CDC report outlines COVID vaccine access disparities
Transportation a hurdle for some
A new report from the Centers for Disease Control and Prevention found discrepancies between distance to COVID-19 vaccination sites among different communities in the U.S., particularly in terms of walkability.
Highlighting opportunities for expanding access to public health services, a major thrust behind the study was preparedness for the future for all.
“An understanding of accessibility to vaccine sites for different populations is essential for effective planning and to ensure equitable access to health resources during public health emergencies,” the CDC said in an email statement.
The report, published in the CDC’s Emerging Infectious Diseases journal, found that, while 96.5% of American adults had a 15minute or less drive time to a COVID vaccination site, fewer than half lived within a 15-minute walk.
Access to transportation is a known social determinant of health, with the American Hospital Association estimating that 3.6 Americans forgo medical treatment annually due to transit-related hurdles.
In Allegheny County, hospital systems and public health officials knew there would be community members who could not get to a vaccine clinic, and focused efforts on closing the transportation gap by holding clinics in vulnerable communities.
Between December 2020 and March 2022, about 700 million doses of the COVID vaccine were delivered to vaccine sites, resulting in nearly 75% of U.S. adults receiving shots, according to the CDC.
Allegheny County saw similar metrics for the primary dosing series, with 76% receiving those first two shots. Percentages dropped to 24% for those in the county who received the bivalent booster, according to the CDC COVID tracker.
To generate the findings, CDC officials used open source road data to calculate walking and driving distance to 131,951 sites offering COVID vaccines across the U.S. Those sites included pharmacies, community health clinics, hospitals and medical facilities.
Walking time varied between urban and rural regions, the report noted. For those not in a metropolitan area, just 53% lived within a one-hour walking distance to a vaccine site, whereas for a large central metropolitan area like the city of Pittsburgh, 98% lived within a one-hour walking distance.
“Planning for increased access to vital health resources within a 15- 30minute walk is an important consideration for future public health mobilization,” the CDC noted.
Lucas Berenbrok, an associate professor at the Pitt School of Pharmacy, used similar analytics for data
published shortly before the initial vaccines were offered in December 2020, which estimated driving distance for residents of each county to where vaccines may be offered. Based on that data, Mr. Berenbrok and the study authors gave suggestions to public health officials regarding how to best plan for equitable vaccine distribution in their county, knowing transportation would be an issue.
And hospital systems got to work planning how vaccines could best reach underrepresented communities.
“Transportation is a major challenge for individuals who need to … get to a primary care physician’s office,” said Margaret Larkins-Pettigrew, senior vice president and chief clinical diversity, equity and inclusion officer at AHN. “We knew that many people were sheltering in, and that they were not going to be able to get to us.
“We basically decided right off the bat that we needed to dedicate specific amounts of our vaccine and focus on Black, brown and disadvantaged communities.”
During the pandemic, Highmark Health’s Enterprise Equitable Equitable Health Institute (EEHI) went directly to churches, barber shops and restaurants to deliver the vaccine. The EEHI was created in 2021 as an institution-wide effort to support Pittsburgh residents’ quality of life through equity and inclusion, which Larkins-Pettigrew oversees.
Bethany Community Ministries partnered with Highmark to set up pop-up vaccine clinics in the Hill District, McKeesport, Mount Oliver and other neighborhoods. The collaboration was built on trust, said Ms. Larkins-Pettigrew — Bethany Community Ministries employed Black nurses who were already members of the community.
Maya Ragavan, of Pitt’s Community Vitality Collaborative, also discovered that trust needed to be a main driver in conversations about vaccine equity.
The Community Vitality Collaborative, a partnership with the Pitt School of Medicine’s pediatrics department and community organizations such as the Neighborhood Resilience Project, formed in July 2020 to increase diversity in COVID vaccine clinical trials, and later, vaccine uptake in disadvantaged communities.
“It started as a way to share information about clinical trials and promote inclusion in trials,” said Ms. Ragavan, assistant professor of pediatrics at Pitt School of Medicine and one of the cofounders of the Community Vitality Collaborative (CVC). “We were really focused on this idea of trust in the medical field.”
Through ongoing weekly meetings with leaders of community organizations, the CVC went on to kickstart pop-up vaccine clinics directly in communities — with the nonprofit partners hosting and UPMC providing the vaccine. Similar to Highmark’s EEHI, they held events in churches, schools and auditoriums.
“What was really helpful for our group was that because we had community partners at the table from the beginning, we were able to ask questions and hear their thoughts in terms of plans,” Ms. Ragavan said. “It takes a while to build these collaborations. Trust doesn’t get built in a day.”
Ms. Ragavan also said the Vitality Collaborative made sure to think about the idea of access from all angles, which included language interpreters, transportation and going to places where people lived.
“We thought a lot about transportation,” she said. “We had a partnership with United Way and their Lyft program, and we went to high-rise buildings to administer vaccines to older folks who couldn’t walk to vaccination sites.”
This mattered for rural and suburban communities, as evident by the CDC report’s findings.
“What’s clear right now is that access to health care is becoming an urban and rural issue,” said John Sullivan, chief medical officer and senior vice president of St. Clair Health.
The hospital system already had a courtesy van service with six vehicles to take people from their homes to doctors’ visits if needed. While the service was suspended from March to June of 2020, it successfully transported people to get COVID vaccines; in the 2023 calendar year, about 13,000 people were shuttled to and from their homes to medical appointments, community screenings and vaccine clinics.
St. Clair Health also went into communities, visiting 25 locations — mostly nursing homes, retirement homes and schools — during the early days of the pandemic.
“There was a unique exacerbation in transportation disparity,” Mr. Sullivan said. “In retrospect, I think our methodology was sound in terms of going out into the community.”
But for those who couldn’t travel or didn’t have a vaccine clinic near them, pharmacies came to the rescue. When vaccines became available, the community pharmacy was uniquely spotlit as an essential place of health care already embedded in communities, said Mr. Berenbrok, the Pitt pharmacist and researcher.
“[Pharmacies] are one of, if not the most accessible health care provider,” he said.
A 2022 study by Mr. Berenbrok and colleagues found that 89% of Americans live within 5 miles of a pharmacy. This is further supported by the recent CDC report, which found that pharmacies comprised the majority of where people went to receive a vaccine.
And despite increases in access via drivability among the rural regions of the CDC study, Mr. Berenbrok noted that not everyone has a car — even in non-metropolitan areas.
“This study helps get people thinking about how we can make the vaccine accessible to people who are using public transportation,” he said.
Moving forward, prioritizing access and equity in health care may help close existing gaps.
“We need to think about the major challenges that are still happening for many people in our communities, especially in rural communities,” Ms. Larkins-Pettigrew said. “We have to make sure we are listening to the voices of the community and exactly what they need.”