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Which groups does the public believe should be prioritized for COVID-19 vaccine access?
In this survey study of 4735 US adults, respondents of all demographic and political affiliations agreed with prioritizing health care workers, adults of any age with serious comorbid conditions, frontline workers (eg, teachers and grocery workers), and Black, Hispanic, Native American, and other communities that have been disproportionately affected by COVID-19. Older adult respondents were less likely than younger respondents to list healthy people older than 65 years as 1 of their top 4 priority groups.
These findings suggest that the US public agrees with the high-priority groups proposed by the National Academies of Science, Engineering, and Medicine but appears to disagree with approaches advanced by others that prioritize older adults but not essential workers or disproportionately affected communities.
As COVID-19 vaccine distribution continues, policy makers are struggling to decide which groups should be prioritized for vaccination.
To assess US adults’ preferences regarding COVID-19 vaccine prioritization.
Design, Setting, and Participants
This survey study involved 2 independent, online surveys of US adults aged 18 years and older, 1 conducted by Gallup from September 14 to 27, 2020, and the other conducted by the COVID Collaborative from September 19 to 25, 2020. Samples were weighted to reflect sociodemographic characteristics of the US population.
Respondents were asked to prioritize groups for COVID-19 vaccine and to rank their prioritization considerations.
Main Outcomes and Measures
The study assessed prioritization preferences and agreement with the National Academies of Science, Engineering, and Medicine’s Preliminary Framework for Equitable Allocation of COVID-19 Vaccine.
A total of 4735 individuals participated, 2730 (1474 men [54.1%]; mean [SD] age, 59.2 [14.5] years) in the Gallup survey and 2005 (944 men [47.1%]; 203 participants [21.5%] aged 55-59 years) in the COVID Collaborative survey. In both the Gallup COVID-19 Panel and COVID Collaborative surveys, respondents listed health care workers (Gallup, 93.6% [95% CI, 91.2%-95.3%]; COVID Collaborative, 80.0% [95% CI, 78.0%-81.9%]) and adults of any age with serious comorbid conditions (Gallup, 78.6% [95% CI, 75.2%-81.7%]; COVID Collaborative, 72.9% [95% CI, 70.7%-74.9%]) among their 4 highest priority groups. Respondents of all political affiliations agreed with prioritizing Black, Hispanic, Native American, and other communities that have been disproportionately affected by COVID-19 (Gallup, 74.2% [95% CI, 70.6%-77.5%]; COVID Collaborative, 84.9% [95% CI, 83.1%-86.5%]), and COVID Collaborative respondents were willing to be preceded in line by teachers and childcare workers (92.5%; 95% CI, 91.2%-93.7%) and grocery workers (85.9%; 95% CI, 84.2%-87.5%). Older respondents in both surveys were significantly less likely than younger respondents to prioritize healthy adults aged 65 years and older among their 4 highest priority groups (Gallup, 23.7% vs 39.1% [χ2 = 2160.8; P < .001]; COVID Collaborative, 23.3% vs 28.8% [χ2 = 5.0198; P = .03]). COVID Collaborative respondents believed the 4 most important considerations for prioritization were preventing COVID-19 spread (78.4% [95% CI, 76.3%-80.3%]), preventing the most deaths (72.1% [95% CI, 69.9%-74.2%]), preventing long-term complications (68.9% [66.6%-71.9%]), and protecting frontline workers (63.8% [95% CI, 61.5%-66.1%]).
Conclusions and Relevance
US adults broadly agreed with the National Academies of Science, Engineering, and Medicine’s prioritization framework. Respondents endorsed prioritizing racial/ethnic communities that are disproportionately affected by COVID-19, and older respondents were significantly less likely than younger respondents to endorse prioritizing healthy people older than 65 years. This provides reason for caution about COVID-19 vaccine distribution plans that prioritize healthy adults older than a cutoff age without including those younger than that age with preexisting conditions, that aim solely to prevent the most deaths, or that give no priority to frontline workers or disproportionately affected communities.
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CME Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships. If applicable, all relevant financial relationships have been mitigated.
Accepted for Publication: March 7, 2021.
Published: April 9, 2021. doi:10.1001/jamanetworkopen.2021.7943
Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2021 Persad G et al. JAMA Network Open.
Corresponding Author: Ezekiel J. Emanuel, MD, PhD, Department of Medical Ethics and Health Policy, University of Pennsylvania Perelman School of Medicine, 423 Guardian Dr, Philadelphia, PA 19104 (firstname.lastname@example.org).
Author Contributions: Drs Emanuel and Sangenito had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.
Concept and design: Persad, Emanuel, Glickman, Largent.
Acquisition, analysis, or interpretation of data: All authors.
Drafting of the manuscript: Persad, Glickman, Phillips, Largent.
Critical revision of the manuscript for important intellectual content: Persad, Emanuel, Sangenito, Glickman, Largent.
Statistical analysis: Sangenito.
Obtained funding: Emanuel.
Administrative, technical, or material support: Glickman, Phillips.
Conflict of Interest Disclosures: Dr Persad reported receiving grants from Greenwall Foundation and personal fees from ASCO Post and the World Health Organization outside the submitted work. Dr Emanuel reported being a partner at ReCovery Partners, LLC, Oak HC/FT, and Embedded Healthcare, LLC; receiving personal fees from Center for Neurodegenerative Disease Research, Genentech Oncology, Council of Insurance Agents and Brokers, America’s Health Insurance Plans, Montefiore Physician Leadership Academy, Greenwall Foundation, Medical Home Network, Healthcare Financial Management Association, Ecumenical Center–UT Health, American Academy of Optometry, Associação Nacional de Hospitais Privados, National Alliance of Healthcare Purchaser Coalitions, Optum Labs, Massachusetts Association of Health Plans, District of Columbia Hospital Association, Washington University, Brown University, McKay Lab, American Society for Surgery of the Hand, Association of American Medical Colleges, America’s Essential Hospitals, Johns Hopkins University, National Resident Matching Program, Shore Memorial Health System, Tulane University, Oregon Health & Science University, United Health Group, CBI, and Blue Cross Blue Shield; and receiving nonfinancial support (travel reimbursement) from the Center for Global Development, The Atlantic, RAND Corporation, and Goldman Sachs outside the submitted work. Dr Glickman reported receiving a gift from the Colton Foundation during the conduct of the study. Dr Largent reported receiving grants from the National Institute on Aging and the Greenwall Foundation outside the submitted work. No other disclosures were reported.
Funding/Support: This work was funded in part with a gift from the Colton Foundation.
Role of the Funder/Sponsor: The funder had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.
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