Can vaccine prioritization reduce disparities in COVID-19 burden for historically marginalized populations?

Abstract

SARS-CoV-2 vaccination strategies were designed to reduce COVID-19 mortality, morbidity, and health inequities. To assess the impact of vaccination strategies on disparities in COVID-19 burden among historically marginalized populations (HMPs), e.g. Black race and Hispanic ethnicity, we used an agent-based simulation model, populated with census-tract data from North Carolina. We projected COVID-19 deaths, hospitalizations, and cases from 2020 July 1 to 2021 December 31, and estimated racial/ethnic disparities in COVID-19 outcomes. We modeled 2-stage vaccination prioritization scenarios applied to sub-groups including essential workers, older adults (65+), adults with high-risk health conditions, HMPs, or people in low-income tracts. Additionally, we estimated the effects of maximal uptake (100% for HMP vs. 100% for everyone), and distribution to only susceptible people. We found strategies prioritizing essential workers, then older adults led to the largest mortality and case reductions compared to no prioritization. Under baseline uptake scenarios, the age-adjusted mortality for HMPs was higher (e.g. 33.3%–34.1% higher for the Black population and 13.3%–17.0% for the Hispanic population) compared to the White population. The burden on HMPs decreased only when uptake was increased to 100% in HMPs; however, the Black population still had the highest relative mortality rate even when targeted distribution strategies were employed. If prioritization schemes were not paired with increased uptake in HMPs, disparities did not improve. The vaccination strategies publicly outlined were insufficient, exacerbating disparities between racial and ethnic groups. Strategies targeted to increase vaccine uptake among HMPs are needed to ensure equitable distribution and minimize disparities in outcomes.

Validating model output in the absence of ground truth data: A COVID-19 case study using the Simulator of Infectious Disease Dynamics in North Carolina (SIDD-NC) model

“…Unlike many other existing COVID-19 ABMs (e.g. Hinch et al, 2021 ; Kerr et al, 2021 ; Krivorotko et al, 2022 ; Nguyen et al, 2021 ; Rosenstrom et al, 2022 ; Shamil et al, 2021 ; Silva et al, 2020 ), SIDD-NC is initialized with ten million agents and produces a health record for each agent for the entirety of the simulation time. Although it has higher computing power requirements, this in turn requires much less extrapolation of results to the study population, as the study population is represented 1:1 in the synthetic population.…”

“…Other COVID-19 specific ABMs have been created, largely emphasizing forecasting and parsimony (e.g. Hinch et al, 2021 ; Kerr et al, 2021 ; Krivorotko et al, 2022 ; Nguyen et al, 2021 ; Rosenstrom et al, 2022 ; Shamil et al, 2021 ; Silva et al, 2020 ; Yin et al, 2021 ).…”

Improving Vaccine Equity: How Community Engagement and Informatics Facilitate Health System Outreach to Underrepresented Groups

“…5 Because many communities at disproportionate risk for COVID-19 face barriers to vaccine access and uptake, it is essential for vaccine equity strategies to include community engagement efforts that facilitate trust, provide accurate and interpretable information, and respond to the needs and values of different community groups. 6,7 For example, Gonzalez and colleagues 8 improved vaccination rates through a community outreach program using a call/recall system that addressed vaccine hesitancy and facilitated real-time vaccine scheduling among eligible Black and Hispanic adults.…”

Data-driven Targeting of COVID-19 Vaccination Programs: An Analysis of the Evidence on Impact, Implementation, Ethics and Equity

“…essential worker status), which takes workplace-related risk differentials into consideration, improves outcomes relative to age-only prioritization. 10-19 Four studies found that it is optimal to switch to a focus on vaccinating the youngest/lowest-risk once most of the oldest/highest-risk people have been vaccinated. 15,20-22 Once the majority of the vulnerable are protected, there is a relatively larger benefit to slowing transmission by vaccinating high-contact groups.…”