Equitable Vaccine Access within an Age-Based Framework

Objectives Several states have adopted age-based prioritization for COVID-19 vaccine eligibility (also prioritizing teachers and child care workers) because it is simple (especially when age is quantized by decade) and age is strongly associated with COVID-19 mortality. But this approach raises equity concerns based in law and ethics. This study proposes data-driven solutions for equitable policy that retains the advantages of an age-based approach. Methods Using data from CDC and U.S. Census Bureau, I analyzed 507,227 COVID-19 deaths in the U.S. by age and race-ethnicity and compared the risk ratios to published data on risk ratios for other conditions. Results COVID-19 mortality in the U.S. rose 2.59-fold per decade of life [95% confidence interval (2.52, 2.66)]. Down syndrome, organ transplantation, and intellectual/developmental disability have risk ratios for COVID-19 mortality that exceed that. Conclusions People with specific conditions (including certain disabilities and certain medical conditions) associated with a risk ratio of 2.59 or 6.71 should be granted vaccine eligibility along with people 10 or 20 years older, respectively. Along with additional recommendations on data collection and reporting, this could help address equity within an age-based framework. 3-Question Summary Box Some states have adopted age-only prioritization for COVID-19 vaccine access, quantized by decade of life, because it is simple, and age has a strong association with COVID-19 mortality. But this raises concerns based in law and ethics. This study quantifies the age effect and documents that COVID-19 mortality increases 2.59-fold per decade of life—a smaller increase than some conditions. People with conditions associated with at least 2.59-fold COVID-19 mortality should be granted vaccine eligibility along with people at least 10 years older.