Did Risk-based or Age-based Vaccine Prioritization for Covid-19 Save More Lives?

Abstract

ImportanceAll U.S. states provided Covid-19 vaccine access to frontline healthcare workers first, but after that, states varied in whether they gave earlier access to the elderly, versus the vulnerable with comorbidities, or school employees or essential workers, reflecting the underlying scientific and policy uncertainty.ObjectiveTo evaluate if risk-based or age-based prioritization is more effective at reducing reported Covid-19 cases and deaths.DesignA serial cross-sectional studySetting50 U.S. states and Washington D.C.Participants60+ years of age, high-risk individuals, K-12 school employees, and essential workersMain Outcomes and MeasuresHospitalizations and deathsResultsSeven to nine weeks after 60-year-olds became eligible for a vaccine, there was a statistically significant 40-50% decline in Covid-19 hospitalizations in that state. In contrast, there was no statistically detectable change in hospitalizations in the 7-9 weeks after K-12 employees become eligible for vaccines. Vaccine eligibility of “high-risk adults” and “essential workers” produces effects somewhere in the middle, with reductions in hospitalization of about 25%. There was a large statistically significant decline in death rates (25-38%) 10 to 11 weeks after people aged over 60 became vaccine-eligible. These effects were generally statistically larger than high risk individuals, K-12 school employees, and essential workers.Conclusions and RelevancePanel data analysis of weekly variation in Covid-19 health outcomes reveals that prioritizing adults 60+ years of age is associated with the largest reduction in hospitalizations and Covid-19 cases, followed by vaccines for adults with high-risk comorbidities. Vaccinations extended to K-12 school employees and essential workers is associated with the smallest reductions in hospitalizations and deaths.Key PointsQuestionDid Risk-based or Age-based Vaccine Prioritization for Covid-19 Save More Lives?FindingsPanel data analysis of weekly variation in Covid-19 health outcomes reveals that prioritizing adults 60+ years of age is associated with the largest reduction in hospitalizations and Covid-19 cases, followed by vaccines for adults with high-risk comorbidities. Vaccinations extended to K-12 school employees and essential workers is associated with the smallest reductions in hospitalizations and deaths.MeaningPrioritizing adults 60+ years of age can lead to a higher estimated reduction in hospitalizations and deaths, followed by a strategy of prioritizing adults with high-risk comorbidities. Our findings add to the limited evidence for the roadmap for prioritizing use of Covid-19 vaccines, and help address uncertainties about the relative effectiveness of different vaccine strategies.

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“…We obtain the eligibility data from the COVID-19 U.S. State Policy (CUSP) database (Raifman et al, 2020;Skinner et al, 2022). The data from CUSP has been used in multiple studies to determine the impact of age-specific vaccine eligibility on the likelihood of delaying or forgoing care (Aslim et al, 2022), mental health problems (Agrawal et al, 2021), risk mitigating behaviors or ex-ante moral hazard (Agrawal, Sood, and Whaley, 2022), as well as hospitalizations and deaths (Smits et al, 2022). A potential challenge in using age-specific vaccine eligibility to recover causal effects is that certain individuals may be eligible for vaccination prior to the policy implementation.…”

“…First of all, more than half of the states initially provided eligibility to 65+ in earlier waves, and importantly, we are able to sample multiple waves across these states where individuals below 65 were not eligible for vaccination. 20 Moreover, there is evidence that vaccine eligibility among the elderly yields the largest reductions in hospitalizations and COVID-19 cases (Smits et al, 2022). Agrawal, Sood, and Whaley (2022) also find a relatively high take-up of vaccine among individuals aged over 65.…”