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

  1. Erik T Rosenstrom
  2. Jessica Mele
  3. Julie S Ivy
  4. Maria E Mayorga
  5. Mehul D Patel
  6. Kristen Hassmiller Lich
  7. Karl Johnson
  8. Paul Delamater
  9. Pinar Keskinocak
  10. Ross Boyce
  11. Raymond Smith
  12. Julie L Swann

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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.

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  1. Version published to 10.1093/pnasnexus/pgab004
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    SciScore for 10.1101/2021.07.27.21261210: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    NIH rigor criteria are not applicable to paper type.

    Table 2: Resources

    No key resources detected.

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Limitations: Validation shows the model underestimated disease burden within the Hispanic community. This is due in part to data limitations surrounding the migrant worker population. As a low estimate, 150,000 migrant farm workers come to North Carolina each growing season, with 94% being native Spanish speakers 47. Nationally, 53% of migrant workers are undocumented which leads to underreporting in census data47 and leads to a misrepresentation of the population within the simulation. The age bracket definitions are also a limitation within the model. For the adult population, we are not able to capture the workplace mobility or community interaction differences. This also limits the assignment of diabetes within the population. The older adult population does not have a workplace peer group, which limits our ability to capture disease spread and the racial/ethnic and comorbidity-based disparities that arise in this population. The variant is modeled by increasing the transmissibility of the disease, rather than introducing a competing strain into the population. This implementation may overestimate the impact of the variant on disease spread. Additionally, there is limited understanding of the variant’s prevalence in the population, as genomic surveillance in North Carolina is limited 48. Finally, we assume masking ends on a particular date whereas in reality, people may continue to wear masks voluntarily and through workplace or school mandates. As a result, our model may...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    Results from scite Reference Check: We found no unreliable references.

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  3. Version published to 10.1101/2021.07.27.21261210v1 on medRxiv