Addressing Inequities in SARS-CoV-2 Vaccine Uptake: The Boston Medical Center Health System Experience

Assoumou, Sabrina A; Peterson, Alicia; Ginman, Ellen; James, Thea; Pierre, Cassandra; Hamilton, Sebastian; Chapman, Sheila; Goldie, John; Koenig, Robert; Méndez-Escobar, Elena; Leaver, Hannah; Graham, Robert M.; Crichlow, Renée; Weaver, Tarsha; Cotterell, Sandra; Valdez, Guale; Nueces, Denise De Las; Scott, Nancy A.; Linas, Benjamin P.; Cherry, Petrina Martin

doi:10.7326/m22-0028

Cited by 27 publications

(19 citation statements)

References 9 publications

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“…Along with racial/ethnic patterns, substantial disparities related to income and education attainment persist, and local health departments continue to call for more long-term investments to close these gaps. Interventions to address vaccine access barriers related to education and poverty—including offering more convenient clinic times, paid sick leave for potential side effects, providing information through trusted community-based sources in multiple languages, and conducting outreach outside of the formal medical sector—will be essential to improving equity across multiple dimensions, including by race and occupation [ 16 ].…”

Section: Discussionmentioning

confidence: 99%

“…Lack of access to a regular health provider and accurate health information contributed to low vaccine uptake among the uninsured, even though the vaccine was free for all who could access it. Additionally, whereas initial vaccine rollout focused on centralized mass distributions sites, community-based delivery has since been shown to be more effective in reaching lower-income people and people of color [ 15 , 16 ]. Lack of paid time off to get vaccinated and recover, limited outreach to non-English speakers, and low trust in the health system have also been barriers [ 17 , 18 ].…”

Section: Introductionmentioning

confidence: 99%

“…Boosters are a critical line of defense in mitigating the impacts of future waves [ 22 , 23 ]. Although the first year of the vaccine rollout involved extensive community outreach [ 16 ], the booster campaign (including the bivalent booster that became available in September 2022) has received less public attention despite its importance for maintaining immunity and protecting against Omicron variants. Closing vaccination gaps requires an understanding of barriers to uptake and identifying geographic areas with low coverage.…”

Section: Introductionmentioning

confidence: 99%

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Inequities in COVID-19 vaccine and booster coverage across Massachusetts ZIP codes after the emergence of Omicron: A population-based cross-sectional study

et al. 2023

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Background Inequities in Coronavirus Disease 2019 (COVID-19) vaccine and booster coverage may contribute to future disparities in morbidity and mortality within and between Massachusetts (MA) communities. Methods and findings We conducted a population-based cross-sectional study of primary series vaccination and booster coverage 18 months into the general population vaccine rollout. We obtained public-use data on residents vaccinated and boosted by ZIP code (and by age group: 5 to 19, 20 to 39, 40 to 64, 65+) from MA Department of Public Health, as of October 10, 2022. We constructed population denominators for postal ZIP codes by aggregating census tract population estimates from the 2015–2019 American Community Survey. We excluded nonresidential ZIP codes and the smallest ZIP codes containing 1% of the state’s population. We mapped variation in ZIP code-level primary series vaccine and booster coverage and used regression models to evaluate the association of these measures with ZIP code-level socioeconomic and demographic characteristics. Because age is strongly associated with COVID-19 severity and vaccine access/uptake, we assessed whether observed socioeconomic and racial/ethnic inequities persisted after adjusting for age composition and plotted age-specific vaccine and booster coverage by deciles of ZIP code characteristics. We analyzed data on 418 ZIP codes. We observed wide geographic variation in primary series vaccination and booster rates, with marked inequities by ZIP code-level education, median household income, essential worker share, and racial/ethnic composition. In age-stratified analyses, primary series vaccine coverage was very high among the elderly. However, we found large inequities in vaccination rates among younger adults and children, and very large inequities in booster rates for all age groups. In multivariable regression models, each 10 percentage point increase in “percent college educated” was associated with a 5.1 (95% confidence interval (CI) 3.9 to 6.3, p < 0.001) percentage point increase in primary series vaccine coverage and a 5.4 (95% CI 4.5 to 6.4, p < 0.001) percentage point increase in booster coverage. Although ZIP codes with higher “percent Black/Latino/Indigenous” and higher “percent essential workers” had lower vaccine coverage (−0.8, 95% CI −1.3 to −0.3, p < 0.01; −5.5, 95% CI −7.3 to −3.8, p < 0.001), these associations became strongly positive after adjusting for age and education (1.9, 95% CI 1.0 to 2.8, p < 0.001; 4.8, 95% CI 2.6 to 7.1, p < 0.001), consistent with high demand for vaccines among Black/Latino/Indigenous and essential worker populations within age and education groups. Strong positive associations between “median household income” and vaccination were attenuated after adjusting for age. Limitations of the study include imprecision of the estimated population denominators, lack of individual-level sociodemographic data, and potential for residential ZIP code misreporting in vaccination data. Conclusions Eighteen months into MA’s general population vaccine rollout, there remained large inequities in COVID-19 primary series vaccine and booster coverage across MA ZIP codes, particularly among younger age groups. Disparities in vaccination coverage by racial/ethnic composition were statistically explained by differences in age and education levels, which may mediate the effects of structural racism on vaccine uptake. Efforts to increase booster coverage are needed to limit future socioeconomic and racial/ethnic disparities in COVID-19 morbidity and mortality.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Inequities in COVID-19 vaccine and booster coverage across Massachusetts ZIP codes after the emergence of Omicron: A population-based cross-sectional study

et al. 2023

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“…At a policy level, FQHC successes demonstrate the value of the federal Health Center Vaccine Program, and support continued investment in this program. We also recommend the expansion of FQHC practices to additional settings such as academic medical centers, where community partnership has been shown to increase vaccine access and trust, and private primary care offices, where provider trust plays a critical role in “last-mile” vaccination efforts ( Assoumou et al, 2022 ; Klein & Hostetter, 2021 ; Scott et al, 2021 ). While the Biden Administration continues to fund the Health Center Vaccine Program, unfortunately, rollbacks in state and federal pandemic funding mean that other successful “hyperlocal” state and county health department outreach programs targeting underserved communities are now in danger of being cut, even as more effective vaccines are becoming available ( Mueller, 2022 ).…”

Section: Discussion and Implications For Practicementioning

confidence: 99%

“We’re Here to Take Care of Our Community”: Lessons Learned From the U.S. Federal Health Center Covid-19 Vaccine Program

Crane

Fabi

Pacia

et al. 2023

Health Promotion Practice

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Equitable access to vaccination is crucial to mitigating the disproportionate impact of Covid-19 on low-income communities and people of color in the United States. As primary care clinics for medically underserved patients, Federally Qualified Health Centers (FQHCs) emerged as a success story in the national effort to vaccinate the U.S. public against Covid-19. In February 2021, the Federal Health Center Covid-19 Vaccine Program began allocating vaccine supply directly to FQHCs in an effort to improve vaccine equity. This qualitative study documents how FQHCs in two states successfully mitigated barriers to vaccine access, responded to patient concerns about vaccination, and worked to maintain and grow community trust in a climate of uncertainty and fear during early vaccine roll-out to the general population. Using a socio-ecological model, we show how FQHCs intervened at multiple levels to advance vaccine equity, revealing valuable lessons for health promotion practice in primary care settings or underserved communities. Our findings provide descriptive context for existing quantitative evidence showing FQHCs’ greater success in vaccinating people of color, and foreground valuable and innovative strategies for trustworthy health communication practices and equitable resource allocation to medically underserved patients and populations.

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“…(Dada et al 2022 ). Research from Boston Medical Center highlighted how a community centered approach that utilized community sites and mobile sites to reach individuals with the highest social vulnerability index resulted in the administration of over 100,000 first doses (Assoumou et al 2022 ). A study in New York City showed that members of the Black Nurses Association were able to partner with community organizations to vaccinate over 22,000 people via community sites (Brown-DeVeaux et al 2021 ).…”

Section: Discussionmentioning

confidence: 99%

Healthcare workers’ perspectives on the COVID-19 vaccine and boosters for themselves, their patients, and their communities: a mixed methods study

Burrowes

Casey

Dobbins

et al. 2022

J Public Health (Berl.)

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Aim To examine experiences and attitudes of a diverse sample of clinical and non-clinical healthcare workers regarding COVID-19 vaccines and boosters for themselves, their patients, and their communities. Subject and methods We conducted a sequential exploratory mixed methods study; 52 healthcare workers participated in qualitative interviews between April 22 and September 7, 2021, and 209 healthcare workers completed surveys between February 17 and March 23, 2022. Interviews and survey questions asked about personal attitudes toward COVID-19 vaccination and boosters and experiences discussing vaccination with patients. Results Participants were predominantly White (56% and 73%, respectively) and female (79% and 81%, respectively). Factors motivating healthcare workers to take the vaccine were the belief that vaccination would protect themselves, their families, patients, and communities. Healthcare workers were accepting of and had high receipt of the booster, though some had diminished belief in its effectiveness after becoming infected with SARS-CoV-2 after initial vaccination. Race related mistrust, misinformation related to vaccine safety, and concerns about vaccine effects during pregnancy were the most common barriers that providers encountered among their patients and communities. Conclusions Healthcare workers’ primary motivation to receive COVID-19 vaccines was the desire to protect themselves and others. Healthcare workers’ perception was that concerns about safety and misinformation were more important barriers for their patients than themselves. Race-related medical mistrust amplified concerns about vaccine safety and hindered communication efforts.

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Addressing Inequities in SARS-CoV-2 Vaccine Uptake: The Boston Medical Center Health System Experience

Cited by 27 publications

References 9 publications

Inequities in COVID-19 vaccine and booster coverage across Massachusetts ZIP codes after the emergence of Omicron: A population-based cross-sectional study

Inequities in COVID-19 vaccine and booster coverage across Massachusetts ZIP codes after the emergence of Omicron: A population-based cross-sectional study

“We’re Here to Take Care of Our Community”: Lessons Learned From the U.S. Federal Health Center Covid-19 Vaccine Program

Healthcare workers’ perspectives on the COVID-19 vaccine and boosters for themselves, their patients, and their communities: a mixed methods study

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