States have been working hard on developing COVID-19 vaccine distribution plans. By the time the vaccine becomes available, about 1 in 4 people in the country may have recovered from COVID-19 and therefore be partially immune, and others who need the vaccine most may avoid it. The distribution plans should therefore address both possible immunity and vaccine reluctance as demand-side issues.
Confirmed COVID-19 cases in the U.S. now approach 9 million. The actual number of cases is estimated to be 6 to 10 times higher than reported — anywhere between 50 and 90 million — considering factors such as under-reporting and limited testing. There is increasing evidence that people who have recovered from COVID-19 are likely to have some lasting immunity against re-infection. Antibody testing, although not perfect, can provide information about whether and when a person may have been infected. With ongoing development, these serology tests could shed light on a person’s acquired immunity to COVID-19.
COVID-19 vaccine distribution plans typically have multiple phases as suggested by the National Academies of Sciences, Engineering, and Medicine consensus study. The plans consider numerous factors such as critical populations, equitable access, population density, cold chains, points of distribution, and training and deploying personnel.
While most plans focus on the supply side, they should more carefully consider major issues on the demand side.
People’s willingness to be vaccinated — uptake — is likely to vary significantly depending on the effectiveness and perceived safety of the vaccine when it becomes available for them. Vaccine uptake can also vary considerably across geographic areas or subpopulations.
From a demographic perspective, the adverse effects of COVID-19 have been most severe on African American and Hispanic populations — age-adjusted hospitalization rates are highest among these groups. This would suggest the potential benefits of prioritizing these groups for vaccination; however, skepticism about the COVID-19 vaccine might be a roadblock. According to a survey conducted by the Associated Press-NORC Center for Public Affairs Research, only 25 percent of African Americans and 37 percent of Hispanics responded yes when asked whether they would receive the COVID-19 vaccine, compared to 56 percent of whites.
States need to understand the perceptions regarding the COVID-19 vaccine and carefully include in their plans effective public health messaging targeted for different groups. Engaging with trusted local community leaders, who may not be public health experts but have the ear of the community, can also help with messaging and increase the uptake rates.
In an ideal scenario, the vaccine would be seen as safe and effective, and therefore every person would be willing to take it. Given limited vaccine supply, it is essential to ensure that those who are still susceptible to COVID-19 are prioritized for vaccination to maximize the impact of the vaccine in protecting the population. This can be achieved if the vaccine administration is combined with serology testing.
After a massive mass vaccination effort, even if a relatively high statewide vaccination rate is achieved, there may be disparities across subpopulations and some of the vaccines may be administered to people who do not need it as much as others. To make the most out of the limited vaccine supply, state plans need to pay more attention to the demand side, combining vaccine distribution efforts with education/awareness efforts and serology testing to ensure that people who need the vaccine most actually get it.
Pinar Keskinocak is the William W. George Chair and professor in the H. Milton Stewart School of Industrial and Systems Engineering and director of the Center for Health and Humanitarian Systems at the Georgia Institute of Technology. She is the president of INFORMS.