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

Wrigley-Field, Elizabeth; Mv, Kiang; Riley, Alicia R; Barbiéri, Magali; Chen, Y; Duchowny, Kate; Matthay, Ellicott C.; Dv, Riper; Jegathesan, Kirrthana; Bibbins‐Domingo, Kirsten; Leider, JP

doi:10.1101/2021.03.25.21254272

Cited by 20 publications

(19 citation statements)

References 40 publications

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“…Because racial and ethnic minorities are overrepresented among essential workers ( Blau et al, 2020 ; Chang et al, 2021 ; Kissler et al, 2020 ), further modeling studies could evaluate the impact of such strategies on also reducing inequities in COVID-19 infection rates. Wrigley-Field et al took a different methodological approach, projecting demographically stratified death rates from 2020 into 2021 assuming various vaccination strategies ( Wrigley-Field et al, 2021 ). In line with the prior study, they found that vaccination strategies that prioritized geographic areas based on socioeconomic criteria or prior COVID mortality rates outperformed age-based strategies in reducing overall mortality and inequities in mortality.…”

Section: Discussionmentioning

confidence: 99%

Modeling the impact of racial and ethnic disparities on COVID-19 epidemic dynamics

Kévin

Menkir

Kissler

et al. 2021

eLife

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Background: The impact of variable infection risk by race and ethnicity on the dynamics of SARS CoV-2 spread is largely unknown. Methods: Here, we fit structured compartmental models to seroprevalence data from New York State and analyze how herd immunity thresholds (HITs), final sizes, and epidemic risk changes across groups. Results: A simple model where interactions occur proportionally to contact rates reduced the HIT, but more realistic models of preferential mixing within groups increased the threshold toward the value observed in homogeneous populations. Across all models, the burden of infection fell disproportionately on minority populations: in a model fit to Long Island serosurvey and census data, 81% of Hispanics or Latinos were infected when the HIT was reached compared to 34% of non-Hispanic whites. Conclusions: Our findings, which are meant to be illustrative and not best estimates, demonstrate how racial and ethnic disparities can impact epidemic trajectories and result in unequal distributions of SARS-CoV-2 infection. Funding: K.C.M. was supported by National Science Foundation GRFP grant DGE1745303. Y.H.G. and M.L. were funded by the Morris-Singer Foundation.

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Section: Discussionmentioning

confidence: 99%

Modeling the impact of racial and ethnic disparities on COVID-19 epidemic dynamics

Kévin

Menkir

Kissler

et al. 2021

eLife

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“…the combination of geography (hence, social determinants) and age when considering vaccination priorities to allow for the joint probability of acquisition risk and severity risk when allocating limited vaccination supply in the short-term. (51) Such efforts would also need to include active, community-tailored efforts to address vaccine confidence/trust which may be lower in communities most affected by COVID-19;(52) and account for implementation challenges with neighbourhood-specific vaccine delivery ensuring it is equitable. (53, 54) Second, the occupational and housing risks identified here may be overcome with structural interventions such as paid leave, housing supports, and alleviating barriers to testing and healthcare access.…”

Section: Discussionmentioning

confidence: 99%

Increasing concentration of COVID-19 by socioeconomic determinants and geography in Toronto, Canada: an observational study

Mishra

Moloney

et al. 2021

Preprint

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Background: Inequities in the burden of COVID-19 observed across Canada suggest heterogeneity within community transmission. Objectives: To quantify the magnitude of heterogeneity in the wider community (outside of long-term care homes) in Toronto, Canada and assess how the magnitude in concentration evolved over time (January 21 to November 21, 2020). Design: Retrospective, population-based observational study using surveillance data from Ontario's Case and Contact Management system. Setting: Toronto, Canada. Participants: Laboratory-confirmed cases of COVID-19 (N=33,992). Measurements: We generated epidemic curves by SDOH and crude Lorenz curves by neighbourhoods to visualize inequities in the distribution of COVID-19 cases by social determinants of health (SDOH) and estimated the crude Gini coefficient. We examined the correlation between SDOH using Pearson correlation coefficients. Results: The Gini coefficient of cumulative cases by population size was 0.41 (95% CI: 0.36-0.47) and were estimated for: household income (0.20, 95%CI: 0.14-0.28); visible minority (0.21, 95%CI: 0.16-0.28); recent immigration (0.12, 95%CI: 0.09-0.16); suitable housing (0.21, 95%CI: 0.14-0.30); multi-generational households (0.19, 95%CI: 0.15-0.23); and essential workers (0.28, 95% CI: 0.23-0.34). Most SDOH were highly correlated. Locally acquired cases were concentrated in higher income neighbourhoods in the early phase of the epidemic, and then concentrated in lower income neighbourhoods. Mirroring the trajectory of epidemic curves by income, the Lorenz curve shifted over time from below to above the line of equality with a similar pattern across SDOH. Limitations: Study relied on area-based measures of the SDOH and individual case counts of COVID-19. We cannot infer concentration of cases by specific occupational exposures given limitation to broad occupational categories. Conclusion: COVID-19 is increasingly concentrated by SDOH given socioeconomic inequities and structural racism. Primary Funding Source: Canadian Institutes of Health Research.

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“…On the other hand, geographic targeting of vaccine doses to disadvantaged communities has potential to accelerate progress toward a more equitable convergence of coverage by July. Previous studies have suggested that disadvantage indices should be used to prioritize allocation (5,6). Beyond their role in improving the equity of the nation's vaccination campaign, place-based allocation strategies are also likely more effective overall, since individuals living in disadvantaged areas, predominantly low-income individuals and people of color, have borne a disproportionate burden of COVID-19 cases, hospitalizations, and deaths (7).…”

Section: Discussionmentioning

confidence: 99%

Addressing racial/ethnic disparities in the COVID-19 vaccination campaign

Reitsma

Goldhaber-Fiebert

Salomon

2021

Preprint

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BackgroundAs of April 19, all adults aged 16 years and older are eligible for COVID-19 vaccination. Unequal vaccination rates across racial/ethnic groups may compound existing disparities in cases, hospitalizations, and deaths among Black, Indigenous, and Hispanic communities.MethodsFrom state websites, we extracted shares of people receiving ≥1 vaccine dose, stratified by age and separately by race/ethnicity, through March 31, 2021. Combining these data with demographic data from the American Community Survey, we estimated relative uptake rates by race/ethnicity within each state as the observed share of vaccinations for a racial/ethnic group, divided by the expected share if uptake across racial/ethnic groups within each age group were proportional to population size, an approach that allowed us to control for historical age-based eligibility. We modeled vaccination scale-up within each census tract in a state under three scenarios: 1) a scenario in which unequal uptake rates persist, 2) a scenario in which uptake rates are equalized across race/ethnicity groups over six weeks, and 3) a scenario in which uptake is equalized and states employ place-based allocation strategies that prioritizes disadvantaged census tracts.ResultsWhite adults received a disproportionate share of vaccinations compared to Black and Hispanic adults through March 31, 2021. Across states, relative uptake rates, adjusted for eligible population size, were a median 1.3 (IQR, 1.2-1.4) times higher for White compared to Black adults, and a median 1.4 (IQR, 1.2-1.8) times higher for White compared to Hispanic adults. Projecting vaccination coverage under persistence of current disparities in uptake, we found that Black and Hispanic populations would reach 75% coverage among adults almost one month later than White populations. In alternative scenarios, we found that interventions to equalize uptake rates across racial/ethnic groups could narrow but not erase these gaps, and that geographic targeting of vaccine doses to disadvantaged communities may be needed to produce a more equitable convergence of coverage by July.DiscussionInterventions are urgently needed to eliminate disparities in COVID-19 vaccination rates. Eliminating access barriers and increasing vaccine confidence among marginalized populations can narrow gaps in coverage. Combining these interventions with place-based allocation strategies can accelerate vaccination in disadvantaged communities, who have borne a disproportionate burden from COVID-19.

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

Cited by 20 publications

References 40 publications

Modeling the impact of racial and ethnic disparities on COVID-19 epidemic dynamics

Modeling the impact of racial and ethnic disparities on COVID-19 epidemic dynamics

Increasing concentration of COVID-19 by socioeconomic determinants and geography in Toronto, Canada: an observational study

Addressing racial/ethnic disparities in the COVID-19 vaccination campaign

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