Equitable and effective vaccine access considering vaccine hesitancy and capacity constraints

Abstract

The COVID-19 pandemic continues to have an unprecedented impact on people's lives and the economy worldwide. Vaccines are the strongest evidence-based defense against the spread of the disease. The release of COVID-19 vaccines to the general public created policy challenges associated with how to best allocate vaccines among different sub-regions. In the United States, after vaccines became widely available for all eligible adults, policymakers faced objectives such as ($i$) achieving an equitable allocation to reduce populations' travel times to get vaccinated and ($ii$) effectively allocating vaccine doses to minimize waste and unmet need. This problem was further exacerbated by the underlying factors of population vaccine hesitancy and sub-regions' varying capacity levels to administer vaccines to eligible and willing populations. Although simple to implement, commonly used pro rata policies do not capture the complexities of this problem. We propose two alternatives to simple pro rata policies. The first alternative is based on a Mixed-Integer Linear Programming Model that minimizes the maximum travel duration of patients and aims to achieve an equitable and effective allocation of vaccines to sub-regions while considering capacity and vaccine hesitancy. A second alternative is a heuristic approach that may be more palatable for policymakers who ($i$) are not familiar with mathematical modeling, ($ii$) are reluctant to use black-box models, and ($iii$) prefer algorithms that are easy to understand and implement. We demonstrate the results of our model through a case study based on real data from the state of Alabama and show that substantial improvements in travel time-based equity are achievable through capacity improvements in a small subset of counties. We perform additional computational experiments that compare the proposed methods in terms of several metrics and demonstrate the promising performance of our model and proposed heuristic. We find that while our mathematical model can achieve equitable and effective vaccine allocation, the proposed heuristic performs better if the goal is to minimize average travel duration. Finally, we explore two model extensions that aim to ($i$) lower vaccine hesitancy by allocating vaccines, and ($ii$) prioritize vaccine access for certain high-risk sub-populations.

Keywords: COVID-19; Capacity; Effectiveness; Travel time equity; Vaccine allocation; Vaccine hesitancy.