Healthcare Allocation Lab

Advocating for fair allocation policies

“A campaign for boosters could lock in that [vaccine] apartheid. This profound global inequity would not only be a humanitarian disaster, but also a significant long-term risk for Americans, as scientists agree that accelerating global vaccination is the only way to prevent the formation of deadly new variants.” – William F. Parker and Govind Persad

The Washington Times, “Why the Biden Administration’s Recommendation on Booster Shots is a Mistake”

Our lab has made normative and empirical contributions to vaccine allocation research, focusing on early phases of domestic US vaccine rollout when doses were absolutely scarce. We advocate for evidence-based policies, such as proactive outreach to underserved communities, place-based allocation, lotteries instead of first-come, first-served, and delaying the second dose of the primary series to reduce inequity and save lives.

Dr. Parker’s opinion pieces and commentaries on these ideas are published in peer-reviewed articles (e.g., Khunti et al., 2023) and featured in local (Chicago Tribune, WBEZ, Chicago Sun-times) and national (USA Today, Washington Post, and The New York Times) outlets.

Quantifying the consequences of vaccine inequity

In empirical work, our lab used econometric approaches to determine the association between inequitable vaccine coverage and severe COVID-19 outcomes in Chicago:

  • Results revealed that zip codes with higher proportions of Black and Hispanic residents had lower vaccination rates and higher mortality due to COVID-19.
Key Publications
  1. Parker WF, Persad G, Peek ME. 2021. Fair allocation at COVID-19 mass vaccination sites. JAMA Health Forum. 2(4):e210464. doi: 1001/jamahealthforum.2021.0464
  2. Parker WF, Persad G, Peek ME. 2021 Feb 10. Four recommendations to efficiently and equitably accelerate the COVID-19 vaccine rollout [blog]. Health Affairs Forefront. doi: 1377/hblog20210204.166874
  3. Parker WF. Caring for the Unvaccinated. 2022. Ann Am Thorac Soc. 19(2):153-156.
  4. Parker WF, Persad G, Peek ME. 2022. Errors in converting principles to protocols: where the bioethics of COVID-19 vaccine allocation went wrong. Hastings Cent Rep. 52(5):8-14.
  5. Strohbehn G, Persad G, Parker WF, Murthy S. 2022. Dose optimisation and scarce resource allocation: two sides of the same coin. BMJ Open. 12(10):e063436. doi: 1136/bmjopen-2022-063436
  6. Zeng S, Pelzer KM, Gibbons RG, Peek ME, Parker WF. 2022. Association of zip code vaccination rate with COVID-19 mortality in Chicago, Illinois.  JAMA Netw Open. 5(5):e2214753. doi: 10.1001/jamanetworkopen.2022.1475
  7. Derman BA, Parker WF. 2023. Fair allocation of scarce CAR T-Cell therapies for relapsed/refractory multiple myeloma. JAMA. 330(8):687–688

    Dose optimisation and scarce resource allocation: two sides of the same coin

    When resources are scarce, this indicates that the supply of a resource cannot meet the demand for it (Strobehn et al., 2022).

    Societies aim to allocate scarce resources in a manner that is consistent with the value of the resources. In order to distribute a drug or vaccine that is in limited supply appropriately, it is critical that to understand the relationship between the dose of a scarce drug and the clinical response that is necessary.

    • We found that during the COVID-19 pandemic, the majority of drug development and repurposing has “been ignorant of scarcity and dose optimisation’s ability to help address it” (Strohbehn et al., 2022).

    • Future pandemic clinical trials should generate data on dose optimization, which will allow medical professionals to ensure that doses are distributed in an appropriate way.

    Figure: “Distinctions between individually and socially optimal dosing approaches for a hypothetical vaccine. (A) A randomised dose-finding study reveals the dose–response curve shown, where a vaccine is found to have maximal efficacy at a 100 µg dose and approximately 75% relative efficacy at quarter-dose. (B) By evaluating the drug’s efficacy relative to the amount of drug administered, we derive the socially optimal dose, maximising the efficacy gained per microgram administered. MDSE, minimum dose with satisfactory efficacy; RCT, randomised controlled trial” (Strobehn et al., 2022)

    Errors in converting principles to protocols: Where the bioethics of U.S. covid-19 vaccine allocation went wrong

    In 2021, the allocation of COVID-19 vaccines, a drug in scarce supply, was the world’s most pressing bioethical challenge. To address this, the US Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices (ACIP) established three guiding ethical principles by which to make allocation decisions: maximize benefits, promote justice, and mitigate health inequities.

    In an essay published in the Hastings Report, we argued that critical components of the ACIP protocol were inconsistent with these ethical principles.

    • The ACIP: 
      • Recommended overly broad health care worker priority in phase 1a.
      • Used being at least seventy-five years of age as the only criterion to identify individuals at high risk of death from Covid-19 during phase 1b.
      • Failed to recommend place-based vaccine distribution.
      • Implicitly endorsed first-come, first-served vaccine allocation.
    • These policies violated the ACIP’s own ethical principles.

    Mistakes may have been prevented and more lives may have been saved if a complete ethical framework that recognized the trade-offs between principles had been developed.

    Table 1: Advisory Committee on Immunization Practices (ACIP) Ethical Principles for Allocation of Covid-19 Vaccines

    Table 2: ACIP Final Recommended Phases for the Initial Covid-19 Vaccine Allocation

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