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Researchers say the U.S. COVID-19 vaccine program worked well, but there are still lessons to be learned. Janice Chen/Getty Images
  • In a new study, researchers analyzed how well the COVID-19 vaccine programs administered by the CDC have worked during the pandemic.
  • They concluded the programs came close to the “optimal” outcomes that were mathematically calculated.
  • They said, though, there are still lessons to be learned in determining goals and distributing vaccines.
  • One of those goals, researchers said, should be equal access to vaccines for all communities.

Now that COVID-19 vaccines — and boosters — have been offered to all people in the United States, a new study examines how the initial vaccine rollout performed against mathematical models that have the benefit of hindsight.

Researchers say they found that the U.S. approach wasn’t perfect, but it did pretty well.

When the Centers for Disease Control and Prevention (CDC) began its COVID-19 vaccine rollout, it prioritized people by age, jobs (frontline medical workers and others got priority), and comorbidities that made COVID-19 more severe, among other factors.

The researchers from Iowa State University then took those characteristics in the CDC’s rollout recommendations and sorted them into 17 subpopulations.

That resulted in more than 17 billion ways vaccines could be allocated and 17 million allocation strategies that could be considered “optimal.”

All told, the CDC’s approach yielded an estimated 0.19 percent more deaths, 4 percent more COVID-19 cases, 4 percent more infections, and slightly less than 1 percent more years of life lost than the mathematically optimal models.

And that’s pretty impressive, said Dr. William Lang, MHA, the medical director of WorldClinic and JobSiteCare as well as the former associate chief medical officer of the Department of Homeland Security.

“The fact that the real-life outcome was so minimally different than the calculated optimization says an awful lot about the quality of the expert opinions used in hammering out the approach we took,” Lang told Healthline.

“While the epidemiological/mathematical approach took into account multiple factors, the real-world experts had to also consider the second and third order effects reactions to include such hard-to-quantify issues, such as the reaction of one socioeconomic group if another was to receive higher prioritization, impacts of various prioritization decisions on vaccine resistance, and relative ability to effectively market vaccinations to one or another target group, among others,” he said.

The question, then, is less about what the CDC got right or wrong, but a more nuanced set of questions around what we prioritize when we are trying to limit harm in the population.

“Any vaccine rollout must balance several competing goals, including minimizing mortality and infections, ensuring equity across demographic groups, and maintaining health care capacity,” the study authors wrote.

They also noted that there was a tension between these competing needs.

For instance, “the most equitable allocation across age groups in terms of mortality performed poorly in all other objectives [while] the allocation that minimized overall mortality led to a more even distribution of deaths among all age groups,” they wrote.

“That’s important to think about,” said Phil Smith, PhD, MS, a public health expert and an assistant professor of kinesiology, nutrition, and health at Miami University in Ohio.

“Is the goal reducing deaths? Reducing transmission? Achieving herd immunity as quickly as possible? Years of life lost? Is the goal equity across age groups or other population groups? Those are very challenging questions to navigate,” he said.

“It is also challenging to determine how many vaccines to allocate across states, which may have their own challenges around distribution,” Smith told Healthline.

“Navigating our healthcare payment and reimbursement structure is challenging because it is incredibly complex, but most of that complicated work happens behind the scenes,” he added.

That complex and overstressed healthcare system might be one of our biggest hurdles to “optimizing” our approaches to the next pandemic, including vaccine rollout.

“For many of us in public health, we knew of the gaps, the health disparities, the health inequalities, and the health inequities,” said Kenneth L. Campbell, MPH, the program director of Tulane University’s online Master of Health Administration and an assistant professor in the Tulane School of Public Health and Tropical Medicine in New Orleans.

“We knew this. But what we didn’t know was how big that gap would be,” he said. “We didn’t know how those deficiencies would paralyze our ability to reach millions of Americans.”

For instance, despite the vaccines being free, uninsured people are vaccinated at nearly half the rate of insured people, research shows.

To produce more optimal outcomes, we need to have more robust structures for supporting our citizens at all times.

“Healthcare, education, and child care should not be an ask. It should be an absolute right for anyone in this country,” Campbell told Healthline. “Not having these things leaves families exposed economically, especially minority communities who are at a social disadvantage already.”

“You have to build systems,” he added. “As a former Marine, we don’t wait for tragedy to happen. We’re already training for that tragedy. That’s what our country has to be ready to do.”