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A healthy dose of justice: When the vaccine comes, a COVID vulnerability index can help achieve both

There’s been lively discussion about whether people will be willing to take a vaccine for COVID-19 when it becomes available. It’s a question each of us will have to answer for ourselves sooner or later. But the debate obscures a more complex reality: when an effective and safe vaccine finally arrives, it will initially be in scarce supply. No country or business has the manufacturing capacity to quickly provide enough doses for an entire population.

The big question we should be considering, therefore, is who should get vaccinated first, and who should be next in line thereafter? Do certain groups within the population deserve priority over others? And if so, what considerations should influence these decisions?

This is not the first time we’ve been faced with this type of “allocation problem.” Typically, vaccine allocation decisions are made with a view toward maximizing the overall health benefit: to achieve the greatest good for the most people, such as the total number of lives saved. For reasons of epidemiology, that doesn’t always mean that people most vulnerable to a disease are the first ones to receive a vaccine. The worst-off groups are prioritized only insofar as it aligns with maximizing the benefits of the vaccine.

But COVID-19 is an exceptional disease — not just because of the rapidity and extent of its spread, but because of the way it has highlighted and heightened the inequities that exist in the United States. It has a disproportionate impact on communities who are disadvantaged by their race and ethnicity, by underlying comorbidities and lack of access to good health care, by their living conditions, or even by the kind of work they do. In the United States, rates of COVID-19 infection among Black, Latinx, and Native American people are more than two-and-a-half times as high as among white people — while hospitalization rates are approaching five times as high, and Black people are dying at twice the rate of white people. Historically, it’s precisely non-white populations that have lower coverage of vaccination for common diseases.

This is why we developed the COVID Community Vulnerability Index (CCVI) — to identify the communities impacted most negligibly by the virus, so we can plan and respond accordingly. It builds on the CDC’s Social Vulnerability Index (SVI) to take into account additional vulnerability factors that come into play with a pandemic disease like COVID-19 — from minority populations and foreign languages spoken, to the amount of household crowding or limited transportation access in a community.

It’s therefore exciting to see that the National Academies of Sciences, Engineering, and Medicine (NASEM) has just launched a set of vaccine allocation recommendations for the United States that make an important departure from the traditional vaccine allocation framework. NASEM aims to achieve not only impact, but also social justice, by taking into account that ethnic minority groups are worse affected by COVID-19.

NASEM proposes a vaccine allocation framework with the goal of reducing severe illness, death, and societal consequences due to COVID-19. Its