key: cord-0858035-5exh1kg0 authors: Abramowitz, Paul W; Cobaugh, Daniel J; Thompson, Kasey K title: Transparent, equitable, safe, and effective use of COVID-19 vaccines: A societal imperative date: 2020-09-23 journal: Am J Health Syst Pharm DOI: 10.1093/ajhp/zxaa335 sha: 70b8bfddc0cdb95435d10856279b84d83620d3ff doc_id: 858035 cord_uid: 5exh1kg0 In an effort to expedite the publication of articles related to the COVID-19 pandemic, AJHP is posting these manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. across the United States are the sites of protests against a multitude of inequities experienced by Black Americans and other minority groups. The junction of these two national emergencies has amplified the disparities that Black Americans, Hispanics, and other persons of color experience daily in our society and our health system. As displayed in Table 1 , COVID-19 infection, hospitalization, and death rates in the United States are higher in Black Americans, Hispanics, and American Indians or Alaska Natives when compared to White non-Hispanic people. 2 In Asian Americans, while we have not witnessed an increase in death rates, increased rates of infection and hospitalization have been observed. Underlying reasons for the disparities that have led to higher SARS-CoV-2 infection rates and worse outcomes in people of color have been attributed to a higher prevalence of comorbidities in these groups and socioeconomic factors that lead to crowded housing and greater frontline employment, with a subsequent increased risk of transmission of the virus. 3 While the current social situation in the United States involves a much broader constellation of socioeconomics, race, and inequities in the criminal justice system, the COVID-19-related disparities we are witnessing in people of color are clearly rooted in many of these broader social justice issues. As we prepare for mass distribution of A c c e p t e d M a n u s c r i p t vaccines through a potentially fragile supply chain, followed by attempts at universal administration and monitoring, these disparities and avoiding their effects must be at the forefront of federal, state, and local planning efforts. This issue of AJHP contains the ASHP Principles for COVID-19 Vaccine Distribution, Allocation, and Mass Immunization, 4 which were approved by the ASHP Board of Directors on August 24, 2020. These principles address 10 essential aspects of successful COVID-19 vaccination efforts: 1. Vaccine development, approval, and postmarketing surveillance; 2. Ethical and equitable distribution; 3. An engaged, prepared, and protected immunizer workforce; 4. Leveraging a highly qualified and empowered clinical pharmacy workforce; 5. Best practices for proper storage and handling; 6. Equitable allocation; 7. Achieving high acceptance and uptake rates; While adherence to each of these principles is essential to a transparent, equitable, safe, and effective COVID-19 vaccination program, given the disproportionate risks to underserved populations, as described in Table 1 Likewise, the increased risks-including social determinants-of COVID-19 infection, hospitalization, and death among underserved populations must be considered by policy makers and clinicians as planning for the allocation, distribution, and administration of COVID-19 vaccines proceeds. As addressed in the ASHP principles, given the likelihood of limits on initial supplies of these vaccines, vulnerable populations, including frontline healthcare workers, must be prioritized. A crucial initial step in ensuring vaccination will be countering misinformation and vaccine hesitancy. As discussed in the ASHP principles, gaining and maintaining trust within the community, including among vulnerable groups, through the provision of credible, culturally sensitive, and health literacy-sensitive education programs that provide evidencebased information about the safety and efficacy of the COVID-19 vaccines is imperative. Pharmacists are well positioned and prepared to participate and lead these public education efforts. In addition, access to vaccine administration sites will be critical to ensuring the success of mass vaccination efforts. We must take full advantage of all locales-including physician offices, pharmacies, churches, schools, and community centers-to ensure administration of COVID-19 vaccines at times and in locations that are accessible and convenient for the public. There is no place for vaccine deserts in this public health crisis. A c c e p t e d M a n u s c r i p t Finally, the costs of vaccines cannot be a barrier to their widespread use. Protection from SARS-CoV-2 infection cannot become an issue of the haves and the have-nots. The ability of underserved individuals to pay for the vaccine for themselves and their familiesespecially in these challenging economic times-cannot be a barrier to access. As stated clearly in the ASHP principles, we must ensure patients' access to COVID-19 vaccines by preventing and removing financial barriers. The COVID-19 pandemic is likely the most monumental public health emergency we will witness in our lifetimes. Establishment of transparent, equitable, safe, and effective mechanisms for broad distribution, administration, and monitoring of COVID-19 vaccines across the global population, including the most vulnerable among us, is our imperative. COVID-19 hospitalization and death by race COVID-19 and racial/ethnic disparities ASHP principles for COVID-19 vaccine distribution, allocation, and mass immunization Values are age-adjusted rate ratios.