What prioritizing worse-off minority groups for COVID-19 vaccines means quantitatively: practical, legal, and ethical implications

To help mitigate structural disadvantage, the National Academies of Science, Engineering and Medicine (NASEM) framework for equitably allocating COVID-19 vaccines proposed increasing allocations to worse-off minorities through the CDC’s Social Vulnerability Index (SVI). However, the extent of benefit is unknown. Moreover, since SVI includes a race variable and could face legal challenges, it is desirable to quantify using an alternative such as the Area Deprivation Index (ADI) that does not include race and can offer more targeted prioritization as it is centered on the blockgroup, not census-tract level. We therefore sought to determine what shares of minorities would be offered vaccines under the NASEM’s allocation framework comparing: 1) no disadvantage index, to 2) SVI to 3) ADI.