A rapid review of covid-19 vaccine prioritization in the u.S. Alignment between federal guidance and state practice

Vageesh Jain*, Lara Schwarz, Paula Lorgelly

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

1 Citation (Scopus)


Background: Population groups to be prioritized for COVID-19 vaccinations in the U.S. have been determined at the Federal level, but there is variation in how States have implemented guidance. This review examines how the position of population groups in vaccine priority lists varies between Federal guidance and State practice. Methods: An online search of State vaccination prioritization plans was conducted. Data were extracted on each population group included and their relative position. A standardized ranking method was applied to provide a directional measure of variability in prioritization between State and Federal guidance, for each population group. Results: Healthcare workers and those in long-term care facilities were largely prioritized in line with Federal guidance. Aside from early education staff, essential workers were often excluded at State level. Almost all States included the 65–74 year age group and most assigned them to a higher position than recommended in Federal guidance. Those with underlying medical conditions were similarly highly prioritized, although there was more variability across States. Some socially vulnerable groups (not included in Federal guidance) were highly prioritized by many States. Conclusions: The prioritization of groups for COVID-19 vaccination has been highly variable despite clear Federal guidance. Future guidance must be relevant to local needs, values, and constraints, to minimize any unwarranted heterogeneity in vaccine access across populations.

Original languageEnglish
Article number3483
JournalInternational Journal of Environmental Research and Public Health
Issue number7
Publication statusPublished - 1 Apr 2021
Externally publishedYes

Bibliographical note

Publisher Copyright:
© 2021 by the authors. Licensee MDPI, Basel, Switzerland.


  • Health economics
  • Health policy
  • Public health


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