Researchers at Harvard University, Tufts University, and Brigham and Women’s Hospital — all three institutions based in Massachusetts — 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 ForumTrusted Source, they assert that “disparities in vaccine coverage highlight ongoing inequities in the approach to COVID-19 and imperil efforts to control the pandemic.”
Scott Dryden-Peterson, M.D., M.Sc., the study’s lead author, is an assistant professor of medicine at Harvard Medical School and an associate physician at Brigham and Women’s Hospital in Boston, MA.
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Following the example of HIV prevention efforts
Dr. Dryden-Peterson and his team analyzed SARS-CoV-2 testing and vaccination data from early 2020 to the middle of 2021.
The data was compiled anonymously from over 6.5 million individuals in 293 communities throughout Boston and Massachusetts.
The researchers created a vaccination-to-infection risk (VIR) ratio to assess how vaccinations aligned with the risk of SARS-CoV-2.
They took cues from a 2018 study covering a regimen for HIV prevention. In an interview with Medical News Today, Dr. Dryden-Peterson explained:
“We noticed that among our patients, those living and working in settings with increased COVID-19 risk were facing the largest challenges accessing vaccination, whereas those able to have lower risk were accessing easily. This paradox reminded us of our efforts to make HIV preventative therapy available.”
Assessing future infection risk
The researchers used each community’s cumulative confirmed SARS-CoV-2 infections as their best indicator of future infection risk.
They also used Lorenz curvesTrusted Source to gauge equity in vaccine distributions. Variable predictors included the:
Dr. Dryden-Peterson and his co-authors observed 649,379 SARS-CoV-2 confirmed infections among 6,755,622 individuals. This total included 3,880,706 fully vaccinated people.
They reported, “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 correlated with lower VIR ratios. This indicated a disparity in vaccinations relative to infection risk.
Communities where more than 20% of the population identified as Black, Latinx, or both had lower vaccinations relative to infection risk. However, communities with higher proportions of seniors showed “improved community vaccine coverage.”
Additionally, communities with fewer than 7,500 residents also showed higher vaccine coverage.
The researchers estimated that 810,000 full vaccinations would need to go to underserved communities to achieve equity.
Results are ‘not unexpected’
The study’s authors state that their analysis indicated “structural disparity in vaccine distribution.”
They emphasize the fact that Massachusetts ignored recommended stepsTrusted Source “to mitigate structural racism.” Instead, the state channeled 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 managing director at Avalere Health, a leading healthcare think tank. He has been instrumental in developing United States and global policies and strategies to improve vaccine access.
In speaking with MNT, Hall remarked: “It’s not unexpected to see variations based on race or ethnicity and socioeconomic vulnerability with regards to vaccination coverage.”
Hall also pointed to data from the Kaiser Family Foundation and the Centers for Disease Control and Prevention (CDC) showing similar trends.