Where Do Vaccine Doses Go, and Who Gets Them? The Algorithms Decide

Health agencies and hospitals are using different formulas to allocate the coronavirus shots, exacerbating disparities in vaccine access.

Credit…Mark Pernice

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By Natasha Singer

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Faced with the daunting task of parceling out a limited supply of coronavirus vaccines, Trump administration officials came up with a seemingly simple formula last year to streamline distribution of the shots.

First, federal administrators would run an automated algorithm to divide vaccine doses nationwide, based on the size of each state’s adult population. Then each state would decide how to dole out the shots to local hospitals, nursing homes and clinics.

But rather than streamline vaccine distribution, public health experts say, the algorithm has increased the burden for many states. It requires them to come up with multiple delivery plans for their weekly quotas of Pfizer and Moderna shots, even if the different shipments are destined for the same clinics and hospitals.

“The way it’s set up is so cumbersome,” said Dr. Michelle Fiscus, the medical director of the Tennessee Department of Health’s Vaccine-Preventable Diseases and Immunization Program. Her team initially resorted to planning out the vaccine deliveries with a big paper map of the state, she said, covered with pink and yellow sticky notes. “If these artificial allotments were scrapped,” she said, “it would help us tremendously.”

The federal vaccine allocation formula is among the dozens of algorithms — some automated systems and others simple prioritization lists — being used by government health agencies and hospital systems across the United States to help determine where the vaccines are sent and who can get them.

The algorithms are intended to speed Covid-19 shots from pharmaceutical plants to people’s arms. The formulas generally follow guidelines from the Centers for Disease Control and Prevention recommending that frontline health care workers, nursing home residents, senior citizens and those with major health risks be given priority for the vaccines.

Yet federal agencies, states, local health departments and medical centers have each developed different allocation formulas, based on a variety of ethical and political considerations. The result: Americans are experiencing wide disparities in vaccine access.

Oregon, for instance, has prioritized teachers over the elderly for Covid shots, an approach that could help schools and businesses reopen. New Jersey has put smokers ahead of educators, which could save lives.

Some prioritization formulas also conflict with one another or impose such prescriptive rules that they hinder immunizations, public health experts say. Yet many Americans may not be aware of the layers of algorithms influencing their access to vaccines.

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