/or reduce morbidity and mortality in order to protect the public’s health and its socioeconomic well-being.”

The tasks for the committee include determining allocation priorities, with identification of appropriate first tier vaccine recipients, and the populations that should be added successively as vaccine supplies increase. Among the factors that the committee is expecting to consider are: health disparities and other health access issues; individuals at higher risk (eg, elderly and those with underlying health conditions); occupations at higher risk (eg, health care workers and essential industries); populations at higher risk (eg, racial and ethnic groups, incarcerated individuals, and residents of nursing homes); geographic distribution of active virus spread; and countries/populations participating in vaccine clinical trials.

The discussion draft presents lessons from previous mass vaccination campaigns. Among examples of programs is Roadmap to Implementing Pandemic Influenza Vaccination of Critical Workforce, developed in 2017 by the CDC and based, in part, on experiences with the 2009 H1N1 pandemic.

Key lessons learned from prior mass vaccination efforts include the need to leverage relationships with professional medical societies and other key stakeholders at the outset. In addition, the issue of rationing at the state, local and practice levels is raised for the possibility of barriers being posed by cost, insurance, or policy.

Other lessons recounted are the need to develop systems for tracking distribution; ensure that ancillary supply distribution is timely and appropriate; and make use of the Vaccines for Children program infrastructure.

The committee also poses the need to promote global regulatory harmonization and standardization in vaccine development, to improve speed, flexibility, and efficiency.

“In addition to lessons learned from prior mass vaccination campaigns, the committee’s deliberations were informed by the goals, principles, and prioritization strategies set forth in guidance and frameworks recently developed for the allocation of scarce resources during the COVID-19 pandemic,” the discussion draft indicates.

A cornerstone of that guidance were ethical discussions, and recommendations that programs endeavor to maintain such fundamental values as maximizing benefit, treating people equally, promoting and rewarding instrumental value (ie, providing benefit to others), and giving priority to the worst-off.

One of the documents prepared by bioethicists that was cited in the discussion draft is a brief from the Working Group on Ethics and COVID-19, convened by the WHO. The WHO group emphasized the need for transparency in formulating allocation decisions and prioritization criteria, including affected groups in the decision making process, being consistent in treatment of all persons in the same categories, and holding decision makers accountable.

The last section of the discussion draft considers the possible political and public health scenarios that may be in place when a vaccine is approved for distribution.

“It is important to emphasize that, whenever they become available, COVID-19 vaccines will be added to an already complex and evolving mix of public health strategies,” the committee observes, and emphasizes “the principle that public policy should be evidence-based is essential to guiding the allocation of scarce countermeasures.”