Fairness and efficiency considerations in COVID-19 vaccine allocation strategies: A case study comparing front-line workers and 65–74 year olds in the United States
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Abstract
The COVID-19 epidemic in the United States has been characterized by two stark disparities. COVID-19 burden has been unequally distributed among racial and ethnic groups and at the same time the mortality rates have been sharply higher among older age groups. These disparities have led some to suggest that inequalities could be reduced by vaccinating front-line workers before vaccinating older individuals, as older individuals in the US are disproportionately Non-Hispanic White. We compare the performance of two distribution policies, one allocating vaccines to front-line workers and another to older individuals aged 65-74-year-old. We estimate both the number of lives saved and the number of years of life saved under each of the policies, overall and in every race/ethnicity groups, in the United States and every state. We show that prioritizing COVID-19 vaccines for 65-74-year-olds saves both more lives and more years of life than allocating vaccines front-line workers in each racial/ethnic group, in the United States as a whole and in nearly every state. When evaluating fairness of vaccine allocation policies, the overall benefit to impact of each population subgroup should be considered, not only the proportion of doses that is distributed to each subgroup. Further work can identify prioritization schemes that perform better on multiple equity metrics.
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SciScore for 10.1101/2022.02.03.22270414: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
NIH rigor criteria are not applicable to paper type.Table 2: Resources
No key resources detected.
Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).
Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:Our analysis is subject to other limitations. First, we focus our analysis on one outcome: deaths. We did not assess the impact of the two vaccination policies on other outcomes such as number of infections, morbidity such as ‘long COVID’, hospitalization or other economic consequences. As it has been show that vaccination strategies …
SciScore for 10.1101/2022.02.03.22270414: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
NIH rigor criteria are not applicable to paper type.Table 2: Resources
No key resources detected.
Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).
Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:Our analysis is subject to other limitations. First, we focus our analysis on one outcome: deaths. We did not assess the impact of the two vaccination policies on other outcomes such as number of infections, morbidity such as ‘long COVID’, hospitalization or other economic consequences. As it has been show that vaccination strategies targeting younger adults can lead to lower number of infections but higher number of deaths 9, it is possible that vaccinating front-line workers would lead to less infections. Second, we assume that the number of deaths occurring after vaccine allocation and roll-out is proportional to the death count up to January 30, 2021 (more exactly is it assumed to be equal to 20% of the cumulative deaths up to that date in each age, race and state combination). We thus assume that the inequalities in infection and mortality rates stay constant over the duration of the pandemic. Third, we only consider the direct effect of vaccination on the vaccinated, and not the indirect effect of vaccination protecting the rest of the population by limiting onward transmission. When this work began, it was unclear how to what extent COVID-19 vaccines reduce transmission 24. While evidence is now accumulating for substantial vaccine effects on infection and onward spread 25, these results reflect the knowledge available at the time prioritization decisions were being made. Moreover, as the B.1.617.2 (Delta) and B.1.1.529 (Omicron) variants have become dominant worldwide...
Results from TrialIdentifier: No clinical trial numbers were referenced.
Results from Barzooka: We did not find any issues relating to the usage of bar graphs.
Results from JetFighter: We did not find any issues relating to colormaps.
Results from rtransparent:- Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
- Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
- No protocol registration statement was detected.
Results from scite Reference Check: We found no unreliable references.
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