Nonprofits provide a range of human and social services in the United States, producing what some call the delegated welfare state. The authors aim to quantify inequities in nonprofit service provision by focusing on two types of vulnerabilities: spatial and socio-demographic. Specifically, the authors develop a service accessibility index to identify mismatch between population demand and locational supply of nonprofits. The authors apply the index to an original data set of more than 1,500 immigrant-serving legal and health organization in California, Nevada, and Arizona. The authors find that immigrants living in rural areas are underserved, especially in access to justice, compared with those in metropolitan areas but that residents of smaller cities have better access, especially to health services, than those in larger cities. The service accessibility index not only brings such inequities into relief but raises critical questions about the determinants and consequences of service-access variability, for vulnerable immigrants and others dependent on the nonprofit safety net.
The debate around vaccine prioritization for COVID-19 has revolved around balancing the benefits from: (1) the direct protection conferred by the vaccine amongst those at highest risk of severe disease outcomes, and (2) the indirect protection through vaccinating those that are at highest risk of being infected and of transmitting the virus. While adults aged 65+ are at highest risk for severe disease and death from COVID-19, essential service and other in-person workers with greater rates of contact may be at higher risk of acquiring and transmitting SARS-CoV-2. Unfortunately, there have been relatively little data available to understand heterogeneity in contact rates and risk across these demographic groups. Here, we retrospectively analyze and evaluate vaccination prioritization strategies by age and worker status. We use a mathematical model of SARS-CoV-2 transmission and uniquely detailed contact data collected as part of the Berkeley Interpersonal Contact Survey to evaluate five vaccination prioritization strategies: (1) prioritizing only adults over age 65, (2) prioritizing only high-contact workers, (3) splitting prioritization between adults 65+ and high-contact workers, (4) tiered prioritization of adults over age 65 followed by high-contact workers, and (5) tiered prioritization of high-contact workers followed by adults. We find that for the primary two-dose vaccination schedule, assuming 70% uptake, a tiered roll-out that first prioritizes adults 65+ averts the most deaths (31% fewer deaths compared to a no-vaccination scenario) while a tiered roll-out that prioritizes high contact workers averts the most number of clinical infections (14% fewer clinical infections compared to a no-vaccination scenario). We also consider prioritization strategies for booster doses during a subsequent outbreak of a hypothetical new SARS-CoV-2 variant. We find that a tiered roll-out that prioritizes adults 65+ for booster doses consistently averts the most deaths, and it may also avert the most number of clinical cases depending on the epidemiology of the SARS-CoV-2 variant and the vaccine efficacy.
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