While the Federal Government is committed to executing a comprehensive COVID-19 vaccination campaign, the distribution of vaccines falls individually on state and local government support. In our blog series on the vaccine rollout, Booz Allen’s Chief Medical Officer Kevin Vigilante and our health experts examine best practices and lessons learned from across the health landscape, including potential strategies and approaches that could help state and local governments improve vaccination rollouts.
Streamline distribution with age-based priority, lottery
To protect the most exposed workers and most at-risk populations (e.g., those with preexisting conditions), an elegantly phased COVID-19 vaccination rollout was created. But many state and local health departments are finding that vaccine distribution plans are missing their mark. Well-intended criteria are hard to define, difficult to document, and are slowing down the process. How do you prove you have diabetes to a volunteer vaccinator? Anyone with a computer and a printer can produce a doctor’s note—or sell them. This has led to conflict, line jumping, and gaming the system—an environment in which influence and privilege usually prevail.
Prioritize by Age, Then Use a Lottery
In a recent New York Times op-ed, Drs. Ashish Jha and Robert Wachter have proposed a simpler approach in which age is the primary criterion for vaccination. They suggest starting with those 75 and over and working down to those 55 and over—approximately 100 million people. This 55 and up age cohort accounts for 92% of all COVID deaths. And unlike the long list of occupations and conditions (which vary by severity) in the current plan, age is easily defined and documented with licenses and birth certificates. Once we have vaccinated all those 55 and above, they advocate that the rest be determined by lottery. Instead of pitting Uber driver against bus driver, a vaccine lottery would determine who goes next.
“Instead of pitting Uber driver against bus driver, a vaccine lottery would determine who goes next.”
Prioritize Health Equity in Vaccine Distribution
But as Drs. Muriel Jean-Jacques and Howard Bauchner have suggested in a recent article in the Journal of the American Medical Association, even with a lottery, more still needs to be done to equalize vaccination opportunities for economically disadvantaged populations. Building trust through culturally sensitive communications is the first step. Locating vaccination sites near socially vulnerable zip codes and near mass transit access points is essential. Simplified registration procedures and centralized statewide scheduling systems that don’t require citizens to explore dozens of websites would also help; as would in-person and phone access for scheduling.
The Bottom Line
An age and lottery-based prioritization approach may not be perfect. But, with a thoughtful implementation that takes health equity into account, it could be a quicker and fairer path to herd immunity. And that would benefit everyone.
Want to stay updated on the COVID-19 vaccine rollout? Check back as we continue to share health insights. And feel free to share this post with those you care about.
