  A major focus of debate about rationing guidelines for COVID-19 vaccines is
whether and how to prioritize access for minority populations that have been
particularly affected by the pandemic, and been the subject of historical and
structural disadvantage, particularly Black and Indigenous individuals. We
simulate the 2018 CDC Vaccine Allocation guidelines using data from the
American Community Survey under different assumptions on total vaccine supply.
Black and Indigenous individuals combined receive a higher share of vaccines
compared to their population share for all assumptions on total vaccine supply.
However, their vaccine share under the 2018 CDC guidelines is considerably
lower than their share of COVID-19 deaths and age-adjusted deaths. We then
simulate one method to incorporate disadvantage in vaccine allocation via a
reserve system. In a reserve system, units are placed into categories and units
reserved for a category give preferential treatment to individuals from that
category. Using the Area Deprivation Index (ADI) as a proxy for disadvantage,
we show that a 40% high-ADI reserve increases the number of vaccines allocated
to Black or Indigenous individuals, with a share that approaches their COVID-19
death share when there are about 75 million units. Our findings illustrate that
whether an allocation is equitable depends crucially on the benchmark and
highlight the importance of considering the expected distribution of outcomes
from implementing vaccine allocation guidelines.
