Measuring and Promoting SARS-CoV-2 Vaccine Equity: Development of a COVID-19 Vaccine Equity Index

Abstract

Purpose: The coronavirus pandemic has created the greatest public health crisis in a century, causing > 500,000 deaths in the United States alone. Minoritized and socioeconomically disadvantaged groups have borne a disproportionate burden of severe illness, hospitalization, and death from COVID-19. Recently developed FDAapproved vaccines have been shown to significantly reduce severe COVID-19-related outcomes. Vaccination campaigns have the potential to advance health equity by prioritizing allocation to those at highest risk while striving for herd immunity. Large integrated health systems have been faced with the daunting task of meeting the rapidly evolving needs of diverse patient populations for the provision of population-based testing, treatment, education, and now vaccine distribution. We have designed a COVID-19 vaccine equity index (CVEI) to guide health system vaccination strategy. Methods: We considered proportion unvaccinated within a health care system. We then used real-time readily available electronic health record (EHR) COVID-19 testing positivity and proportion hospitalized to measure burden of illness by race/ethnicity. We used conditional probability and statistical theory to measure equity for unvaccinated individuals and to derive an index to highlight these inequities for specific subgroups. Results: We present an illustrative hypothetical example using simulated data for which we calculated the CVEI for non-Hispanic White, non-Hispanic Black, non-Hispanic Asian, and Hispanic patients. In the example, non-Hispanic Black and Hispanic patients had inequitable outcomes. Conclusion:The index can be widely implemented to promote more equitable outcomes among racial/ethnic groups, reducing morbidity and mortality within the overall population as we pursue the collective goal of herd immunity through mass vaccination.

Inequality in the distribution of Covid-19 vaccine: a systematic review

“…For example, according to some studies in the United States and the United Kingdom [ 39 , 49 ], the rate of vaccine injection is higher in women than men. Also, older people had greater access to vaccination [ 34 , 36 , 39 , 40 , 42 , 44 , 48 , 50 , 51 ]. A study by Cardona et al in Maryland found that vaccination rates were lower in blacks [ 32 ].…”

COVID-19 in pregnancy by race and ethnicity: Implications for development of a vaccination strategy

“…We previously developed the CVEI 22 as a practical tool intended to provide insight into the impact of vaccination strategies on addressing disparities, promoting more equitable outcomes among racial/ethnic groups, and reducing overall morbidity and mortality within the population as we pursue the collective goal of herd immunity through mass vaccination. The index is designed to enhance equity, the attainment of equivalent outcomes among all subgroups.…”

“…Objective 3: To calculate the Covid-19 Vaccine Equity Index (CVEI) 22 for pregnant women to identify subgroups to target for vaccine outreach.…”

Sequential allocation of vaccine to control an infectious disease

“…Fairness is often an important concern when allocating scarce medical resources such as vaccines [11] , [18] , [19] , [20] . Our optimization problems (OPT1) – (OPT2) can be extended to include an equity constraint: where is the minimum fraction of the population in group that must be vaccinated in time period .…”