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The authors provide the first age-standardized race/ethnicity-specific, state-specific vaccination rates for the United States. Data encompass all states reporting race/ethnicity-specific vaccinations and reflect vaccinations through mid-October 2021, just before eligibility expanded below age 12. Using indirect age standardization, the authors compare racial/ethnic state vaccination rates with national rates. The results show that white and Black state median vaccination rates are, respectively, 89 percent and 76 percent of what would be predicted on the basis of age; Hispanic and Native rates are almost identical to what would be predicted; and Asian American/Pacific Islander rates are 110 percent of what would be predicted. The authors also find that racial/ethnic vaccination rates are associated with state politics, as proxied by 2020 Trump vote share: for each percentage point increase in Trump vote share, vaccination rates decline by 1.08 percent of what would be predicted on the basis of age. This decline is sharpest for Native American vaccinations, although these are reported for relatively few states.

The US Food and Drug Administration (FDA) has issued emergency use authorizations (EUAs) for monoclonal antibodies (mAbs) for nonhospitalized patients with mild or moderate coronavirus disease 2019 (COVID-19) disease and for individuals exposed to COVID-19 as postexposure prophylaxis. EUAs for oral antiviral drugs have also been issued. Due to increased demand because of the Delta variant, the federal government resumed control over the supply and asked states to ration doses. As future variants (eg, the Omicron variant) emerge, further rationing may be required. We identify relevant ethical principles (ie, benefiting people and preventing harm, equal concern, and mitigating health inequities) and priority groups for access to therapies based on an integrated approach to population health and medical factors (eg, urgently scarce healthcare workers, persons in disadvantaged communities hard hit by COVID-19). Using priority categories to allocate scarce therapies effectively operationalizes important ethical values. This strategy is preferable to the current approach of categorical exclusion or inclusion rules based on vaccination, immunocompromise status, or older age, or the ad hoc consideration of clinical risk factors.

AbstractReserve systems are a tool to allocate scarce resources when stakeholders do not have a single objective. This paper introduces some basic concepts about reserve systems for pandemic medical resource allocation. At the onset of the Covid-19 pandemic, we proposed that reserve systems can help practitioners arrive at compromises between competing stakeholders. More than a dozen states and local jurisdictions adopted reserve systems in initial phases of vaccine distribution. We highlight several design issues arising in some of these implementations. We also offer suggestions about ways practitioners can take advantage of the flexibility offered by reserve systems.

IMPORTANCE: As COVID-19 vaccine distribution continues, policy makers are struggling to decide which groups should be prioritized for vaccination. OBJECTIVE: To assess US adults' preferences regarding COVID-19 vaccine prioritization. DESIGN, SETTING, AND PARTICIPANTS: This survey study involved 2 independent, online surveys of US adults aged 18 years and older, 1 conducted by Gallup from September 14 to 27, 2020, and the other conducted by the COVID Collaborative from September 19 to 25, 2020. Samples were weighted to reflect sociodemographic characteristics of the US population. EXPOSURES: Respondents were asked to prioritize groups for COVID-19 vaccine and to rank their prioritization considerations. MAIN OUTCOMES AND MEASURES: The study assessed prioritization preferences and agreement with the National Academies of Science, Engineering, and Medicine's Preliminary Framework for Equitable Allocation of COVID-19 Vaccine. RESULTS: A total of 4735 individuals participated, 2730 (1474 men [54.1%]; mean [SD] age, 59.2 [14.5] years) in the Gallup survey and 2005 (944 men [47.1%]; 203 participants [21.5%] aged 55-59 years) in the COVID Collaborative survey. In both the Gallup COVID-19 Panel and COVID Collaborative surveys, respondents listed health care workers (Gallup, 93.6% [95% CI, 91.2%-95.3%]; COVID Collaborative, 80.0% [95% CI, 78.0%-81.9%]) and adults of any age with serious comorbid conditions (Gallup, 78.6% [95% CI, 75.2%-81.7%]; COVID Collaborative, 72.9% [95% CI, 70.7%-74.9%]) among their 4 highest priority groups. Respondents of all political affiliations agreed with prioritizing Black, Hispanic, Native American, and other communities that have been disproportionately affected by COVID-19 (Gallup, 74.2% [95% CI, 70.6%-77.5%]; COVID Collaborative, 84.9% [95% CI, 83.1%-86.5%]), and COVID Collaborative respondents were willing to be preceded in line by teachers and childcare workers (92.5%; 95% CI, 91.2%-93.7%) and grocery workers (85.9%; 95% CI, 84.2%-87.5%). Older respondents in both surveys were ...

Once effective coronavirus disease 2019 (COVID-19) vaccines are developed, they will be scarce. This presents the question of how to distribute them fairly across countries. Vaccine allocation among countries raises complex and controversial issues involving public opinion, diplomacy, economics, public health, and other considerations. Nevertheless, many national leaders, international organizations, and vaccine producers recognize that one central factor in this decision-making is ethics (1, 2). Yet little progress has been made toward delineating what constitutes fair international distribution of vaccine. Many have endorsed ?equitable distribution of COVID-19?vaccine? without describing a framework or recommendations (3, 4). Two substantive proposals for the international allocation of a COVID-19 vaccine have been advanced, but are seriously flawed. We offer a more ethically defensible and practical proposal for the fair distribution of COVID-19 vaccine: the Fair Priority Model.The Fair Priority Model is primarily addressed to three groups. One is the COVAX facility?led by Gavi, the World Health Organization (WHO), and the Coalition for Epidemic Preparedness Innovations (CEPI)?which intends to purchase vaccines for fair distribution across countries (5). A second group is vaccine producers. Thankfully, many producers have publicly committed to a ?broad and equitable? international distribution of vaccine (2). The last group is national governments, some of whom have also publicly committed to a fair distribution (1).These groups need a clear framework for reconciling competing values, one that they and others will rightly accept as ethical and not just as an assertion of power. The Fair Priority Model specifies what a fair distribution of vaccines entails, giving content to their commitments. Moreover, acceptance of this common ethical framework will reduce duplication and waste, easing efforts at a fair distribution. That, in turn, will enhance producers' confidence that vaccines will be fairly allocated to benefit people, thereby motivating an increase in vaccine supply for international distribution. ; Fil: Emanuel, Ezekiel J. University of Pennsylvania; Estados Unidos ; Fil: Persad, Govind. University of Denver.; Estados Unidos ; Fil: Kern, Adam. University of Princeton; Estados Unidos ; Fil: Buchanan, Allen. University of Arizona; Estados Unidos ; Fil: Fabre, Cécile. All Souls College; Reino Unido ; Fil: Halliday, Daniel. University of Melbourne; Australia ; Fil: Heath, Joseph. University of Toronto; Canadá ; Fil: Herzog, Lisa. University of Groningen; Países Bajos ; Fil: Leland, R. J. University of Manitoba; Canadá ; Fil: Lemango, Ephrem T. No especifíca; ; Fil: Luna, Florencia. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Facultad Latinoamericana de Ciencias Sociales; Argentina ; Fil: McCoy, Matthew S. University of Pennsylvania; Estados Unidos ; Fil: Norheim, Ole F. University of Bergen; Noruega ; Fil: Ottersen, Trygve. Norwegian Institute Of Public Health; Noruega ; Fil: Schaefer, G. Owen. Yong Loo Lin School Of Medicine; Singapur ; Fil: Tan, Kok-Chor. University of Pennsylvania; Estados Unidos ; Fil: Wellman, Christopher Heath. Washington University in St. Louis; Estados Unidos ; Fil: Wolff, Jonathan. University of Oxford; Reino Unido ; Fil: Richardson, Henry S. Kennedy Institute Of Ethics; Estados Unidos