# Do We Have a Common Understanding of How Vaccine Policy Affects Health Equity? Evaluating Variability in the Advisory Committee on Immunization Practices’ Equity Assessment

## TL;DR

This study examines how consistently the ACIP evaluates vaccine equity, finding significant variability in judgments that could affect health equity decisions.

## Contribution

The paper identifies variability in equity assessments within ACIP's EtR framework, suggesting a need for clearer guidelines.

## Key findings

- 61.4% of EtRs had variable judgments in at least one domain, with 20.4% showing variability in Equity.
- Values and Equity domains showed the most variability, especially for RSV prevention and pediatric products.
- EtRs leading to shared clinical decision-making had greater variability than routine recommendations.

## Abstract

Background/Objectives: The Advisory Committee on Immunization Practices’ (ACIP) Evidence to Recommendation (EtR) Framework has assessed vaccine equity, in addition to clinical and epidemiological data, since 2020. The domain’s use has not yet been evaluated. Methods: Authors assessed web-published, Equity domain-inclusive ACIP Work Group EtR presentations occurring between October 2020 and October 2023. Domain judgments were scored and assigned variability ratings based on the number and spread of domain categories selected. Equity domain trends were evaluated using sample statistics and one- and two-way analyses of variance. Results: Of the 44 assessed EtRs, 27 (61.4%) had variable judgments for at least one domain; 9 (20.4%) had variable Equity judgments. Across domains, Values had the greatest variability, followed by Equity. Across disease targets, EtRs assessing products for RSV prevention were most variable. Pediatric product EtRs had greater variability than adult products, and EtRs resulting in shared clinical decision-making (SCDM) recommendations had greater variability than those resulting in routine recommendations. Conclusions: Values and Equity domains judgment imprecision highlights a need for additional clarity to support consistent assessment.