Navigating vaccine distribution: tools to increase vaccine equity

Vaccine Insights 2023; 2(12), 471–474

DOI: 10.18609/vac.2023.63

Published: 5 January
Viewpoint
Rebecca Weintraub


“With uncertain vaccine supply, decision makers needed localized updated data to plan efficient and equitable vaccine delivery.”



Early in the COVID-19 pandemic, vaccine distribution in the US was irregular. Each public health jurisdiction had different regulations and procedures. In addition, many Americans live in vaccine deserts, without convenient access to vaccines. This article describes two tools created to increase vaccine equity throughout the country—the COVID-19 Vaccine Allocation Planner and the Vaccine Equity Planner.

In the US, there has been a longstanding call for investments in public health infrastructure, including national data tracking systems. The state-specific, complex nature of the existing immunization systems poses challenges.

The COVID-19 pandemic highlighted the urgency to modernize the architecture of immunization record-keeping. Not knowing the amount of vaccine supply that was administered and delivered to various populations made it difficult for the nation to efficiently allocate a scarce resource equitably. Compounding the lack of centralized record-keeping across the country, all 64 public health jurisdictions in the US had different levels of available technical resources to analyze and assess their own data.

To address this challenge, the COVID-19 Vaccine Allocation Planner emerged as a tool to help jurisdictions plan for the early stages of vaccine distribution. This tool allowed planners to understand how much vaccine they would need to send to different counties, according to equity guidelines written by the National Academy for Science, Engineering, and Medicine and the CDC’s Advisory Committee on Immunization Practices. It quantified the number of people in each county that met various criteria for being prioritized so that states could distribute accordingly.

During the pandemic, the scarce supply of vaccines relied upon existing secure cold chain resources to protect them. They were delivered to locations that could accommodate them—not based on where risk was highest. So, while there were approximately 50,000 active vaccination sites, these sites were, for the most part, concentrated in high-population centers, leaving many Americans without close geographic access to vaccines.

With 15% of unvaccinated Americans naming travel considerations as a primary roadblock in obtaining a vaccination, this geographic barrier made reaching the goal of 70% country-wide vaccination rate very difficult [2]Weintraub RL, Miller K, Rader B, et al. Identifying COVID-19 Vaccine Deserts and Ways to Reduce Them: A Digital Tool to Support Public Health Decision-Making. Am. J. Public Health 2023; 113, 363–367..

To address the issue of vaccine deserts, public health leaders need clear and accurate data about where distance is a barrier and how it could be addressed.

Accordingly, the Vaccine Equity Planner (VEP) was built as part of a private–academic partnership. The open-access, online tool (available at www.vaccineplanner.org) [2]Weintraub RL, Miller K, Rader B, et al. Identifying COVID-19 Vaccine Deserts and Ways to Reduce Them: A Digital Tool to Support Public Health Decision-Making. Am. J. Public Health 2023; 113, 363–367.Weintraub RL, Miller K, Rader B, et al. Identifying COVID-19 Vaccine Deserts and Ways to Reduce Them: A Digital Tool to Support Public Health Decision-Making. Am. J. Public Health 2023; 113, 363–367. located active vaccination sites using databases from the government, retail pharmacies, and data aggregators. It then identified catchment areas around current sites that were 15 or 30 min by car, 30 min by public transport, or 15 or 30 min walking, using calculations provided by a team at Google. The areas not part of any site’s catchment area were termed vaccine deserts [1]Ariadne Labs and Boston Children’s Hospital. COVID-19 Vaccine Equity Planner, Oct 2022.Ariadne Labs and Boston Children’s Hospital. COVID-19 Vaccine Equity Planner, Oct 2022.. The tool enabled planners to look at social vulnerability within vaccine deserts, according to the CDC’s Social Vulnerability Index, to prioritize efforts and plan for equity. Planners could also identify potential sites for vaccination delivery within deserts, including health-related sites, schools, or places of worship. As the end of the national effort to vaccinate the population for free grew near, the tool added the option to see what percentage of people lack health insurance in each desert [1]Ariadne Labs and Boston Children’s Hospital. COVID-19 Vaccine Equity Planner, Oct 2022.Ariadne Labs and Boston Children’s Hospital. COVID-19 Vaccine Equity Planner, Oct 2022.. Data from the VEP allowed for targeted outreach and intervention, and, because it was updated frequently, provided a time series for officials to evaluate the effectiveness of their interventions in improving geographic access to the COVID-19 vaccine [2]Weintraub RL, Miller K, Rader B, et al. Identifying COVID-19 Vaccine Deserts and Ways to Reduce Them: A Digital Tool to Support Public Health Decision-Making. Am. J. Public Health 2023; 113, 363–367.Weintraub RL, Miller K, Rader B, et al. Identifying COVID-19 Vaccine Deserts and Ways to Reduce Them: A Digital Tool to Support Public Health Decision-Making. Am. J. Public Health 2023; 113, 363–367..

While the VEP was successful in enabling informed public health planning during the COVID-19 pandemic, to prepare for future pandemics, it will be important to create a tool that incorporates all barriers to vaccine access, not just geographic barriers. For example, level of vaccine confidence, historical injustice, language differences, and lack of paid time off work are all barriers to equitable vaccine administration. In addition, further work is required to recognize and rectify the correlated inequities that exist within vaccine deserts. Vaccine deserts not only depict disparities in access to a vaccine but, in a broader context, they are also oftentimes primary care deserts.
Tools like the VEP can be integrated into planning and monitoring to assess progress in accelerating equitable, efficient, and effective delivery.

References

1. Ariadne Labs and Boston Children’s Hospital. COVID-19 Vaccine Equity Planner, Oct 2022.  Crossref

2. Weintraub RL, Miller K, Rader B, et al. Identifying COVID-19 vaccine deserts and ways to reduce them: a digital tool to support public health decision-making. Am. J. Public Health 2023; 113, 363–367.  Crossref

Biography

Rebecca Weintraub is the Founding Director of the Global Health Delivery Project at Harvard University, and co-leads the Global Health Delivery Intensive. She is an Associate Professor in the Department of Global Health and Social Medicine at Harvard Medical School, and an Associate Physician at Brigham and Women’s Hospital. She launched the Better Evidence Program at Ariadne Labs to design, test, and scale strategies to equip the current and future health workforce with the latest evidence to improve health outcomes. Weintraub is currently on the Council for Quality Health Communication and the CSIS Bipartisan Alliance for Global Health Security on Routine Immunizations and Global Health Security.

In the midst of the pandemic, Weintraub expanded her portfolio to support public health decision makers to deliver COVID-19 vaccines. She advises public health departments, employers, the US Department of Health and Human Services, and Ministries of Health. Her work has been published in the New England Journal of Medicine, Nature, Health Affairs, and Harvard Business Review and cited by The New York Times, BBC, Netflix, and National Public Radio.

Weintraub was named a Young Global Leader by the World Economic Forum and is a Health Innovator Fellow of the Aspen Global Leadership Network. Weintraub graduated from Yale University, Stanford School of Medicine, and completed her medical training at Brigham and Women’s Hospital.

Affiliation

Rebecca Weintraub MD
Founding Director,
Global Health Delivery Project at Harvard University,
and
Associate Professor,
Harvard Medical School;
Associate Physician,
Brigham and Women’s Hospital;
Faculty,
Ariadne Labs

Authorship & Conflict of Interest

Contributions: All named authors take responsibility for the integrity of the work as a whole, and have given their approval for this version to be published.

Acknowledgements: Thank you to Ariadne Labs, a joint center for health systems innovation at Brigham and Women’s Hospital and the Harvard T.H. Chan School of Public Health, and the Ariadne Labs COVID-19 Vaccine Delivery team, which was funded in part by The Commonwealth Fund, the Patrick J McGovern Foundation, and the Andrew and Corey Morris‑Singer Foundation. Thank you to our partners, Surgo Ventures, Google, and the Computational Epidemiology Lab at Boston Children’s Hospital, which was funded in part by the Centers for Disease Control and Prevention, Facebook, and The Rockefeller Foundation.

Thank you to all reviewers and public health leaders who provided feedback.

Disclosure and potential conflicts of interest: Weintraub R has a leadership/fiduciary role in the CSIS Bipartisan Alliance for Global Health Security Working Group on Routine Immunizations and Global Health Security.

Funding declaration: The author received no financial support for the research, authorship and/or publication of this article.

Article & Copyright Information

Copyright: Published by Vaccine Insights under Creative Commons License Deed CC BY NC ND 4.0 which allows anyone to copy, distribute, and transmit the article provided it is properly attributed in the manner specified below. No commercial use without permission.

Attribution: Copyright © 2023 Weintraub R. Published by Vaccine Insights under Creative Commons License Deed CC BY NC ND 4.0.

Article source: Invited.

Revised manuscript received: Dec 12, 2023; Publication date: Jan 5, 2024.


This article is part of the Tools of tomorrow spotlight