A Rapid Review of COVID-19 Vaccine Prioritization in the U.S.: Alignment between Federal Guidance and State Practice

  1. Vageesh Jain
  2. Lara Schwarz
  3. Paula Lorgelly

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Abstract

Background: Population groups to be prioritized for COVID-19 vaccinations in the U.S. have been determined at the Federal level, but there is variation in how States have implemented guidance. This review examines how the position of population groups in vaccine priority lists varies between Federal guidance and State practice. Methods: An online search of State vaccination prioritization plans was conducted. Data were extracted on each population group included and their relative position. A standardized ranking method was applied to provide a directional measure of variability in prioritization between State and Federal guidance, for each population group. Results: Healthcare workers and those in long-term care facilities were largely prioritized in line with Federal guidance. Aside from early education staff, essential workers were often excluded at State level. Almost all States included the 65–74 year age group and most assigned them to a higher position than recommended in Federal guidance. Those with underlying medical conditions were similarly highly prioritized, although there was more variability across States. Some socially vulnerable groups (not included in Federal guidance) were highly prioritized by many States. Conclusions: The prioritization of groups for COVID-19 vaccination has been highly variable despite clear Federal guidance. Future guidance must be relevant to local needs, values, and constraints, to minimize any unwarranted heterogeneity in vaccine access across populations.

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  1. Version published to 10.3390/ijerph18073483
  2. ScreenIT

    SciScore for 10.1101/2021.03.11.21253411: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board Statementnot detected.
    Randomizationnot detected.
    BlindingThe second reviewer was blinded to any previous results, but provided with the same data extraction framework used by the first reviewer, to ensure comparability of findings.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    All data were extracted to Microsoft Excel, enabling a comparison of how population groups are prioritized by individual States.
    Microsoft Excel
    suggested: (Microsoft Excel, RRID:SCR_016137)

    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:
    Strengths and Limitations: Unlike previous analyzes of U.S. COVID-19 vaccine priority lists8 this rapid review systematically aggregated States across the country by population group. This allowed us to create a directional measure of disparity between Federal guidance and State practice, for each population group, providing us with a better understanding of how Federal guidance is working differently for some groups compared to others, and the potential implications on equity. A key limitation in our analysis was the inability to measure the time taken to progress through different vaccine allocation phases, and how this might vary across States. Given variable vaccine supplies, group sizes, and ways of labelling priority phases, priority groups may not have been directly comparable. For instance, three States (Connecticut, Florida and Mississippi) prioritized several groups in parallel as part of one single phase. Some other States split their rollout into several, smaller phases. To minimize the impact of this on our analysis, we did not use subgroups within phases where reported (e.g. phase 1A.1, 1 A.2, 1A.3). As both Federal and State plans prioritized distinct groups we were able to assess the overall translation of guidance into practice, despite inconsistent methods of prioritization across States. Secondly it was not possible to assess variation in vaccine prioritization at the County level due to a lack of routinely available published documentation. Finally, the ex...

    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.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  3. Version published to 10.1101/2021.03.11.21253411v1 on medRxiv