Committee discusses potential COVID-19 vaccine distribution framework

On September 2, the National Academies of Sciences, Engineering and Medicine hosted a Zoom discussion with a broad group of stakeholders about the potential distribution framework for when a COVID-19 vaccine is ready to be released.

The goal of the first discussion was to hear from diverse voices in the health care community to identify at-risk communities and framework channels to distribute COVID-19 vaccines when they are ready for public consumption. 



There are four potential allocation phases, with the first phase including high-risk workers in health care settings, people of all ages with comorbidities or underlying diseases that put them at higher risk, and the elderly living in overcrowded settings.

The second phase would include critical risk workers, teachers and school staff, all other elderly people not included in phase one, people living in homeless shelters, and all those in prisons, jails, or similar facilities.  

Phase three would include children, young adults, and all essential workers in industries necessary for society to function. 

The final stage, phase four, would include everyone else living in the U.S. who were not eligible to receive the vaccine in any of the other phases. 

As part of his opening remarks, President of the National Academy of Medicine President Dr. Victor Dzau said having the correct framework in place will help make the distribution process easier and more effective.

“Despite prominent efforts, the initial doses will be limited in supply, at least in the very beginning… given this, the scarce vaccines will need to be allocated in ways that are thoughtful, strategic and fair.”

Because public health and safety rely so much on this distribution framework, Dzau said, it’s important that it be constructed without government or private interest interference. 

The discussion, part of a larger study sponsored by the Centers for Disease Control and Prevention and the National Institute of Health, aims to identify other areas of consideration the public wants before vaccines are ready.

Dr. Helene Gayle, CEO of Chicago Community Trust, said the expectation of this framework is to help inform health authorities’ decisions, including the Advisory Committee on Immunization Practices, while they implement distribution guidelines. 

The committee asked several questions to identify the best vaccine allocation channels, including keeping in mind equitable distribution plans both in the U.S. and globally. 

“First of all, in doing this, we started with some of the lessons learned in other efforts that were relevant to our charge and our task,” Gayle said, including H1N1 and the West Africa Ebola outbreak.

The committee’s allocation criteria, Gayle said, are “the risk of acquiring infection, the risk of severe morbidity and mortality, the risk of negative societal impacts, and the risk of transmitting the disease to others.”

Dr. Elizabeth Ofili with the Association of Black Cardiologists (ABC) spoke during the comment portion of the discussion with concerns that ethnic minorities were not being prioritized enough in the current drafted framework. 

“The ABC strongly recommends that mitigating health inequities should specifically prioritize ethnic minorities who are most severely impacted by COVID-19,” she said. “The ABC and others have documented that African Americans have poorer outcomes of care regardless of socioeconomic status.”

She also asked that increased time and effort to overcome vaccine hesitancy be added to the draft framework.

Alaska Native Tribal Health Consortium Director Dr. Ellen Provost strongly encouraged the committee to include Alaskan Native as a very high risk population for COVID-19. 

“Alaska Native people are explicitly named as a high-risk group for the influenza vaccine and this designation should be the case for the COVID-19 vaccine as well,” she said. 

After the nearly five-hour-long discussion, Gayle thanked all the participants for their perspectives and recommendations for vaccine distribution.

“We have a lot of work to continue… We will be going back together as a committee and deliberating about all of these issues,” she said. 

The committee is still taking comments online about the drafted distribution framework until 11:59 p.m. ET September 4.