Full Citation

Title: RESEARCH FINDINGS# 46: COVID-19 Vaccination Prioritization Scenarios and Their Effects on Eligibility by Poverty Level, Race, and Ethnicity

Citation Type: Miscellaneous

Publication Year: 2021

ISBN:

ISSN: 0149-2195

DOI: 10.15585/MMWR.MM695152E2

NSFID:

PMCID:

PMID: 33382671

Abstract: Policymakers at all levels of government are currently working to distribute the new COVID-19 vaccine to the U.S. population. Prioritizing vaccine resources across population groups poses difficult decisions for policymakers (Biggerstaff, 2020; Dooling et al., 2021). What are the implications of alternative prioritizations for national economic security versus public health and safety? Should resources be prioritized for individuals with the greatest risk of exposure to SARS-CoV-2, those most likely to develop severe COVID-19 if they become infected, those most likely to transmit the virus to others, or some combination? Should distribution be based on information regarding employment and health, or more simply based on age, and how should that information be verified? The Centers for Disease Control and Prevention (CDC) recently published guidelines for vaccination priority that seek to balance these competing objectives (CDC, 2021; White House, 2021). The guidelines prioritize groups based on long-term care residence, age, health status, and occupation, reflecting guidance from the Advisory Committee on Immunization Practices (ACIP) (McClung et al., 2020; Dooling et al., 2021). In addition to these national recommendations, every state is tailoring its vaccination plan to local factors, resulting in considerable variation across the country. Against this backdrop, this Research Findings report explores how different prioritization strategies can affect vaccine eligibility across poverty levels and across race/ethnicity. Understanding the implications of prioritization strategies on these dimensions takes on particular importance given striking inequities across the population in health risk factors and in COVID-19 mortality (Centers for Disease Control and Prevention, 2020a). We use data from the 2014–2017 Medical Expenditure Panel Survey (MEPS), sponsored by the Agency for Healthcare Research and Quality (AHRQ, 2019), to construct hierarchical population estimates for potential vaccine priority groups. MEPS is a household survey of the civilian noninstitutionalized population that collects a wide range of data including demographic characteristics, health conditions, use of medical services, charges and source of payments, access to care, satisfaction with care, health insurance coverage, income, and employment. It does not include nursing home residents or adults who are incarcerated, two groups with particularly high rates of COVID-19 morbidity and mortality. Nevertheless, MEPS is a valuable resource for conducting vaccine prioritization analyses of the rest of the population, because many key variables, including detailed employment and detailed health risk data, as well as income and race and ethnicity, are collected in the same survey—thereby capturing patterns of overlap across vaccine groups. We present three scenarios for vaccine prioritization. All three scenarios begin by prioritizing healthcare workers and then individuals age 65 and older (reflecting announcements already made in many states as of February 2021). The first scenario next prioritizes other groups of essential workers based on their having above-average risk of infection and potential to spread infection to others. The second scenario instead prioritizes adults at increased risk of severe COVID-19, conditional on infection. The third scenario examines the most administratively simple strategy of focusing solely on age (after healthcare workers). The priority groups we examine differ from those used in ACIP and CDC recommendations in several ways. Our definition of essential workers is based on U.S. Department of Homeland Security guidelines, and we combine this with information on ability to work at home. This likely differs from ACIP’s essential frontline and other essential worker categories. Also, our definition of adults with increased risk or potentially increased risk of severe COVID-19 includes adults with treated high blood pressure and current smokers, whereas neither risk factor would qualify an adult for inclusion in ACIP or CDC groups with underlying medical conditions. Finally, note also that all three prioritization scenarios follow many states in giving high priority to adults age 65 to 74. For each of the three prioritization scenarios we present estimates of eligibility group sizes and cumulative distributions stratified by health risk, occupation, and, of particular interest in this study, poverty level and race and ethnicity. Our focus is primarily on early prioritization, when infection rates are high and before the share of the population with immunity reaches levels that substantially reduce new infections. Our estimates focus on the characteristics of adults who would be eligible for the vaccine. The rates at which eligible populations become vaccinated will depend on a range of factors outside the scope of this analysis.

Url: https://www.meps.ahrq.gov/data_files/publications/rf46/rf46.shtml

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Authors: Selden, Thomas M.; Berdahl, Terceira A.; Fang, Zhengyi

Publisher: Centers for Disease Control MMWR Office

Data Collections: IPUMS Time Use - ATUS

Topics: Health, Poverty and Welfare, Race and Ethnicity

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