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Solomon Center Hosts Panel on COVID-19 Vaccine Equity

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On March 22, 2021, the Solomon Center for Health Law and Policy and the Yale Health Law and Policy Society (YHeLPS) held a panel discussion centered on COVID-19 vaccines and equity. The conversation explored equity from three angles: vaccine trials, vaccine allocation, and vaccine outreach. The panel included Dr. Kirstin Bibbins-Domingo, Professor and Chair of the Department of Epidemiology and Biostatistics, and the Lee Goldman, MD Endowed Chair and Professor of Medicine at the University of California, San Francisco; Holly Fernandez Lynch, the John Russell Dickson, MD Presidential Assistant Professor of Medical Ethics in the Department of Medical Ethics and Health Policy at the Perelman School of Medicine; and Dr. Saad Omer, Director of the Yale Institute for Global Health, Associate Dean and Professor of Medicine at the Yale School of Medicine, and the Susan Dwight Bliss Professor of Epidemiology of Microbial Diseases at the Yale School of Public Health.

Holly Fernandez Lynch led the conversation by highlighting the importance of participation, persuasion, and inclusion in drug trials as key ways to advance health equity. She discussed the failure to design clinical trials for COVID-19 vaccines with racial equity in mind. While there was diversity for age and gender to capture different responses to the vaccine from physiology, racial diversity (to address inequities and comorbidities in the trial) wasn’t prioritized. Fernandez Lynch also pointed to how the participation rate among Black people — even in the Moderna trial, which paused to include more racial diversity — was not proportional to the Black population in the U.S. This undermines the critical public health and equity goals of vaccine trial participation. She emphasized the necessity of addressing the barriers to vaccination, such as distrust and economic stressors, to reach these goals.

Saad Omer then spoke about developing a values framework and vaccine prioritization schema for the National Association of Sciences, Engineering, and Medicine. With an interdisciplinary group, he developed risk-based criteria to guide the allocation of vaccines through the international COVAX program. They weighted morbidity/mortality first, followed by a social vulnerability scale that factors in race, income, transportation in a community, crowding, and age of the population. Omer made a strong case to lead with values for this kind of work by focusing on core principles and aligning them with public health objectives. COVAX does not expect to go beyond 20 percent of the world’s vaccination need in the next four years. He emphasized that while this is better than the normal expectation, it doesn’t erase the amount of avoidable suffering that will occur. Omer closed by reminding the audience of the critical role law plays in shaping vaccine equity — internally to each country, and internationally in the frameworks that allow nations to cooperate and advance global public health.

Kirsten Bibbins-Domingo closed out the conversation with her own real-world example of implementing health equity efforts in the COVID-19 pandemic. She outlined four ways that COVID-19 threatens to persist: 

  1. abandoning important public policy measures like social distancing, 
  2. evolution and spread of variant strains of the virus, 
  3. global spread due to vaccination disparities, and 
  4. immunity inequities within the United States. 

Bibbins-Domingo focused on the last point, arguing that equitable vaccination is effective. At the time of this panel, no state had vaccinated 20 percent of Black residents — despite some getting to 30 percent of all residents. Her solution? Take the vaccine to where the virus is. She talked about the success of geography-focused public health during COVID-19, from Protect Chicago to her work providing COVID-19 tests to everyone who wanted it in a neighborhood of San Francisco with high homelessness rates. Bibbins-Domingo argued it is critical to vaccinate everyone in vulnerable areas, based on the social vulnerability index. She said this is because you can’t prioritize vaccinating some people who face homeless over others, given how high the risk for COVID-19 is. This ZIP code-focused targeting also helps break neighborhood chains of transmission, helping front-line, low-wage workers. Their partnership found that being consistent and present in the community allowed for real mobilization that combatted hesitancy towards getting tested—to such an extent that they had twice the number of patients they could serve.

A final wrap-up question asked each speaker what we could learn from the path of the pandemic to date. They agreed on several key points: 

  1. It is necessary to get money to local jurisdictions fast to help drive vaccination rates. 
  2. A laser-like focus on public health — not just age — to drive vaccination tiering is key to help people with the most serious comorbidities. 
  3. Taking good data is necessary to address inequity. We need to know more to better target the drivers of health disparities.