A new study highlights a pressing need for policy interventions that address social vulnerability and COVID-19 vaccine hesitancy in the current phase of the nation’s vaccination efforts.
These two factors were independently significant in predicting county-level COVID-19 vaccination rates among adults, according to a study published in the November issue of Health Affairs.
“We were analyzing county vaccination rates throughout the pandemic and trying to make sense of the disparities that we saw between counties,” lead author Matthew A. Crane, a third-year medical student at the Johns Hopkins University School of Medicine in Baltimore, told Fierce Healthcare.
With limited public health resources, it’s important for policymakers to specifically target their outreach efforts. “Counties have unique situations regarding their hesitancy levels and social vulnerability levels. Because of that, policies may need to be custom-tailored to meet each county’s individual needs,” said Crane, who previously served as a district health commissioner in Los Angeles.
In the report, the authors expressed a sense of urgency. “Despite some uptick in recent weeks, vaccination rates for protection against COVID-19 in the U.S. continue to fall short, threatening the country’s ability to control transmission and avoid outbreaks,” they wrote. “The growing predominance of the B.1.617.2 (Delta) variant of SARS-CoV-2 in the U.S. presents challenges, with increased transmissibility pointing to the need for greater adoption of COVID-19 vaccines.”
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Analyzing data from the Centers for Disease Control and Prevention (CDC), the authors explored COVID-19 vaccine coverage from March 28, 2021, to Aug. 1, 2021 in 2,868 U.S. counties with a total of 229.1 million adult residents.
COVID-19 vaccine coverage represented the fully vaccinated proportion of the population ages 18 or older. County vaccine hesitancy was based on an analysis by the Department of Health and Human Services, which relied on the most recent estimates (May 26, 2021 to June 7, 2021) of the Household Pulse Survey.
In that survey, hesitancy was characterized as the percentage of residents who reported that they would “probably not” or “definitely not” opt for COVID-19 vaccination at this point in time. Counties were stratified into tertiles of low, moderate and high hesitancy, with equal numbers in each tertile.
To compare vulnerability between counties, the authors employed the CDC’s Social Vulnerability Index—a 15-item scale measuring socioeconomic status, household composition and disability, racial and ethnic minority status and language, and housing type and transportation. Higher values suggested more vulnerability.
The authors’ research revealed that both hesitancy and social vulnerability have independent negative associations with COVID-19 vaccine coverage. “Over time, hesitancy became a stronger predictor of the differences between counties, but social vulnerability continued to be a factor—and increasingly important in magnitude,” the authors noted in the report.
Even after the authors adjusted for social vulnerability, by the conclusion of the study the average vaccination rate was 17% lower in high-hesitancy counties than in low-hesitancy counties. However, they found that “counties with high hesitancy and vulnerability were and continue to be most at risk of failing to attain high COVID-19 vaccine coverage.”
Nearly 20% of counties evaluated in the study “fit this description,” they concluded. “At the final week of analysis, these counties, which are socially and politically complex, had COVID-19 vaccination rates well below the average in our analysis sample (56%). For both public health and equity reasons, these counties should be a top priority for state and national intervention.”
The authors also found it to be “particularly concerning” that the gap in COVID-19 vaccination rates between counties with high social vulnerability and those with moderate and low social vulnerability has widened over time. They recommended “a renewed focus on targeting efforts to reduce disparities stemming from social vulnerabilities.”
Setting up vaccine clinics and “meeting people where they are” in disadvantaged communities would be paramount to spearheading a more successful vaccination campaign, Crane told Fierce Healthcare. “Our study underscores the complexity of trying to reach the population that still is not vaccinated in the United States,” he said. “There’s isn’t a one-size-fits-all approach for every county.”