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Framework for Equitable Allocation of COVID-19 Vaccine

The framework finalizes four-phased approach that initially prioritizes a limited supply of vaccine doses for high-risk health workers, first responders, people with significant comorbid conditions

The  National Academies of Science, Engineering, and Medicine (NASEM) Committee on Equitable Allocation of Vaccine for the Novel Coronavirus released the finalized for Equitable Allocation of COVID-19 Vaccine (press release).  The framework finalizes four-phased approach that initially prioritizes a limited supply of vaccine doses for high-risk health workers, first responders, people with significant comorbid conditions, and older adults in congregate or overcrowded conditions.

The Committee provides the following recommendations for the application of the framework:

Allocation Framework – On p. 88, the Committee recommends that the Department of Health and Human Services (HHS) and state, tribal, local, and territorial (STLT) governments should adopt the equitable allocation framework when developing national and local guidelines for COVID-19 vaccine allocation. NASEM also notes that the framework is also to inform the Centers for Disease Control and Prevention (CDC) Advisory Committee on Vaccine Practices (ACIP).

Coordination Considerations – Beginning on p. 135, the Committee outlines recommendations for administering and implementing an effective and equitable national COVID-19 vaccination program. Specifically, NASEM recommends that HHS leverage and expand the use of existing systems, structures, and partnerships across all levels of government and provide necessary resources to ensure equitable allocation, distribution, and administration of COVID-19 vaccine. These actions include:

Providing needles, syringes, personal protective equipment, resources for ultra-cold chain management.

Developing the capacity and systems to collect and integrate the necessary data from public health and private providers to facilitate identification and monitoring of people with preexisting conditions.

Establishing a robust and comprehensive surveillance system to monitor, detect, and respond to identified problems, gaps, inequities, and barriers.

Implementing a rigorous COVID-19 safety monitoring program.

Cost Considerations – With regard to cost, the Committee recommends on p. 140 that HHS should coordinate across agencies to ensure that:

A COVID-19 vaccine is available at no cost to the public health and health care sectors and thus free to individuals;

Providers are assured they have the ability to submit for reimbursement of allowable and reasonable administration fees to a third party without cost sharing to individuals; and

Public health mass vaccination clinicals are federally supported and funded to provide vaccinations at no cost to individuals.

Communication and Community Engagement Considerations – Beginning on p. 149, the framework recommends that HHS should create and appropriately fund a COVID-19 vaccination risk communication and community engagement program to support STLT authorities as a part of an effective national COVID-19 vaccination program. Such a program should:

Ensure public understanding of the foundational principles, procedures, expected outcome, and performance of vaccination efforts;

Be informed by the concerns and beliefs of current COVID-19 vaccine attitudes, with special attention to information gaps and misinformation;

Support STLTs in their engagement and partnership with community-based organization and local stakeholders to reach diverse populations;

Rely on transparent, trustworthy assessments of vaccine safety and efficacy.

Vaccine Acceptance Considerations – NASEM recommends that the CDC should develop and launch a national, branded, multi-dimensional COVID-19 vaccine promotion campaign, using rigorous, evidence-informed risk and health communication, social marketing, and behavioral science techniques (p. 161). The CDC and the National Institutes of Health (NIH) should also invest in building an evidence base for effective strategies for COVID-19 vaccine promotion and acceptance.

Global Equitable Allocation – Beginning on p. 175, the Committee recommends that the U.S. government should commit to a leadership role in the equitable allocation of COVID-19 vaccine globally.

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