Will There Be Equitable Access to the SARS-COV-2 Vaccine?

The SARS-COV-2 virus has devastated the world, infecting millions and killing hundreds of thousands across the globe. The U.S. reached a tragic milestone of 100,000 deaths in late May, and the numbers continue to rise as individuals struggle with isolation due to social distancing, job loss, and finances.

As parts of the country reopen, however, we are resting our hopes on the pharmaceutical companies that are developing vaccines and treatments against the virus. Fifteen companies are currently in the race to get a viable vaccine against this novel coronavirus into the market, with Moderna leading the pack, having initiated phase 2 of its mRNA-1273 vaccine trial.

Is the U.S. Prepared for Widespread Vaccine Administration? 

The following issues may create barriers for an equitable roll-out of a COVID-19 vaccine(s) when available:

  • There is immense experience among public health officials with managing vaccination programs for children but running a widespread program for adults would need a lot more manpower and resources.
  • Public health departments will need massive provider and consumer education to prevent false information from spreading about vaccine safety.
  • Federal funding for these large-scale vaccinations are needed. Budget cuts at the federal level, such as within the Centers for Disease Control & Prevention (CDC), can have far-reaching consequences on state-level immunization programs.

Over the years, CDC’s Immunization Program has seen significant budget cuts. The Infectious Disease Society identified that the FY2021 budget has not increased funding for the immunization program to prevent vaccine-preventable deaths. The budget, which proposes slashing funding for NIH (7%) and the CDC (9%), was released in February 2020, just as the COVID-19 epidemic was setting its stronghold in the nation. 

  • Preparedness budgets saw significant cuts: $200 million reduction in funds for the BioShield fund, which stockpiles drugs and vaccines on the national scale.
  • CDC’s public health preparedness and response programs might receive $25 million less in 2021—these funds support the CDC and local and state public health departments.
  • There is also a proposed $18 million reduction in funding for the Assistant Secretary for Preparedness and Response’s Hospital Preparedness Program that provides grant support to hospitals to prepare for COVID-19–type outbreaks. 

Crystal Watson, DrPH, MPH, of the Johns Hopkins Center for Health Security believes these cuts will limit the country’s preparedness for infectious diseases. “In some cases, it will even degrade our ability to respond to infectious disease emergencies,” Dr. Watson said.

However, these cuts have to be approved by Congress. While such cuts have been rejected by Congress in the past, funding levels have remained stable; but these levels are already much lower than what the Immunization Program needs, which in turn impacts the reach of vaccination programs at the national, state, and local levels.

Vaccines and Insurance Coverage

While the Affordable Care Act expanded insurance coverage to millions of adults, the numbers have declined in recent years. Those who maintained coverage, maybe through marketplace plans, have access to free preventive services, which include vaccines. However, the public health departments and federally qualified health centers are short-staffed, and resource starved.

The statistics are disturbing. The 2020 annual report released by Vaccinate Your Family, State of the ImmUnion, shared these facts:

  • Children covered by Medicaid or living in rural areas may be undervaccinated for certain vaccines by as much as 20%
  • Less than 1% of privately insured children receive no vaccines compared to over 7% of uninsured children
  • Improving vaccination among seniors will require expanding first dollar coverage of vaccines to Medicare Part D and encouraging MA and stand-alone Medicare Prescription Drug Plans to include vaccines in the zero cost-sharing tier
  • Barriers remain on required vaccinations for pregnant women under Medicaid coverage in certain states
  • Black women and women living under the poverty line have nearly 20% lower vaccination rates compared with white women or those with higher socioeconomic status

One of the legislative responses that provided relief for COVID-19 was the Coronavirus Aid, Relief, and Economic Security (CARES) Act. In addition to $415 million for R&D efforts for vaccines and antiviral drugs, the CARES Act requires coverage of any COVID-19 vaccine without cost sharing under Medicare, which is a good policy call to removing access, at least for our seniors enrolled in Medicare.

Policy Recommendations to Improve Access

Vaccinate Your Family makes the following recommendations to Congress:

  • Increase federal appropriations to the CDC, states, and territories to boost their response to existing and emerging vaccine-preventable outbreaks. These funds will also help public health authorities raise awareness among health care providers and the public and allow them to efficiently run vaccine programs in the community.
  • Increase funding to the Indian Health Service that includes support for immunization activities, clinical service delivery, and electronic health record systems.
  • Focus on our children: Ensure access to the Vaccine for Children program for all children enrolled in state CHIP programs for timely access to vaccines.
  • Focus on our seniors: Raise vaccine awareness among seniors and educate them about vaccination, in addition to eliminating out-of-pocket costs for vaccines covered by Medicare Part D by supporting S. 1872/H.R. 5076 (Protecting Seniors Through Immunization Act)


Vaccination Rates Among Pregnant Women

Protecting pregnant women against COVID-19 should also be a priority. Currently our knowledge about how the virus affects pregnant women and their newborn child is extremely limited. While the transmission of this virus from mother-to-child during pregnancy may be unlikely, contact with an infected person following birth can make a newborn susceptible to infection. 

CDC data show that despite the protective benefits of the influenza and pertussis vaccines (Tdap):

  • A little over 50% of pregnant women received an influenza vaccine or a Tdap vaccine in early 2019
  • Among women whose care providers offered vaccination or referral for vaccination, only 65.7% received influenza vaccine and 70.5% received Tdap vaccine 
  • Reasons for not getting vaccinated included 
  • lack of awareness on getting vaccinated during pregnancy
  • non-belief in the efficiency of the vaccine
  • safety concerns for the infant


It is also important to note that Medicaid covers nearly 50% of all pregnant women, and that state-based policies may determine if their vaccine requires patient cost sharing. States are developing creative policies to improve the current status of vaccination in the maternal population:

  • Medi-Cal, California’s Medicaid plan, is including incentives in the managed care delivery system for prenatal providers who administer the Tdap vaccine to pregnant members
  • California pharmacists can provide immunization without a doctor’s prescription
  • Routinely administered adult vaccines are covered under Medicaid without prior authorization in California
  • Colorado is tracking immunization records through the Colorado Immunization Information System to identify areas of highest need and using these data to develop outreach programs
  • Wisconsin is also tracking vaccination rates in various regions in the state to identify areas of highest needs and to improve maternal immunization rates

Taken together, these policy changes can have a strong bearing on reaching the most vulnerable populations, along with expanding the reach of the local public health programs within the general population, once the SARS-COV-2 vaccine is available.