COVID-19 vaccine rollout needs more federal infrastructure support, says Commonwealth
A Commonwealth Fund study published Thursday found that many states will need strong federal support in order to distribute a COVID-19 vaccine effectively.
"The success of a future COVID-19 vaccination program rests on achieving high rates of uptake, especially in states with higher case counts and states with larger Black, Latino, and American Indian populations," wrote the research team.
Researchers examined past vaccination efforts for the seasonal flu and H1N1 to make predictions about a potential COVID-19 vaccine rollout. Although both programs aimed to vaccinate more than 70% of all adults on a voluntary basis, no state managed to inoculate more than half of its adults against seasonal flu in calendar year 2019.
The H1N1 results were even direr: Although government agencies had more direct control over allocation and distribution, uptake only averaged about 23%.
"We must not let the success of a breakthrough COVID-19 vaccine slip through our fingers. Having such a vaccine is merely a first step," said Dr. David Blumenthal, president of the Commonwealth Fund and former National Coordinator for Health IT, in a statement.
"The federal government must provide the leadership and resources to ensure that all states have what they need to distribute and administer vaccines, particularly for high-risk populations and communities of color that not only have been disproportionately impacted by the pandemic, but face greater barriers to vaccination," Blumenthal added.
WHY IT MATTERS
The study found that some states with a higher current COVID-19 case burden – namely, those in the Rocky Mountains and the Midwest – have had lower flu vaccination rates in the past. In 2019, for example, between 32.5% and 41.2% of adults in Illinois obtained the flu vaccine. As of early December, the state had one of the highest per-capita numbers of COVID-19 cases in the country.
Vaccination rates were also generally low in the southeastern United States, which was walloped by the novel coronavirus earlier this year.
A similar pattern held for the H1N1 vaccine. Again, southwestern states exhibited low vaccination rates, with less than 13% of adults vaccinated against the virus in some states.
"Although nearly a decade separates the two vaccination programs, and distribution of the vaccines differed, similarities exist in how rates varied from state to state," wrote researchers.
There existed a stark racial gap in vaccination rates, with 19 states reporting at least a 10-percentage-point flu-vaccination gap between Black and white residents in 2019. This is particularly troubling, given the disproportionate effects of COVID-19 on communities of color.
As researchers noted, systemic and medical racism is likely to affect vaccination rates, with distrust among many communities of color stemming in large part "from institutional experiences with racism and unethical medical experimentation." Vaccines are also linked to coverage and financial barriers that reflect a legacy of racial inequity, they write.
The federal government can respond, write the researchers, through a coordinated federal agency response to expand state funding, standardize distribution strategies, operate centralized storage and administration facilities, and sponsor local vaccine-awareness campaigns.
The government should also prioritize racial and ethnic equity in allocation, produce a robust media campaign and eliminate vaccine cost-sharing in public programs, the report advised.
THE LARGER TREND
As global vaccine rollout looms, some countries have turned to digital health technologies to monitor uptake and side effects.
In the United Kingdom, the Medicines and Healthcare Regulatory Authority contracted for the development of an AI tool to process any adverse drug reactions to the vaccine.
And Indonesia's COVID-19 Handling and National Economic Recovery Committee is strategically collaborating with the Indonesian Pediatrician Association Immunization Task Force, as well as a sanctioned COVID-19 Vaccine-Testing Team, to speed the preparation of the vaccine.
ON THE RECORD
"The rapid spread of the coronavirus throughout the U.S. underscores the need for rapid distribution of COVID-19 vaccines. A strong federal response is essential to deliver a vaccine when and where it is most needed. If we fail to adequately vaccinate the public, the pandemic will continue to claim lives and livelihoods everywhere," Commonwealth Fund SVP for policy and research Dr. Eric Schneider said in a statement.