Geographically targeted COVID-19 vaccination is more equitable and averts more deaths than age-based thresholds alone

Elizabeth Wrigley-Field; Mathew V Kiang; Alicia R Riley; Magali Barbieri; Yea-Hung Chen; Kate A Duchowny; Ellicott C Matthay; David Van Riper; Kirrthana Jegathesan; Kirsten Bibbins-Domingo; Jonathon P Leider

doi:10.1126/sciadv.abj2099

Geographically targeted COVID-19 vaccination is more equitable and averts more deaths than age-based thresholds alone

Sci Adv. 2021 Oct;7(40):eabj2099. doi: 10.1126/sciadv.abj2099. Epub 2021 Sep 29.

Authors

Elizabeth Wrigley-Field^{1

2}, Mathew V Kiang^{3

4}, Alicia R Riley⁵, Magali Barbieri^{6

7}, Yea-Hung Chen⁸, Kate A Duchowny⁵, Ellicott C Matthay⁹, David Van Riper², Kirrthana Jegathesan¹⁰, Kirsten Bibbins-Domingo^{5

11}, Jonathon P Leider¹²

Affiliations

¹ Department of Sociology, University of Minnesota, Twin Cities, Minneapolis, MN, USA.
² Minnesota Population Center, University of Minnesota, Twin Cities, Minneapolis, MN, USA.
³ Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CA, USA.
⁴ FXB Center for Health and Human Rights, Harvard University, Boston, MA, USA.
⁵ Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA.
⁶ Department of Demography, University of California, Berkeley, CA, USA.
⁷ French Institute for Demographic Studies, Paris, France.
⁸ Institute for Global Health Sciences, University of California San Francisco, San Francisco, CA, USA.
⁹ Center for Health and Community, University of California San Francisco, San Francisco, CA, USA.
¹⁰ University of Minnesota School of Public Health, Minneapolis, MN, USA.
¹¹ Department of Medicine, University of California San Francisco, San Francisco, CA, USA.
¹² Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, MN, USA.

Abstract

COVID-19 mortality increases markedly with age and is also substantially higher among Black, Indigenous, and People of Color (BIPOC) populations in the United States. These two facts can have conflicting implications because BIPOC populations are younger than white populations. In analyses of California and Minnesota—demographically divergent states—we show that COVID vaccination schedules based solely on age benefit the older white populations at the expense of younger BIPOC populations with higher risk of death from COVID-19. We find that strategies that prioritize high-risk geographic areas for vaccination at all ages better target mortality risk than age-based strategies alone, although they do not always perform as well as direct prioritization of high-risk racial/ethnic groups. Vaccination schemas directly implicate equitability of access, both domestically and globally.

Abstract

Grants and funding