Is the COVID-19 vaccination fair in California yet?

As of March 2021, California had one of the least equitable vaccine distribution programs for COVID-19 in the United States. To remedy this, Governor Newsom ordered that 40% of California’s vaccine supply be reserved for the census areas in the lowest quartile of the Healthy Places Index (HPI).

California plans to lift all statewide restrictions and open them fully on June 15, 2021, using four main indicators to assess readiness: 1. district adjusted daily case numbers, 2. district test positive rates, 3. measurement of health equity based on test positive rates in the lowest quartile HPI tracts; and 4. Measure vaccination equity based on total vaccinations in the most vulnerable neighborhoods of the state.

Examining the predictions for equality of opportunity and vaccine coverage in California in different scenarios

Researchers at the University of California, Davis recently conducted a brief investigation to examine the current vaccine quota and projections of vaccine coverage in California through June 15, 2020 in various scenarios. This study will be published on the preprint server medRxiv *.

The researchers collected HPI data for individual census areas from the Public Health Alliance of California and single-dose and full-dose vaccination rates for each district from the California Department of Public Health. They examined current vaccination equity using a simple linear regression between the county’s mean HPI and single and 2-dose vaccination rates. They also predicted the future vaccination coverage per district using a mathematical compartment model based on the 30-day average rate with 4 different rate change scenarios.

The results show that at the current vaccination rate, over 50% of the population will be fully vaccinated by June 15

The study results showed a strong positive association between the county’s average HPI and single and full-dose vaccination rates. Counties in the San Joaquin Valley area had consistently low HPI and vaccination rates.

The observations predict that 66.2% of the state’s population will receive at least a single dose of the vaccine and 53.8% will be fully vaccinated by June 15, provided current rates are maintained. However, the model predictions show some differences when broken down by county, as only 18 out of 58 counties are expected to be broken by Aug.15.

“Of the eight counties (San Joaquin, Stanislaus, Merced, Madera, Fresno, Kings, Tulare, and Kern), seven are in the lowest quartile for the county’s average HPI, and Fresno currently tops the total vaccination rate at 31%. ”

Country-wide forecasts from the simple compartment model.

Country-wide forecasts from the simple compartment model.

Vaccination reluctance due to social and demographic factors is the reason for inadequate vaccination rates

According to the authors, a clear link between the county’s HPI and vaccination rates shows that despite previous participation programs, California lacks an equitable foundation on which to initiate opening plans. While California as a state as a whole is optimistic about lifting restrictions in June 2021, success has been largely confined to urban centers and is not homogeneous across the state. The least vaccinated counties are also the ones with the most vulnerable populations.

The main reason given for the state not achieving sufficient vaccination rates is the reluctance to vaccinate due to social and demographic factors. According to a vaccine hesitation survey, the temporary hiatus from the Janssen COVID-19 vaccine caused 39% of unvaccinated Hispanic women to hesitate.

Unless vaccination rates change, many of the counties at risk may not open by June 15 with no consequences.

“Using an aggregate vulnerability index in this simple study likely obscures how various aspects of vulnerability have created inequalities across the state.”

*Important NOTE

medRxiv publishes preliminary scientific reports that are not peer-reviewed and therefore should not be considered conclusive, that guide clinical practice / health-related behavior or are treated as established information.

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