COVID-19 vaccine prioritisation for people with disabilities
Authors: Sabrina Epstein, Kara Ayers, Bonnielin K Swenor
Journal: The Lancet Public Health (2021)

For many people around the world, the COVID-19 vaccine rollout has brought unprecedented hope. For people with disabilities, vaccine prioritisation schemes are the latest aspect of the pandemic response to raise concerns.1Andrews EE Ayer KB Brown KS Dunn DS Pilarski CR No body is expendable: medical rationing and disability justice during the COVID-19 pandemic.Am Psychol. 2020; (published online July 23.)https://10.1037/amp0000709Google Scholar In the USA, for example, each state and territory has adopted the Centers for Disease Control and Prevention (CDC) guidelines differently.2US Centers for Disease Control and PreventionInterim considerations for phased implementation of COVID-19 vaccination and sub-prioritization among recommended populations.https://www.cdc.gov/vaccines/covid-19/phased-implementation.html#ConsiderationsDate accessed: April 13, 2021Google Scholar As a result, the COVID-19 vaccine rollout is uneven and has perpetuated inequities in the pandemic response. In response, the Johns Hopkins Disability Health Research Center created the COVID-19 Vaccine Prioritization Dashboard for People with Disabilities in collaboration with The Center for Dignity in Healthcare for People with Disabilities. This tool compiles COVID-19 vaccine prioritisation information from all 50 US states, the District of Columbia, and five US territories, which is abstracted from state and territory public health websites weekly. Five disability-related categories are tracked: long-term care settings, other congregate care settings (eg, group homes), chronic conditions, any additional disability-related category (eg, specific types of disabilities, recipients of home-based care, and certain Medicaid beneficiaries), and caregivers for people with disabilities receiving home-based care. The dashboard intends to be an accessible resource that allows comparison of US state and territory vaccine prioritisation schemes for these groups. The data generated additionally provide important insight with regard to inequities for the disability community. Although the COVID-19 response has largely been data-driven, few pandemic surveillance efforts have collected data for people with disabilities,3Reed N Meeks LM Swenor BK Disability and COVID-19: who counts depends on who is counted.Lancet Public Health. 2020; 5: e423Google Scholar preventing the prioritisation of many people with disabilities in the vaccine rollout. The CDC has prioritised a small number of high-risk conditions on the basis of available evidence,2US Centers for Disease Control and PreventionInterim considerations for phased implementation of COVID-19 vaccination and sub-prioritization among recommended populations.https://www.cdc.gov/vaccines/covid-19/phased-implementation.html#ConsiderationsDate accessed: April 13, 2021Google Scholar but COVID-19 data are not available for many disability groups and rare conditions. This paucity of COVID-19 data does not equate to an absence of risk. The variation in the vaccine prioritisation has resulted in inequities in the rollout for people with disabilities: differences of weeks or even months have been observed in the eligibility of people with disabilities to receive the vaccine based on which state or territory they reside in. Accessibility in vaccine prioritisation information is also a persistent barrier to equity. As a result of each state managing its own vaccine rollout, 56 different websites have been developed and a variety of accessibility issues exist. According to a non-profit web accessibility organisation, nearly all of the webpages, which included general vaccine and registration information failed to comply with accessibility measures.4Weber L Recht H Covid vaccine websites violate disability laws, create inequity for the Blind. Kaiser Health News, St Louis, MOFeb 25, 2021https://khn.org/news/article/covid-vaccine-websites-violate-disability-laws-create-inequity-for-the-blind/Date accessed: March 10, 2021Google Scholar If people with disabilities are unable to identify whether they qualify for vaccination from their state or territory websites, this represents a failure of the public health system. The dashboard aims to address this issue by providing an accessible source of information. People with disabilities have not been adequately included in the COVID-19 response, resulting in pandemic-related inequities,1Andrews EE Ayer KB Brown KS Dunn DS Pilarski CR No body is expendable: medical rationing and disability justice during the COVID-19 pandemic.Am Psychol. 2020; (published online July 23.)https://10.1037/amp0000709Google Scholar but also reflecting deeper social injustice and exclusion. At this inflection point in the pandemic, commitment to advancing health equity for the remainder of the vaccine rollout and beyond is paramount. For people with disabilities, this goal can only be achieved through improved approaches to tracking disability disparities and prioritising partnerships with the disability community. As the so-called new normal is envisioned, the disability community must no longer be an afterthought. We declare no competing interests. We thank the members of the COVID-19 Vaccine Prioritization Dashboard team, Jessica Campanile, Caroline Cerilli, Sarah Phillips, Leah Smith, Maureen van Stone, and Tracy Waller.