Who Will Get the Covid Vaccine First? A New Tool Aims to Help States Decide

When the coronavirus vaccine arrives on the market, demand will far exceed supply. During those first few months, state and county public health officials will face tough questions about who should be first in line to get one of the limited vaccine doses. The Vaccine Allocation Planner for Covid-19, a new tool released Wednesday, aims to help make those decisions with data. 

Jointly developed by Ariadne Labs, a project run out of Brigham and Women’s Hospital and the Harvard T.H. Chan School of Public Health, and the Surgo Foundation, a nonprofit at the intersection of behavioral and data science, the tool allows policymakers to look at region-specific data. They can estimate the size of high-risk populations, consider factors like particular community’s vulnerabilities, and run scenarios based on an estimated number of vaccine doses available.

Using data from the census, the Centers for Disease Control and Prevention, and the Bureau of Labor Statistics, local leaders can identify which counties have the most individuals at risk to catch the coronavirus and suffer complications from it. It also allows state and county governments to set aside portions of their vaccine stock to geographic areas where whole communities might be more vulnerable due to a lack of access to health care or tough socioeconomic circumstances.

Sema Sgaier, the executive director of the Surgo Foundation, said that the tool can make the challenge of vaccine distribution more manageable. “State and local leaders are going to need to make decisions about how to distribute their allotted Covid-19 vaccine doses, and there are many permutations those decisions could take,” she said in a statement. “Our tool gives them the concrete, localized data they will need to estimate with precision and maximize the public health impact of the coronavirus vaccine, while at the same time prioritizing vulnerable populations.”

This month, states turned in rough drafts of their plans for distributing vaccines to the CDC, with leaders emphasizing that there is still a lot to plan for and many variables still up in the air. For example, the different vaccines being developed will require different levels of refrigeration and, right now, it isn’t clear which ones will get approved by the federal government. It’s also expected that people will be required to get two shots, which will complicate rollout plans.

The allocation tool utilizes guidelines recently released by the National Academies of Sciences, Engineering, and Medicine, which separate vaccine distribution into four phases based on the risk of people catching and spreading the disease in the initial period of time when demand for the vaccine will exceed supply. 

The first phase prioritizes first responders and front-line health workers in hospitals, nursing homes, or those who are providing home care. Researchers noted that it is critical to prioritize this group as they have “a critical role in maintaining health care system functionality, high risk of exposure to patients exhibiting symptoms of Covid-19, and higher risk of then transmitting the virus to others, including family members.” In the second part of phase one, people with serious underlying conditions like cancer and heart problems would be prioritized, along with those over the age of 65 who are living in communal housing like nursing homes, homeless shelters, and prisons. Combined, these groups make up about 15% of the U.S. population. 

The second phase would cover an additional 30% to 35% of the population, and would include essential workers like school staff and child care workers, public transit operators, and those who work at grocery stores. Also included in this phase are people who have more mild underlying health conditions, people of all ages living in communal settings, and anyone over 65 who was not included in phase one.

Phase three would bring in another 40% to 45% of the population through the vaccination of remaining critical workers at colleges, hotels, and gyms, all of which have a strong potential to be outbreak vectors. Children and young adults between the ages of 18 and 30 would also be targeted in this phase, as they “typically have broader social networks than older adults, increasing their risks of infection and transmission.” Phase four would expand vaccine access to anyone who hasn’t already gotten vaccinated in the prior phases.

NASEM Committee Co-chair Dr. Helene Gayle said that the four-phased approach will still leave some uncertainties that state and local leaders will have to plan for. “This tool helps them do that, providing the most reliable estimates of high-priority populations and allowing them to weigh that data against potential scenarios,” she said in a statement.

Since the beginning of the pandemic, those who worked on the roll out of the H1N1 vaccine in 2009 have urged local leaders to think about different scenarios for vaccine distribution as soon as possible, so that the eventual rollout of an approved vaccine can be smoother and more targeted to those who need it most.

Even for those with a jump on planning, it’s likely the biggest challenge facing local governments will be funding the vaccine rollout. The CDC has allocated $200 million to jurisdictions for vaccine preparedness, but much of that hasn’t arrived at the local level yet. State and local governments are scrambling to figure out how to pay for distribution systems that the CDC says need to be set up by Nov. 1. After that, it’s a waiting game until a vaccine is developed and approved. Most experts predict a vaccine won’t be in wide distribution until mid-2021 at the earliest.

Earlier in the month, New York Gov. Andrew Cuomo and Arkansas Gov. Asa Hutchinson, the leaders of the National Governors Association, wrote to President Trump asking for clarification about the vaccine rollout process and associated funding for it. "We need to know: What is the plan?" Cuomo said on October 15. "Let's figure it out now because this virus has been ahead of us every step of the way — it's about time this country catches up."