Reimagining COVID vaccine distribution: reflecting on waste and equity

Efficient distribution and administration of vaccines are critical to preventing unnecessary morbidity and mortality. We assess the distribution, uptake, and wastage of COVID-19 vaccine doses across the U.S., providing insights for optimizing future vaccination distribution strategies. We quantify the impact of limiting vaccine wastage and illustrate incidence and deaths averted under two targets set by the Global Alliance for Vaccines and Immunization (GAVI).

We obtained COVID-19 vaccine doses administered by location and wastage data from jurisdictions, pharmacies, and federal entities from the Centers for Disease Control and Prevention through a Freedom of Information Act. From this data, along with county-level data on COVID-19 vaccine hesitancy, we conducted a retrospective analysis covering the period from December 2020 to October 2022 involving 761 million vaccine doses distributed across all counties and states in the U.S. We use GAVI targets of 25% and 15% vaccine waste to serve as benchmarks for assessing the impact of potential improvements in vaccine distribution and acceptance at the county and state levels in the U.S.

We estimate the proportion of vaccines wasted, and then incidence and deaths averted had adherence to GAVI waste targets occurred to inform on the quality of the national vaccination effort and identify potential regions for improvement. Among the 761 million distributed COVID-19 vaccine doses, only 600 million were administered, resulting in a national average of 1.8 doses per capita. Substantial regional disparities were observed, with the District of Columbia reaching 2.5 doses per capita and Alabama lagging at 1.3 doses per capita. Thirty states exceeded the GAVI 15% vaccine waste target, corresponding to 64.2 million unused doses. Meeting the 15% target would have averted 36.1 million incidences and 7.8 thousand deaths.

Addressing the causes of county-level variations and targeting states with below-average vaccine hesitancy and above-target vaccine waste would likely maximize future vaccine distribution efforts and minimize wastage-related losses. This strategy highlights an avenue for improving future vaccine distribution policy.