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#c19vaxequity

Vaccine Allocation

and Social Justice

DAY 1

DEC 4, 2020

Three sessions from

10:30 am - 2:30 pm

EASTERN STANDARD TIME

WEB CONFERENCE

9:00 am - 11:30 am

EASTERN STANDARD TIME

DAY 2

DEC 9, 2020

WEB CONFERENCE

 

ABOUT THE EVENT

Safe and effective Covid-19 vaccines are now potentially within reach. Yet, because of production bottlenecks and other constraints, for months, supply will not meet demand. Rationing will be inevitable. A major theme in emerging policy guidance is that vaccines should be allocated in ways that reduce inequities. More concretely, vaccine allocation needs to respond directly to the fact that disadvantaged groups—and especially racial and ethnic minorities—have been hit much harder by Covid-19 in terms of unemployment, illness, and deaths compared to the more privileged white majority.  How can federal and state policy makers ensure vaccine allocation reduces inequities and contributes to social justice as they scramble to prepare for allocation efforts that are unprecedented in their logistical complexity?

 

To advance debate and planning, policy makers, public health workers, community leaders, activists, researchers, reporters, and the general public are invited to hear from leading experts about concrete steps that can be taken to dramatically improve the chances of equitable vaccine allocation. Of particular focus is ensuring that vulnerable groups that have often experienced—and experience—structural racism and other forms of systemic injustice are central to this effort.

 

The co-hosts 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, invite you to a 4-part symposium and seminar series on two days.

 

DECEMBER 4, 2020

SESSION 1 - Practical, legal, and ethical ways of allocating vaccines equitably using novel approaches: an overview

How statistical measures of disadvantage can help prioritize disadvantaged populations at the national and sub-national level

 

SESSION 2 - Addressing challenges in distribution and uptake

An update on vaccine development, allocation implementation, and overcoming widespread vaccine hesitancy

SESSION 3 - In the midst of scarcity: how leaders are preparing systems for equitable vaccine allocation

An introduction to States' and other jurisdictions' plans to address disadvantage in vaccine allocation, including practical aspects of data integration

 

DECEMBER 9, 2020

 

SESSION 4 - Social justice and domestic vaccine allocation: Perspectives from a global advisory committee, funding body, and low- middle- and high-income countries

An interactive discussion of how social justice is being considered in low middle and high income countries under constraints of the realpolitik of health policy  

DEC 4, 2020

SESSION 1

10:30 - 11:55 am EST

Practical, legal, and ethical ways of allocating

vaccines equitably using novel approaches: an overview

Sessions Stage

Welcome

Why allocating in ways that reduces, rather than maintains (or worse, exacerbates), inequities matters now

Saad Omer, Advisor, Strategic Advisory Group of Experts on Immunization (SAGE), World                                 Health Organization

Michelle Williams, Dean, Harvard T.H. Chan School of Public Health

Practical and legal aspects of using different statistical measures of disadvantage

Lawrence Gostin, Director, O'Neill Institute for National and Global Health Law

Read the paper

How different adjustments to allocation frameworks impact vaccine distribution to disadvantaged populations

Parag Pathak, Professor of Economics, MIT

M Utku Ünver, Professor of Economics, Boston College

Tayfun Sönmez, Professor of Economics, Boston College

Read the paper

Read the paper

Read the paper

Normative reference points for pragmatic adjustments

Harald Schmidt, Assistant Professor of Medical Ethics & Health Policy, University of Pennsylvania

Read the paper

Read the paper

Slides

Session Closing & Next Steps

SESSION 2

12:00 - 1:00pm EST

Addressing Challenges in Distribution and Uptake

Addressing Challenges in Distribution and Uptake (Panel discussion)

Dayna Bowen Matthew, Dean, George Washington University School of Law

Caroline Johnson, Deputy Health Commissioner, City of Philadelphia

Nicole Lurie, Strategic Advisor to the CEO, Coalition for Epidemic Preparedness Initiatives

Paul Offit, Director of the Vaccine Education Center, Children's Hospital of Philadelphia

Alison Buttenheim, Director of Engagement, Leonard Davis Institute of Health Economics

SESSION 3

1:05 - 2:30 pm EST

In the Midst of Scarcity: How Leaders are Preparing Systems for Equitable Vaccine Allocation

Opening

Atul Gawande, Founder and Chair, Ariadne Labs

States and other jurisdictions’ initial vaccine allocation plans

Rebecca Weintraub, Assistant Professor, Harvard Medical School, Ariadne Labs

Kate Miller, Senior Scientist, Ariadne Labs

Read the paper

 

The ethical framework of the Advisory Committee on Immunization Practices

Nancy McClung, Epidemiologist, CDC Vaccine Task Force

Equity and vaccine allocation – ASTHO perspective 

Mary Ann Cooney, VP, Health Equity, Association of State and Territorial Health Officials

Equity and vaccine allocation – State perspective: Tennessee

Michelle D. Fiscus, Medical Director,  Vaccine-Preventable Diseases and Immunization Program, Tennessee Department of Health

Slides

 

Equity and vaccine allocation – State perspective: California 

Erica Pan, Acting State Health Officer, California State 

Equity and vaccine allocation – State perspective: Illinois

Heidi Clark, MPH , Chief, Division of Infectious Diseases, Office of Health Protection, Illinois Department of Public Health

Closing

Rebecca Weintraub, Assistant Professor, Harvard Medical School, Ariadne Labs

Slides

 
 
 
 

DEC 9, 2020

SESSION 4

9:00 - 11:30 am EST 

Social Justice and domestic vaccine allocation: perspectives from a global advisory body, low- middle- and high-income countries, and a funding agency

Opening  

Kjell Arne Johannson, Chair, International Society for Priorities in Health

Harald Schmidt, Assistant Professor of Medical Ethics & Health Policy, University of Pennsylvania

Slides

National Equity and WHO SAGE Guidance

Ruth Faden, Advisor, Strategic Advisory Group of Experts on Immunization (SAGE), World                               Health Organization

United Kingdom

Arzoo Ahmad, Research OfficerNuffield Council on Bioethics

Miqdad Asaria, Assistant Professorial Research Fellow, LSE Health

India

Priyadarshini  Chidambaram, Madras Medical College

Anant Bhan, Adjunct Professor and Researcher, Yenepoya University

Equity and supply chain management

Prashant Yadav, Senior Fellow, Center for Global Development

Funding agency
Austen Davis, Senior Advisor, Global Health Section, NORAD

 

Closing

Rebecca Weintraub, Assistant Professor, Harvard Medical School, Ariadne Labs

 

SESSION RECORDINGS

December 4, 2020 

Sessions 1 & 3

December 9, 2020 

Sessions 4

 

SPEAKERS

Updates in progress - All speakers listed in Agenda above are confirmed

Want to ask a question to our speakers? Submit ahead of the event through this form

Michelle Williams

 

Dean of the Faculty,

Harvard T.H. Chan School of Public Health

 

Professor in Public Health & Intl. Development

Harvard T.H. Chan School of Public Health

      Harvard Kennedy School

Saad Omer

Member,

World Health Organization

Strategic Advisory Group of Experts (SAGE) Working on Covid-19 Vaccines

Director,

Yale Institute for Global Health 

Professor of Medicine, 

Yale University

Lawrence Gostin

 

University Professor,

Georgetown Law

Faculty Director,

O'Neill Institute

Mirzan Kiros

Parag Pathak

 

Professor of Economics, MIT

 

Co-director and Founder,

NBER Working Group on Market Design

Tayfun Sönmez

 

Professor of Economics,

Boston College

M. Utku Ünver

 

Professor of Economics,

Boston College

Harald Schmidt

 

Assistant Professor of Medical Ethics & Health Policy

University of Pennsylvania

Senior Fellow,

Leonard Davis Institute

Dayna Bowen Matthew

 

Dean,

George Washington University School of Law

Professor of Law,

George Washington University 

Caroline Johnson

 

Deputy Health Commissioner,

Dept. of Health, City of Philadelphia

Acting Director,

Division of Disease Control, Philadelphia Dept. of Public Health 

Nicole Lurie

 

Strategic Advisor to the CEO,

Coalition for Epidemic Preparedness Initiatives

Former Asst. Secretary for Preparedness & Response,

Department of Health and Human Services

Paul Offit

 

Director,

Vaccine Eduction Center

Professor of Pediatrics, 

Division of Infectious Diseases,

Children's Hospital of Philadelphia

Alison Buttenheim

 

Associate Professor of Family & Community Health,

University of Pennsylvania

Director of Engagement,

Penn LDI

Scientific Director,

Center for Health Incentives & Behavioral Economics

Atul Gawande 

 

Founder and Chair,

Ariadne Labs

Professor,

Harvard T.H. Chan School of Public Health

Harvard Medical School

Rebecca Weintraub

 

Assistant Professor of Medicine, 

Harvard Medical School 

Associate Physician,

Brigham & Women's Hospital

Associate Faculty,

Ariadne Labs

Kate Miller

Senior Scientist, Ariadne Labs

Nancy McClung

 

Epidemiologist, 

CDC Vaccine Task Force

Mary Ann Cooney

VP, Health Equity,

Association of State and Territorial Health Officials

Michelle Fiscus

 

Medical Director,

Vaccine-Preventable Diseases and Immunization Program,

Tennessee Department of Health

Erica Pan

 

Acting State Health Officer, 

California State

 

Epidemiologist, Deputy Director,

Center for Infectious Diseases, 

California Department of Public Health

Heidi Clark

 

Chief,

Division of Infectious Diseases,

Office of Health Protection,

Illinois Department of Public Health

Kjell Arne Johannson

 

Chair,

International Society for Priorities in Health

Professor,

University of Bergen

Bergen Center for Ethics & Priority Setting

Ruth Faden

Member,

World Health Organization

Strategic Advisory Group of Experts (SAGE) Working on Covid-19 Vaccines

Founder,

Berman Institute

Professor of Biomedical Ethics,

Johns Hopkins University

Priyadarshini Chidambaram 

 

Madras Medical College

Anant Bhan 

 

Adjunct Professor and Researcher,

Yenepoya University

Arzoo Ahmed

 

Research Officer,

Nuffield Council on Bioethics

Miqdad Asaria

 

Assistant Professorial Research Fellow,

LSE Health

Prashant Yadav

 

Senior Fellow,

Center for Global Development

Affiliate Professor of Technology & Operations Management

INSEAD

Austen Davis

 

Senior Advisor,

Global Health Section

Norwegian Agency for Development Cooperation (NORAD)

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GENERAL

RESOURCES

1. APM Research Lab. The color of coronavirus: covid-19 deaths by race and ethnicity in the US. 2020.

2. Ariadne Labs and Surgo Foundation's Vaccine Allocation Planner

3. The CDC’s Social Vulnerability Index (SVI)

 

4. The Area Deprivation Index (ADI)/Neighborhood Atlas

 

5. Surgo Foundations’ Community Vulnerability Index (CCVI)

6. Ariadne Labs/Center for Global Development COVID- 19 Predictions 

 

RESEARCH

Multi-criteria framework, focused on maximizing benefits. Suggests in broad overview guidance that the total number of lives saved, and the total number of lives saved should simultaneously receive the highest priority and that worst-off groups should be prioritized only insofar as this aligns with maximizing benefits.

Sets out an ethical framework emphasizing the common good, the importance of treating individuals fairly and promoting social equity (for example by addressing racial and ethnic disparities in COVID mortality), and the promotion of legitimacy, trust and a sense of community ownership over vaccine policy, while respecting the diversity of values and beliefs in our pluralist society. 

 

Analyzes the consequences of rationing medical resources through a reserve system, in which resources are placed into multiple categories. Argues that the approach can guide allocations in ways that  reflect different ethical values between these categories, and offers a middle-ground approach that balances competing objectives.

 

Argues that economically, epidemiologically, and ethically, worse-off communities should prioritized in allocating safe and effective vaccines, using a statistical measure of disadvantage.

 

High-level expert report, noting that, regarding within-country allocation, a narrow focus on maximizing utility can perpetuate and even exacerbate existing injustices, highlights that health equity requires reducing unjust disparities in allocating vaccines.

 

High-level expert report to advise the CDC’s ACIP on equitable allocation: establishes a risk-based framework that leads to a 4-phases allocation framework with specific subpopulations. Recommends that “In each population group, vaccine access should be prioritized for geographic areas identified through CDC’s Social Vulnerability Index or another more specific index.”

 

Outlines significance of NASEM and WHO’s SAGE recognition to focus not just on maximizing benefits, but also on the distribution of benefits, and discusses differences among in-principle usable disadvantage indices.

 

Notes that using a statistical index to prioritize worse-off minorities is likely to be challenged legally, and that it would be safer to use an index that does not include race, but is likely to achieve  the same outcome.

Update on ACIP’s ethical framework, comprising maximizing benefits and minimizing harms; equity; justice; fairness and transparency. Notes that equity demands to reduce, rather than increase, health disparities in each phase of vaccine distribution.

 

Quantifies what number of minorities would be prioritized using SVI, SVI with the race variable removed, or ADI. Surfaces a dilemma in that the legally safer standard prioritizes fewer worse-off minorities.

 

Presents data showing that shares of worse-off population are not equal in the US’s states. Allocating vaccines proportionate to population therefore increases scarcity for worse-off populations in states where they account for an above-average share. Shows that a 10% reserve taken from the national level benefits worse-off groups more than a 10% reserve set aside at the level of each state.

Articulates 4 principles: Maximize benefits and minimize harms, Promote justice, Mitigate health inequities, Promote transparency that are integrated with epidemiological and implementation-related considerations to establish priorities for health care personnel, other essential workers, adults with high-risk medical conditions, and adults older than 65 years. Notes that “Vaccine allocation strategies should aim to both reduce existing disparities and to not create new disparities”, but unlike NASEM report, does not propose prioritization within phases by disadvantage. 

Argues that equitable access is essential for achieving sufficient immunization rates, along with transparent, evidence-based strategies to promote COVID-19 acceptance (generating demand for the vaccine, allocating the vaccine, distributing the vaccine, and verifying coverage). 

Reviews initial allocation plans of CDC's 64 jurisdictions. Finds that 19 states use a disadvantage index five types of equity goals: 1) to prioritize disadvantaged groups directly, 2) to define priority groups in phased systems, 3) to plan tailored outreach and communication, 4) to plan the location of dispensing sites and 5) to monitor uptake. Argues that planners at the federal, state and local levels should carefully consider on what grounds they decline to adopt equity measures that other planners deem important and feasible.

For additional resources, see the International Society for Priorities in Health's Resource List

HOSTS

International Society for

Priorities in Health