183:oral Ventilator rationing under crisis standards of care: what lessons have we learned regarding impact on social, racial and ethnic justice?

Abstract

Covid-19 vaccine allocation plans. The dominant model is the CDC's Social Vulnerability Index (SVI), developed for natural disaster response efforts (mapping well onto a conceptualization in the philosophical literature: Wolff/De-Shalit, 'Disadvantage', OUP 2007, as well as public preferences: Schmidt et al. 'US adults' preferences…' JME, 2021). Main DI uses: planning dispensing site locations, targeted outreach/communication, increasing vaccine quantities, and monitoring uptake/ course-correcting. Adapted forms were also used for tests and antiviral treatment allocation. The scoping review of SVI uses is ongoing at the time of submission; preliminary findings are that around 50% of N=119 publications use DIs 'off-label', ie in non-emergency settings, indicating an unmet need. Emergent themes include: budgetary allocations, healthcare service access planning, targeted prevention. Discussion In Spring 2020, the dominant theme in Covid-19 allocation frameworks was maximizing overall benefits-often risking exacerbating existing inequities. The rapid and widespread DI adoption opened a major new chapter, holds major potential to improve equity in allocation beyond Covid-19, and should be explored further.