Geographically targeted COVID-19 vaccination is more equitable and averts more deaths than age-based thresholds alone

Abstract

COVID-19 mortality increases markedly with age and is also substantially higher among Black, Indigenous, and People of Color (BIPOC) populations in the United States. These two facts can have conflicting implications because BIPOC populations are younger than white populations. In analyses of California and Minnesota-demographically divergent states-we show that COVID vaccination schedules based solely on age benefit the older white populations at the expense of younger BIPOC populations with higher risk of death from COVID-19. We find that strategies that prioritize high-risk geographic areas for vaccination at all ages better target mortality risk than age-based strategies alone, although they do not always perform as well as direct prioritization of high-risk racial/ethnic groups. Vaccination schemas directly implicate equitability of access, both domestically and globally.

Racial/ethnic disparities in intent to obtain a COVID-19 vaccine: A nationally representative United States survey

“…Access and equity issues are as important as public trust in vaccines. Initially, neighborhoods with high vaccination rates had a greater share of White and Asian people and a lower share of Black and Latino people ( Sacarny and Daw, 2021 ), reinforcing that prioritization of high-risk racial/ethnic groups is needed to ensure equitable access ( Wrigley-Field et al, 2021 ). Equity in vaccination rates is critical to ensure that COVID-19 health disparities are reduced.…”

The impact of mandatory COVID-19 certificates on vaccine uptake: Synthetic Control Modelling of Six Countries

“…A detailed age-specific analysis revealed that particularly those below the age of 20 had the highest increased uptake, followed by those 20-29 years, holding for both first and second doses. When introduced and incentives in particular settings (nightclubs, events >1,000 people), higher uptake was found mainly in the youngest age group in Switzerland and when certification was extended to broader settings (events >30 people, entire hospitality sector, leisure activities) and increase was also observed in older groups (30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41)(42)(43)(44)(45)(46)(47)(48)(49).…”

“…Certification alone is not a silver bullet to increase vaccine uptake, with other measures such as geographically targeted interventions being more effective for certain groups. 30 Limitations include a lack of access to granular daily age-based uptake for all countries and ability to examine confounders such as ethnicity or socioeconomic status. Certification was introduced at different phases during the pandemic for different reasons and across regional and national-level conditions with varying levels of age eligibility, supply, vaccine hesitancy, enforcement and variation in infections and mortality.…”

“…The targeted access restrictions appear to have only affected the youngest (below 20), while we barely observe a change amongst older groups. Extending these restrictions to more general activities continued to impact uptake in the youngest, but also uptake amongst older age groups (30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41)(42)(43)(44)(45)(46)(47)(48)(49).…”

Reductions in US life expectancy during the COVID-19 pandemic by race and ethnicity: Is 2021 a repetition of 2020?

“…Risk factors for COVID-19 infection and mortality, such as crowded living conditions, frontline jobs with high exposure to infection and low pay, dependence on public transport, low access to quality healthcare, and high rates of select chronic conditions, still characterize these groups, suggesting continued racial/ethnic disparities in COVID-19 mortality (Figueroa et al, 2021;Goldman et al, 2021;Macias Gil et al, 2020;Maness et al, 2021;Rodriguez-Diaz et al, 2020). A strategicallytargeted vaccine distribution had the potential to reduce racial/ethnic disparities in COVID-19 mortality in 2021 (Wrigley-Field et al, 2021), but many individuals faced barriers to vaccination in the early months, including difficulty scheduling vaccine appointments online, lack of transportation to vaccination sites, and lack of time off work to get vaccinated and recover from side effects (Feldman, 2021;Stone, 2021). The resulting inequitable vaccine distribution and uptake may have further exacerbated racial/ethnic disparities in COVID-19 mortality.…”