A rapid review of COVID-19 vaccine prioritization in the U.S.: alignment between Federal guidance and State practice

Jain, V.; Schwarz, L.; Lorgelly, P.

Background: Population groups to be prioritized for COVID-19 vaccinations in the U.S. have been determined at the Federal level. Evidence suggests that there is variation in how States have implemented this guidance. This review examines how the position of population groups in vaccine priority lists varies between Federal guidance and State practice. Methods: An online search of State vaccination prioritization plans was conducted. Data were extracted on each population group included and their relative position. A standardized ranking method was applied to provide a directional measure of variability in prioritization between State and Federal guidance, for each population group. Results: Healthcare workers and those in long-term care facilities were largely prioritized in line with Federal guidance. Aside from early education staff, essential workers were often excluded at State level. Of the 37 States including frontline essential workers, 12 assigned them to a lower priority than recommended. Almost all States included the 65-74 year age group and most assigned them to a higher position than recommended in Federal guidance. Those with underlying medical conditions were similarly highly prioritized, although there was more variability across States. Some socially vulnerable groups (not included in Federal guidance) were highly prioritized by States. Conclusions: Across the U.S, the prioritization of groups for COVID-19 vaccination has been highly variable. Essential workers were the most often excluded or less highly prioritised group compared to Federal guidance. Some socially vulnerable groups were highly prioritized in State plans, whilst others were mentioned in only a few States. Future guidance must be relevant to local needs and values, to minimise any unwarranted heterogeneity in vaccine access across populations.