New COVID-19 vaccine study challenges stereotypes about who gets vaccinated

New COVID-19 vaccine study challenges stereotypes about who gets vaccinated

Overall, the researchers found that stark disparities in vaccine and booster coverage persist across the state, leaving thousands vulnerable to severe illness as increasingly transmissible forms of the virus circulate.

“Despite a lull in COVID-19 infection rates, MA is in a precarious position,” they wrote.

In the study, which was posted online Monday but not yet published in a peer-reviewed journal, the team analyzed state data on vaccinated and boosted residents by zip code through March 1. They also looked at census tract population estimates and postal code. level socio-economic and demographic data, including level of education, household income and occupation.

When the researchers took education and age into account, they found that many communities with large concentrations of black and Latino residents and essential workers had higher vaccination levels than similar communities with many residents. whites and fewer essential workers.

For example, consider the towns of Randolph and Dartmouth. Both are south of Boston and have residents with similar age distributions and college graduation rates of around 27%. In Randolph, where black and Latino residents make up about 53% of the population, 81% of the town had been vaccinated. Yet in Dartmouth, where 8% of residents are black or Latino, only 60% of the community had been vaccinated.

“That’s not to say race doesn’t matter,” said Jacob Bor, assistant professor of epidemiology and global health at Boston University’s School of Public Health and lead author of the study. .

Race, ethnicity, age and education levels overlap, he said. The team found that communities of color and those with lots of essential workers are, on average, younger and have lower levels of education and income, which can affect people’s access to vaccines.

“These differences in income and education among Black, Latino and Indigenous populations are the product of long-standing patterns of differential access to education, wealth and opportunity,” Bor said.

Income, the team found, was also a good predictor of vaccination coverage. A $10,000 increase in median household income by postal code was associated with higher vaccination and recall rates. From the lowest to the highest income levels, booster coverage increased from less than 30% to over 60%.

“Our analysis shows that education and income explain the patterns better than race or ethnicity itself,” said Dr. Jonathan Levy, who chairs the environmental health department at BU’s School of Public Health. and is the lead author of the research.

But despite high and relatively equitable coverage for the initial vaccination schedule in adults, the researchers found large inequalities in rates among children and very large inequalities for booster shots across all age groups.

In ZIP codes with the highest proportion of college-educated residents, approximately 70% of children have been vaccinated. Conversely, less than 40% of children were vaccinated in the 10% of ZIP codes with the lowest percentage of college-educated residents, including those with the highest percentages of black, Latino, and Latino populations. Americans and Natives.

“We need to redouble our efforts to overcome barriers related to poverty and education, such as working with community partners who offer vaccination outside of health care settings, after hours and on weekends. end, and provide clear and accurate information from trusted sources,” said Dr. Bisola Ojikutu, Boston Public Health Commissioner and co-author of the study.

“The only way to remedy this inequity,” she said, “is through perseverance.”

The disparities were also pronounced when looking at who had received at least one booster shot, and controlling for education and age levels did not change this picture as it did for the primary vaccine series. . The share of residents 65 and older who received a booster was just over 50% in ZIP codes with the lowest proportion of college graduates and the highest proportion of Black, Latino, or Indigenous people, found the researchers. Still, booster coverage was over 70% in the most educated ZIP codes and those with larger white populations.

A better understanding of the causes of the disparities should help policymakers address them, experts said.

“This report highlights that people with complicated lives, and many people stereotyped as hesitant, actually had high vaccination rates. And that really indicates that this is an access issue and that we need to do better,” said Atyia Martin, executive director of Next Leadership Development, a nonprofit that focuses on building leadership. resilience in black communities.

While vaccines have been widely offered at local pharmacies and doctor’s surgeries, Martin and others said many low-income essential workers often lack transportation or free time, especially if they are suffering from side effects. secondary after being vaccinated.

“We need to have more sophisticated strategies and consider people’s real lives and what they’re up against,” Martin said. “And we need to let the data guide the decisions we make.”

The researchers suggested that strategies used successfully during the initial rollout of the vaccine, such as setting up more convenient locations and times for essential workers to get vaccinated, should be broadly extended to boosters. They also said Massachusetts should particularly target this push in low-educated communities, regardless of racial makeup.

Brennan Klein, a postdoctoral researcher at Northeastern University who has studied COVID and racial bias, said that “the researchers’ cautious statistical approach. . . offers [state policy leaders] a great roadmap for how to steer vaccination efforts forward.

Nadia Abuelezam, an associate professor specializing in biostatistics and health inequalities at Boston College’s Connell School of Nursing, said the study offers very specific geographic information – down to the zip code level – to refine public messaging in future immunization initiatives.

“It allows us to think about where people live, work and play, and how that influences their health,” she said.

Michael Curry, chief executive of the League of Community Health Centers, was struck by the strong correlation researchers found between level of education and vaccination status. And he said policymakers, as well as health care providers, must use this finding to guide ongoing and future vaccination efforts.

“We need to stop relying on people with a college degree or a high school diploma to get what they need to make decisions about their health,” he said.

“We need employers to be in sync with health providers and plans, consistently providing health information and wellness guidance that can prevent the high morbidity and mortality rates in this pandemic,” did he declare.

And, Curry added, this approach would be effective for other health initiatives, such as cancer screening or diabetes care.

But the researchers have expressed concern that the lessons of the pandemic and the disparities revealed by their work are not being taken into account even now.

“Rates of new vaccinations and boosters have slowed as Massachusetts emerged from the winter surge and officials now anticipate a ‘return to normal,'” said Bor, the study’s lead author. further efforts to expand coverage, these inequalities are likely to persist.”

The result, he said, is that “there will be many people in poorer, less educated ZIP codes – regardless of their racial makeup – who will suffer in future waves of COVID due to low vaccination and booster rates.


Kay Lazar can be reached at kay.lazar@globe.com Follow her on Twitter @GlobeKayLazar.

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