RESUMEN
Background: Despite the development of safe and effective vaccines and antiviral treatments against COVID- 19, marginalized racial/ethnic groups in the United States continue to be disproportionally burdened by COVID-19. In response to this inequity, public health officials in several states designed, usually in an ad-hoc manner, policies aimed to be more equitable in both access and distribution of COVID-19 interventions. Method(s): We constructed an age- and race-stratified mathematical model of SARS-CoV-2 transmission and COVID-19 vaccination. We fit our model to data from Oregon at the beginning of 2021. Next, we explored counterfactual scenarios where we determined the optimal use of limited amounts of vaccine over the first 4 months of 2021 with the goal of minimizing 1) number of deaths or Years of Life Lost (YLL), 2) the inequity in mortality or YYL between race groups, 3) a combination of both. We compared them to a base-case scenario without vaccination. Result(s): When vaccine supply is very limited (enough to cover 10% of the population), there is a trade-off between minimizing mortality or minimizing inequity (Fig.1). For minimizing mortality, it is optimal to allocate vaccine to the oldest age group, irrespective of race. To minimize inequity, vaccine needs to be allocated first to the marginalized populations in the young- and middle-aged groups, incurring significantly more deaths in all groups, including the marginalized ones, compared to minimizing mortality (Fig.1). When minimizing both deaths and inequity, the optimal vaccination strategy achieved a significant reduction in inequity while preserving most of the reduction in mortality (Fig.1). When minimizing YYL and inequity, the optimal allocation resulted in a more equitable distribution of resources and outcomes across race groups. Once vaccine supply was enough to cover 20% of the population, our results suggest that it is possible to minimize both mortality (or YYL) and inequity, by protecting marginalized communities and the oldest populations at the same time. Conclusion(s): With low vaccine supply, there is a trade-off between being more equitable and reducing mortality. This is true because COVID-19 related mortality is concentrated in the oldest population while marginalized populations are predominately young. This trade-off quickly disappears when more vaccine is available. An interdisciplinary approach is needed to address the inequitable distribution of resources and outcomes in public health. Mortality rate (left), Years of Life Lost (center) and Indices of Disparity (right) with no vaccination (top row), minimizing deaths (2nd row), inequity (3rd row) or both (4th row) with enough vaccine to cover 10% of the population.