Study highlights disparities in vaccination, risk of infection

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Researchers highlight existing disparities in SARS-CoV-2 infections and access to vaccination. Adam Glanzman / Bloomberg via Getty Images
  • Although marginalized communities had the greatest number of severe cases of COVID-19, these populations had less access to vaccines.
  • Now researchers in Massachusetts are highlighting structural racism in the state’s vaccination strategy.
  • While access to vaccines has improved dramatically, vaccine reluctance remains a formidable challenge for vaccine equity.

Researchers at Harvard University, Tufts University and Brigham and Women’s Hospital – the three Massachusetts-based institutions – argue that COVID-19 vaccination priorities in the state are an example of institutional racism.

In their research letter, which appears in the JAMA Health Forum, they claim that “disparities in vaccine coverage highlight persistent inequalities in the approach to COVID-19 and jeopardize efforts to control the pandemic.”

Scott Dryden-Peterson, MD, M.Sc., lead author of the study, is Assistant Professor of Medicine at Harvard Medical School and Associate Physician at Brigham and Women’s Hospital in Boston, MA.

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Dr Dryden-Peterson and his team analyzed SARS-CoV-2 testing and vaccination data from early 2020 to mid-2021.

The data was compiled anonymously from more than 6.5 million people in 293 communities in Boston and Massachusetts.

The researchers created a vaccination-risk of infection (VIR) ratio to assess how vaccinations aligned with the risk of SARS-CoV-2.

They were inspired by a 2018 study of an HIV prevention regimen. In an interview with Medical News Today, Dr Dryden-Peterson explained:

“We noticed that among our patients, those who lived and worked in settings at increased risk of COVID-19 faced the greatest challenges in accessing vaccination, while those able to be at lower risk had access to it. easily. This paradox reminded us of our efforts to make HIV preventive therapy available.

The researchers used the cumulative confirmed SARS-CoV-2 infections from each community as their best indicator of future infection risk.

They also used Lorenz curves to assess equity in vaccine distributions. Variable predictors included:

  • proportion of the population aged 65 or over
  • proportion of people identified as black, Latin or both
  • socioeconomic vulnerability quartile
  • community size

Dr. Dryden-Peterson and his co-authors observed 649,379 confirmed infections with SARS-CoV-2 in 6,755,622 people. This total included 3,880,706 fully immunized people.

They reported: “The cumulative incidence of confirmed SARS-CoV-2 infection (minimum, 1.6%; maximum, 24.1%) and complete vaccination (minimum, 26.5%; maximum, 99.6%) varied considerably between communities.

Communities with higher socioeconomic vulnerability were correlated with lower VIR ratios. This indicated a disparity in vaccinations relative to the risk of infection.

Communities where more than 20% of the population identified as black, Latin or both had lower vaccinations relative to the risk of infection. However, communities with higher proportions of older people showed “improved community immunization coverage”.

In addition, communities of less than 7,500 inhabitants also showed higher vaccination coverage.

Researchers have estimated that 810,000 complete vaccinations would need to be performed in underserved communities to achieve equity.

The study’s authors say their analysis indicated “a structural disparity in vaccine distribution.”

They point to the fact that Massachusetts ignored recommended steps “Reduce structural racism”. Instead, the state funneled vaccinations to mass vaccination sites and large hospital systems.

However, the team admits that their research does not “directly assess the mechanisms of disparity.”

Jason Hall is the CEO of Avalere Health, a leading healthcare think tank. He has been instrumental in shaping policies and strategies in the United States and around the world to improve access to vaccines.

Speaking with MNT, Hall noted, “It is not surprising to see variations based on race or ethnicity and socio-economic vulnerability in immunization coverage.

Hall also pointed to data from the Kaiser Family Foundation and the Centers for Disease Control and Prevention (CDC) showing similar trends.

Has the lack of access to vaccines or the reluctance towards vaccines been a greater barrier to the equity of the COVID-19 vaccine among minorized groups? Dr. Dryden-Peterson answered this question during his interview:

“Our study did not directly examine this, but the Massachusetts experience suggests that access prevents vaccine hesitancy. In the few cases where vaccines have been made available to high-risk communities early and by long-standing trusted community organizations, uptake has been as high as in high-income cities. “

Olveen Carrasquillo, MD, MPH, is the chief of the division of general internal medicine at the Miller School of Medicine at the University of Miami. He also leads the Florida statewide component of the National Institute of Health’s Community Engagement Alliance Against COVID-19 program.

In an interview with MNTDr Carrasquillo agreed that “minority communities were excluded” from vaccination efforts at the start of the pandemic. However, the doctor noted that the inequalities are decreasing.

He also mentioned that some efforts have naturally contributed to the fears related to vaccination:

“Let’s say you want to reach uninsured and undocumented populations who are getting vaccinated. You do not [want to] have people dressed in military fatigues.

Fortunately, said Dr Carrasquillo, changes in federal leadership in early 2021 paved the way for better access to vaccines.

Today, experts say, the biggest challenge to vaccine equity stems from a persistent wave of misinformation.

Hall found that the reasons for vaccine reluctance among minority groups include:

  • concerns about potential side effects
  • distrust of the government regarding the safety and efficacy of vaccines
  • general mistrust of vaccines
  • fear of getting SARS-CoV-2 from the vaccine

He underlined: “[T]here, there is certainly a lot of work to be done to combat the myths and misconceptions that prevent many people from getting vaccinated. “

Dr. Carrasquillo works with community partners to counter anti-vax messages that have been “very culturally competent. [and] highly targeted on specific minority subgroups.

Ultimately, the study argues, disparities in immunization coverage reflect structural inequalities. The authors stress: “Our approach needs to match this rather than blaming groups for being suspicious of a system that has left them behind. “

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