#c19vaxequity

Vaccine Allocation

and Social Justice

WEB CONFERENCE

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.

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DECEMBER 4, 2020

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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

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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

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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

SESSION 2

12:00 - 1:00pm EST

Addressing Challenges in Distribution and Uptake

SESSION 3

1:05 - 2:30 pm EST

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

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

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

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Member,

World Health Organization

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

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Director,

Yale Institute for Global Health 

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Professor of Medicine, 

Yale University

Lawrence Gostin

University Professor,

Georgetown Law

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Faculty Director,

O'Neill Institute

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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​

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M. Utku Ünver

Professor of Economics,

Boston College

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Atul Gawande 

Founder and Chair,

Ariadne Labs​

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Professor,

Harvard T.H. Chan School of Public Health

Harvard Medical School

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Nancy McClung

Epidemiologist, 

CDC Vaccine Task Force

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

Priyadarshini Chidambaram 

Madras Medical College

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GENERAL

RESOURCES

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

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

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

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

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5. Surgo Foundations’ Community Vulnerability Index (CCVI)

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

RESEARCH

• Emanuel, Ezekiel J., Govind Persad, Ross Upshur, Beatriz Thome, Michael Parker, Aaron Glickman, Cathy Zhang, Connor Boyle, Maxwell Smith, and James P. Phillips. "Fair allocation of scarce medical resources in the time of Covid-19." (2020): 2049-2055.

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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.

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• Toner E, Barnill A, Krubiner C, et al. Interim Framework for COVID-19 Vaccine Allocation and Distribution in the United States. Baltimore, MD: Johns Hopkins Center for Health Security; 2020

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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. 

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• Pathak PA, Sönmez T, Ünver MU, Yenmez MB. Fair allocation of vaccines, ventilators and antiviral treatments: leaving no ethical value behind in health care rationing. arXiv:2008.00374  [econ.TH]. [Preprint]. 2020

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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.

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• Schmidt, Harald, “ Vaccine Rationing and the Urgency of Social Justice in the Covid‐19 Response” Hastings Center Report  50 (2020):  46– 49. DOI: 10.1002/hast.1113

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

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• World Health Organization. WHO SAGE values framework for the allocation and prioritization of COVID-19 vaccination. 14 Sep 2020. 

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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.

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• National Academies of Sciences, Engineering, and Medicine. Framework for equitable allocation of covid-19 vaccine. 2020.

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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.”

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• Schmidt Harald, Pathak Parag, Sönmez Tayfun, Ünver M Utku. Covid-19: how to prioritize worse-off populations in allocating safe and effective vaccines   BMJ  2020;  371 :m3795

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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.

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• Schmidt H, Gostin LO, Williams MA. Is It Lawful and Ethical to Prioritize Racial Minorities for COVID-19 Vaccines?  JAMA. Published online October 14, 2020. doi:10.1001/jama.2020.20571

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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.

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• Bell BP, Romero JR, Lee GM. Scientific and Ethical Principles Underlying Recommendations From the Advisory Committee on Immunization Practices for COVID-19 Vaccination Implementation. JAMA. 2020 Oct 22.

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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.

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• Schmidt, Harald and Unver, Utku and Williams, Michelle A. and Pathak, Parag A. and Sonmez, Tayfun Oguz and Gostin, Lawrence O., What prioritizing worse-off minority groups for COVID-19 vaccines means quantitatively: practical, legal and ethical implications 

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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.

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• Schmidt, Harald and Pathak, Parag A. and Williams, Michelle A. and Sonmez, Tayfun Oguz and Unver, Utku and Gostin, Lawrence O., Rationing Safe and Effective COVID-19 Vaccines: Allocating to States Proportionate to Population May Undermine Commitments to Mitigating Health Disparities (November 12, 2020). SSRN Working paper 

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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.

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• McClung N, Chamberland M, Kinlaw K, et al. The Advisory Committee on Immunization Practices’ Ethical Principles for Allocating Initial Supplies of COVID-19 Vaccine — United States, 2020. MMWR Morb Mortal Wkly Rep 2020;69.

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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. ​

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• ​Weintraub RL, Subramanian L, Karlage A, Ahmad I, Rosenberg J. COVID-19 Vaccine To Vaccination: Why Leaders Must Invest In Delivery Strategies Now: Analysis describe lessons learned from past pandemics and vaccine campaigns about the path to successful vaccine delivery for COVID-19. Health Affairs. 2020 Nov 19:10-377  

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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). 

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• ​Harald Schmidt, Rebecca Weintraub, Michelle A. Williams, Alison Buttenheim, Emily Sadecki, Helen Wu, Aditi Doiphode, Lawrence O. Gostin, Angela A. Shen. Equitable Allocation of Covid-19 Vaccines: An Analysis of the Initial Allocation Plans of CDC's Jurisdictions with Implications for Disparate Impact Monitoring. SSRN working paper, December 1.  

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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.

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

HOSTS

International Society for

Priorities in Health