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Transportation is an essential piece of equitable, effective COVID-19 vaccine distribution

A four-phased approach to vaccine allocation is being recommended by the National Academies of Sciences, Engineering, and Medicine as part of an eventual process for overcoming coronavirus disease 2019 (COVID-19) in the United States. Transportation will be an important factor in determining who gets vaccinated and when. In addition to providing essential services, the industry will literally connect people to the vaccine.

Transportation’s role in stopping the spread of COVID-19 reaches beyond the public transit, ridehailing, and airport employees risking their health. It’s an important piece in how each person will be immunized, especially if initial vaccines are limited to where they will be distributed.

The transportation industry, particularly freight transportation driving the supply chain, will be vital in ensuring a COVID-19 vaccine reaches the people who need them. Distribution of the vaccine will present its own set of complex challenges related to cost, access, logistics, and allocation/prioritization of the limited number of doses that will be available in the early stages if a vaccine is successful, as well as mitigating concerns about vaccine safety. One specific concern are insufficient cold supply chains able to maintain storage and shipping at an ultra-cold temperature, but companies developing vaccines are exploring ways to make the vaccines stable at higher temperatures. Other potential solutions include prefilling plastic syringes or using new systems or materials for vials. The supply chain will also need to transport massive numbers of syringes and needles along with any vials to ensure vaccine efficacy.
It’s unlikely that people included in the first two phases to receive the vaccine will simply be able to make an appointment at their preferred doctor’s office. Vaccines may be offered to approved personnel at central locations. Many of those who meet the conditions for early phases may not be walking or using personal vehicles to reach the vaccination center.

It’s unlikely that people included in the first two phases to receive the vaccine will simply be able to make an appointment at their preferred doctor’s office. Vaccines may be offered to priority populations at central locations. Many of those who meet the conditions for early phases may not be walking or using personal vehicles to reach the vaccination site.

The National Academies’ Framework for Equitable Allocation of COVID-19 Vaccine provides an overarching structure for equitable COVID-19 vaccine allocation designed to assist and guide policymakers planning for allocation under conditions of scarcity that will necessitate phases over time. The expectation is that the framework will help inform the decisions by health authorities and advisory bodies, including the Advisory Committee on Immunization Practices, as they create and implement national and/or local guidelines for COVID-19 vaccine allocation.

The goal of the federal government’s Operation Warp Speed is to deliver millions of doses of a safe, effective vaccine for COVID-19 in 2021. NIH and CDC requested the National Academies study and recommend vaccination plans be in place before an actual vaccine is available.

Criteria to reduce severe morbidity and mortality as well as negative societal impact
An individual’s risk of acquiring or transmitting COVID-19 are two criteria for placement in each of the four phases. Other risk-based criteria include risk of severe morbidity and mortality and risk of negative societal impact. Frontline health workers, first responders, those in skilled nursing facilities, and older adults living in socially vulnerable settings and other individuals with select high-risk comorbid conditions are included in Phase 1.

Included in Phase 2, along with those living or working in specific group settings, are people whose work in essential industries (those needed to keep society and the economy functioning) and whose occupations causes them to have a high level of exposure to persons with infection. Since the beginning of the pandemic, millions of people have been going to work and risking exposure to the virus to ensure there is food in markets; pharmaceutical products in drug stores; mail and packages delivered; buses, trains and planes operated; and teachers.

Essential public transportation employees including those needed to operate buses, trains, car services, or planes are at increased risk, especially in localities or situations where passengers are not required to wear masks. An estimated 179,000 public transit workers are accounted for as part of those recommended to be included in Phase 2 of a vaccine. There is no single complete list of all workers encompassed in Phase 2, the likelihood of uncontrolled exposure will vary by location and situation.

Other groups dependent on public transportation, such as those living in homeless shelters or group homes and all other older adults not included in Phase 1 may be covered in Phase 2.

Adequately and equitably distributing vaccines based on vulnerability
The phased approach applies the best available current evidence to implementing the framework’s foundational principles to inform the federal government’s work. The report provides a framework that is implementable in and adaptable to a range of possible circumstances.

In defining each priority group, the report committee considered their equity implications. Successful immunization programs ensure that vaccine is allocated in adequate quantities and at locations accessible to vulnerable populations. The CDC’s Social Vulnerability Index identifies areas of vulnerability based on 15 census variables which capture many:

  • social determinants of health (e.g., income or race/ethnicity)
  • indicators of access (e.g., transportation)
  • infection transmission (e.g., crowding)
  • increased risk of adverse COVID-19 outcomes (e.g., proportion 65 or older)

Accounting for the unknown
Various vaccine trials are underway, but many uncertainties remain. Quantities, in terms of how many doses will be available, how many different options may be available, and how many doses a person may need to be considered vaccinated are unclear. Efficacy, safety, uptake, administration, and legal contexts are all dependent upon the details of an actual vaccine. The framework addresses various possible scenarios.

Charting the phases



National Academies of Sciences, Engineering, and Medicine resource cited:

External resource cited:
Additional TRB resources:
Contact:

Beth Ewoldsen, Content Strategist
Transportation Research Board
202-334-2353; bewoldsen@nas.edu
Published October 7, 2020

This Summary Last Modified On: 10/6/2020

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