Inequalities in COVID-19 vaccination in Massachusetts
Massachusetts researchers reported structural disparities in vaccine distribution across the state, particularly “vaccine coverage lower than the risk of infection in communities with increased socioeconomic vulnerability and higher proportions of black and Latin individuals. 1 according to Scott Dryden-Peterson, MD, MSc, of the Division of Infectious Diseases, Department of Medicine, Brigham and Women’s Hospital; Department of Immunology and Infectious Diseases, Harvard TH Chan School of Public Health; and Botswana-Harvard AIDS Institute, Boston.
In this study, Dryden-Peterson explained that he and his team examined the alignment of vaccination and SARS-CoV-2 risk in Massachusetts by creating and applying a vaccination-infection risk (VIR) ratio. . They analyzed data from the Massachusetts Department of Public Health and the Boston Public Health Commission from January 29, 2020 to June 24, 2021, from 278 cities and towns and 15 Boston neighborhoods representing 6,755,622 residents (98.6%).
The VIR ratio and Lorenz curves were used to assess vaccine equity. The first was the quotient of the number of fully vaccinated individuals divided by the cumulative number of confirmed SARS-CoV-2 infections in each community; Lower than state average VIR ratios indicated lower vaccine coverage relative to their risk of infection. The latter, which assesses equity in the distribution of resources, described immunization against the burden of COVID-19 and calculates summaries of inequalities and the extent of vaccine reallocation needed to achieve equity, said explained Dryden-Peterson.
Data from the Massachusetts Department of Public Health and the American Community Survey were used to determine the age, race, and ethnic makeup of the community. Socioeconomic vulnerability was estimated using the Socioeconomic Status domain of the Social Vulnerability Index.
The Dryden-Peterson team reported that as of June 24, 2021, 649,379 (8.9%) SARS-CoV-2 infections had been confirmed in 6,755,622 residents and 3,880,706 (57.4%) had received 2 vaccines.
Main results of the study
“The cumulative incidence of confirmed SARS-CoV-2 infection (minimum, 1.6%; maximum, 24.1%) and complete vaccination (minimum, 26.5%; maximum, 99.6 %) has varied considerably [among] communities. Communities with increased socio-economic vulnerability had lower VIR ratios indicating less equitable vaccination relative to the risk of infection, ”the investigators reported.
Multivariate analysis showed that a decrease in vaccination relative to the risk of infection was independently associated with increasing socioeconomic vulnerability and when more than 20% of the community was black and / or Latin (p
Dryden-Peterson also reported that the Lorenz curves indicated considerable inequity, with an estimated Gini coefficient (1, total equity; 0, total inequality) of 0.51 between communities and 0.47 depending on race and l ‘Ethnicity. It is estimated that 810,000 full immunization courses should be diverted to under-immunized communities to achieve equity.
Investigators suggested that the state relied on large hospital systems and mass vaccination sites to distribute the vaccines, which may not have been focused on alleviating structural racism. The study concluded that disparities in vaccine coverage highlight persistent inequalities in the approach to COVID-19 and jeopardize efforts to control the pandemic.
Dryden-Peterson S, Velásquez GE, Stopka TJ, et al. Disparities in the risk of SARS-CoV-2 vaccination during the COVID-19 pandemic in Massachusetts. JAMA Health Forum 2021; 2 (9): e212666. doi: 10.1001 / jamahealthforum.2021.2666