This A Kansas Twist blog series highlights the steps that have been taken – and the challenges that remain – in ensuring that COVID-19 vaccines are distributed in an equitable manner. If you have questions about the COVID-19 vaccines that you would like to see addressed in a future edition, please submit them here.
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Kansas Distribution of COVID-19 Vaccines
In this installment of A Kansas Twist, we will describe the Kansas plan for COVID-19 vaccinations, examine some of the differences in how counties are implementing that plan, and highlight opportunities to ensure an equitable distribution of the vaccines.
Each state is, largely, responsible for allocating vaccine supplies among providers. Additional vaccine supplies are allocated through federally administered programs such as the Federal Retail Pharmacy Program. Generally, these providers are required to vaccinate those deemed eligible in the state prioritization plan.
The Kansas Department of Health and Environment (KDHE) posted the initial COVID-19 Vaccination Plan in October 2020. This plan provided the framework for vaccine provider recruitment, storage, communication, safety monitoring and data systems. On January 7, 2021, Governor Laura Kelly announced the Kansas Vaccine Prioritization Plan, which was informed by the independent Coronavirus Vaccine Advisory Committee (COVAC). The Kansas plan outlines five phases by which the population of Kansas will be eligible to receive a COVID-19 vaccine:
- Phase 1. Healthcare workers; residents or patients in long-term care (LTC), senior housing or LTC-supported independent living; workers critical to pandemic response continuity.
- Phase 2. Persons aged 65+; congregate settings; high-contact critical workers.
- Phase 3. Persons aged 16-64 with severe medical risks; other critical workers.
- Phase 4. Persons aged 16-64 with other medical risks.
- Phase 5. Remainder of the population 16+ and children.*
*Note: Subject to research on vaccine risks and effectiveness for children.
Kansas is currently in Phase 2 of vaccine distribution, which is estimated to include about 1 million people, or a third of the total population of the state. Within each phase of the state plan, local health departments can make determinations as to which subgroups within the active phase should be prioritized based on the allocation of vaccine that the county receives. The state makes adjustments to the allocations received by each local health department weekly based on the number of doses allocated to the state, the total vaccine allocated over time, the total number of people in each phase and the CDC Social Vulnerability Index. More details on the allocation process are available in the Kansas Vaccine Distribution Provider Manual.
Flexibility to prioritize different groups within each phase gives local health departments both the opportunity and challenge of incorporating equity in vaccine decision-making. For example, within Phase 2, some counties may elect to vaccinate those aged 65 and older first while other counties may select a subset of high-contact critical workers to vaccinate first. Counties also may weigh the impact on other populations at risk, including those in congregate settings, which have seen large numbers of cases across the state.
To better understand how some counties elected to vaccinate their residents, KHI reviewed vaccine plans, public announcements and social media posts for 26 of 105 Kansas counties. The 26 counties reviewed included all six urban counties and 20 additional counties from each of the four non-urban peer groups (semi-urban, densely-settled rural, rural and frontier) across the six KDHE regions, covering 2,078,545 Kansans or 71.3 percent of the population (see map).
Of the 26 Kansas county plans reviewed as of March 1, only 16 counties publicly published how they were prioritizing their vaccine supply among the groups in Phase 2. By “prioritizing,” we mean the county publicly identified a specific population group as being eligible or a priority, although other population groups might not be excluded. Among the 16 counties with published details, there was much variation in how a county incorporated equity when deciding which groups to prioritize within Phase 2. Some examples include:
- While those age 65+ are eligible according to Phase 2 of the state plan, three (3) counties we reviewed prioritized older populations of 70+, 73+ and 85+.
- One (1) county gave a higher priority to individuals age 65 and older living in certain zip codes, using the CDC Social Vulnerability Index.
- Eight (8) counties we reviewed selected a subset of high-contact critical workers to vaccinate first (e.g., first responders, transportation workers, school teachers).
- One (1) county included low-wage, high-contact critical workers (e.g., food service workers) when identifying a subset of populations for Phase 2 prioritization.
- Two (2) counties we reviewed specifically prioritized individuals in congregate settings (e.g., behavioral health institutions, correctional facilities) when identifying a subset of populations for Phase 2 prioritization.
The remaining counties stated they were in Phase 2 and have sign up forms or wait lists that could be used to prioritize people in each phase.
To monitor vaccine distribution in Kansas, KHI also is reviewing the Kansas COVID-19 Vaccination Overview. This dashboard is regularly updated and includes a variety of key data about vaccine distribution in Kansas, such as doses distributed (1,015,940), total doses administered (658,459) and percent of Kansans vaccinated (15.1 percent) as of March 8. Additionally, the state has now published demographic information for vaccines administered. While demographic information is missing/not reported for about 15 percent of administered doses, the data available help to get a sense of who has been vaccinated to date.
The age group with the highest rate of administration is those 85+ at about 560.0 per 1,000 population. It is also notable that the rate of vaccine administration among White Kansans is about 2.3 times higher than among Black Kansans (124.1 and 54.7 per 1,000, respectively). Additionally, Kansans who are not Hispanic or Latinx have an immunization rate about 1.7 times higher than those who are Hispanic or Latinx (127.0 and 75.9 per 1,000).
If you have not yet received the COVID-19 vaccine and think you may be eligible, please utilize the VaccineFinder tool made available by the CDC.
Equity and Distribution of COVID-19 Vaccine (March 8, 2021)
Scientists first published the genetic sequence for the COVID-19 virus on January 11, 2020. Fourteen months later, three vaccines have received Emergency Use Authorization (EUA) in the United States. Work is now underway to implement a critical step to protect people from COVID-19 — getting them vaccinated.
Health equity, as defined by the Robert Wood Johnson Foundation, means “that everyone has a fair and just opportunity to be as healthy as possible. This requires removing obstacles to health such as poverty, discrimination and their consequences, including powerlessness and lack of access to good jobs with fair pay, quality education and housing, safe environment and health care.” An equitable approach to vaccine distribution recognizes that vaccine supply is limited and that a variety of barriers to accessing the vaccine must be addressed. Successful, equitable vaccine distribution will require equity to be considered throughout the process.
Achieving a high COVID-19 vaccination rate will be particularly important among Black and Hispanic/Latinx Kansans, who tend to be overrepresented in jobs considered essential during the pandemic, putting them at risk of ongoing exposure to the virus. To help, the scientific and public health workforce are working to increase trust among communities of color, particularly with Black communities for whom historic failures such as the Tuskegee Syphilis Experiment, HPV vaccine development and Henrietta Lacks may be top of mind. These failures likely have contributed to lower confidence in COVID-19 vaccines in the U.S. among Black Adults, with just 41 percent indicating they had already gotten the vaccine or would get it as soon as possible, compared to 61 percent of White Adults.
The Federal Government and COVID-19 Vaccines
We start with a brief outline of the federal vaccine development process, the roles of the Food and Drug Administration (FDA) and the Centers for Disease Control and Prevention (CDC), and how it considered equity and informed the Kansas plan for vaccinations.
The FDA oversees the development and authorization of vaccines, along with the Vaccines and Related Biologic Products Advisory Committee (VRBPAC), an external advisory committee. The CDC and the Advisory Committee on Immunization Practice (ACIP) — like the VRBPAC, ACIP is a group of experts external to the Federal agencies — review clinical trial data and other research to recommend vaccination for specific populations. These independent bodies of external experts are one example of the safeguards to protect the vaccine development process from undue political, industry or other pressures. More information detailing the clinical trial process is available from the FDA online.
In June 2020, the FDA released guidance to manufacturers detailing the standards that any vaccines would have to meet before they could be authorized. The FDA provided an effectiveness threshold that would have to be met before a vaccine would be approved and strongly encouraged manufacturers to include diverse populations, specifically racial and ethnic minorities, in vaccine trials. For the Pfizer vaccine currently available, it was reported that 10 percent of trial participants were Black and 13 percent were Hispanic. Similarly, the Moderna vaccine trial included 10 percent Black participants and 20 percent Hispanic participants. Actively recruiting Black and Hispanic/Latinx clinical trial participants ensured that when the FDA was making determinations about vaccine safety, there were adequate data to state that there were no differences in safety based on ethnic or racial groups.
While the FDA and manufacturers worked to ensure that a vaccine product would be available that was safe and effective, the CDC was working on distribution plans. An early step in this process was the release of Guiding Ethical Principles by the ACIP that would inform how any recommendations for vaccination would be made. These four Guiding Principles included:
- Maximize benefits and minimize harms
- Mitigate health inequities
- Promote Justice
- Promote Transparency
These Guiding Principles informed how the ACIP described the phases for vaccine distribution. Subsequently Kansas, like other states, used this information to develop its Vaccine Prioritization Plan.
Since the first EUAs were issued in December, about 60 million Americans had received at least one dose of a COVID-19 vaccine by March 8, 2021. Despite this progress, concerns remain that vaccines are not always going to those who need them most. The next blog in this series will detail the Kansas plan for vaccine distribution and provide progress notes on the work in our state to vaccinate those who need it most.
The Kansas Health Institute supports effective policymaking through nonpartisan research, education and engagement. KHI believes evidence-based information, objective analysis and civil dialogue enable policy leaders to be champions for a healthier Kansas. Established in 1995 with a multiyear grant from the Kansas Health Foundation, KHI is a nonprofit, nonpartisan educational organization based in Topeka.