Evaluation of Vaccination Strategies to Compare Efficient and Equitable Vaccine Allocation by Race and Ethnicity Across Time

• Published in: JAMA health forum 2021-08, Vol.2 (8), p.e212095-e212095
• Main Authors: Kipnis, Patricia, Soltesz, Lauren, Escobar, Gabriel J, Myers, Laura, Liu, Vincent X
• Format: Article
• Language: English
• Subjects: Adult; Age; Comments; Computer Simulation; Coronaviruses; COVID-19 - prevention & control; COVID-19 vaccines; COVID-19 Vaccines - therapeutic use; Disease control; Ethnicity; Female; Health care delivery; Hispanic people; Hospitalization; Humans; Immunization; Integrated delivery systems; Male; Middle Aged; Online Only; Original Investigation; SARS-CoV-2; Severe acute respiratory syndrome coronavirus 2; Vaccination
• ISSN: 2689-0186; 2689-0186
• DOI: 10.1001/jamahealthforum.2021.2095

Identifying the most efficient COVID-19 vaccine allocation strategy may substantially reduce hospitalizations and save lives while ensuring an equitable vaccine distribution. To simulate the association of different vaccine allocation strategies with COVID-19-associated morbidity and mortality and their distribution across racial and ethnic groups. We developed and internally validated the risk of COVID-19 infection and risk of hospitalization models on randomly split training and validation data sets. These were used in a computer simulation study of vaccine prioritization among adult health plan members who were drawn from an integrated health care delivery system. The study was conducted from January 3, 2021, to June 1, 2021, in Oakland, California, and the data were analyzed during the same period. We simulated the association of different vaccine allocation strategies, including (1) random, (2) a US Centers for Disease Control and Prevention (CDC) proxy, (3) age based, and (4) combinations of models for the risk of adverse outcomes (CRS) and COVID-19 infection (PROVID), with COVID-19-related hospitalizations between May 1, 2020, and December 31, 2020, that were randomly permuted by month across 250 simulations and assessed vaccine allocation by race and ethnicity and the neighborhood deprivation index across time. The study included 3 202 679 adult patients (mean [SD] age, 48.2 [18.0] years; 1 677 637 women [52.4%]; 1 525 042 men [47.6%]; 611 154 Asian [19.1%], 206 363 Black [6.4%], 642 344 Hispanic [20.1%], and 1 390 638 White individuals [43.4%]), of whom 36 137 (1.1%) were positive for SARS-CoV-2. A risk-based strategy (CRS/PROVID) showed the largest avoidable hospitalization estimates (4954; 95% CI, 3452-5878) followed by age-based (4362; 95% CI, 2866-5175) and CDC proxy (4085; 95% CI, 2805-5109) strategies. Random vaccination showed substantially lower reductions in adverse outcomes. Risk-based strategies also showed the largest number of avoidable COVID-19 deaths (joint CRS/PROVID) and household transmissions. Risk-based (PROVID) and CDC proxy strategies were estimated to vaccinate the highest percentage of Hispanic and Black patients in 8 months (joint CRS/PROVID: 642 570 [100%] Hispanic, 185 530 [90%] Black; PROVID: 642 570 [100%] Hispanic, 198 480 [96%] Black; CDC proxy: 605 770 [95%] Hispanic and 151 772 [74%] Black) compared with an age-based approach (438 423 [68%] Hispanic, 154 714 [75%] Black). Overall, the PROVID and joint CRS/PROVID ri