A Boston Children's Hospital–led study reveals that COVID-19 vaccine uptake lagged among US children with more social vulnerability, lower socioeconomic status (SES), and greater household composition and disability (HCD) as of July 2022.
The study, published today in Pediatrics, also identified longer travel times to vaccination sites for rural, uninsured, White, and Native American families.
Uneven access to vaccination sites
The researchers mined the Centers for Disease Control and Prevention's (CDC's) Vaccine Tracking System in July 2022 to estimate vaccination-site accessibility by geocoding the sites, measuring travel times to the nearest site, and weighting population demographics to arrive at nationally representative vaccination estimates for October 2021 to July 2022.
The team also compared COVID-19 county-level vaccine coverage by Social Vulnerability Index scores, SES, HCD scores, minority status and language (MSL), and housing and transportation types. HCD concerns the number of people living in a household, and disability refers to the disability of anyone in the household.
Children from marginalized and minoritized communities have also faced disparate impacts across the COVID-19 care continuum.
COVID-19 has disproportionately affected marginalized and minority communities across the country, but access to testing, clinical trials, vaccines, and treatments haven't been equitably allocated to socially and clinically vulnerable adults, the study authors noted.
"Children from marginalized and minoritized communities have also faced disparate impacts across the COVID-19 care continuum, including inequities in rates of COVID-19 infection and COVID-19-related hospitalization, ICU admission, complication (eg, multisystem inflammatory syndrome), mortality, and loss of a primary caregiver," they wrote.
Long travel times for youngest kids
More than 15.2 million COVID-19 vaccine doses (271,589 doses of the Pfizer/BioNTech vaccine for children 6 months to 4 years, 6,270 doses of the Moderna vaccine for the same age-group, and 14,956,097 doses of the Pfizer vaccine for children aged 5 to 11 years) were given at 27,526 sites.
In total, 2.0% of the US population and 2.7% of uninsured, 10.5% of rural, 13.2% of American Indian and Alaska Native (AIAN), 2.0% of White, 2.2% of Hispanic, and 1.2% of Black children lived more than 30 minutes from the nearest vaccination site for children 5 to 11 years.
In contrast, 13.7% of the population and 65.9% of rural, 15.3% of uninsured, 25.3% of AIAN, 14.5% of White, 11.8% of Hispanic, and 9.0% of Black children lived more than 30 minutes from the nearest site for children 6 months to 4 years.
Rural children had longer travel times than their urban peers in all demographic subgroups and both vaccine age-groups, with large differences in the accessibility to sites for the younger age-group. Relative to White children, who lived a median of 4.8 minutes away, AIAN children (13.5 minutes) lived farther from the nearest site for younger children, while Asian (2.2 minutes), Hispanic (2.7), and Black (3.4) children lived closer.
For children 5 to 11 years old, the median travel time was 2.3 minutes for White children, 4.1 minutes for AIAN children, 4.1 minutes for Asian American children, 1.3 minutes for Hispanic children, and 1.6 minutes for Black children.
Lower vaccine uptake was linked to higher Social Vulnerability Index scores, lower SES, and greater HCD among children aged 6 months to 4 years (overall incidence rate ratio [IRR], 0.70; SES IRR, 0.66; HCD IRR, 0.38) and 5 to 11 years (overall IRR, 0.85; SES IRR, 0.71; HCD IRR, 0.67). Social vulnerability by MSL, however, was tied to higher uptake (6 months to 4 years IRR, 5.16; 5 to 11 years IRR, 1.73).
Parental education, reminders
"Pediatric COVID-19 vaccine uptake and accessibility differed by race, rurality, and social vulnerability," the authors wrote. "National supply data, spatial accessibility measurement, and place-based vulnerability indices can be applied throughout public health resource allocation, surveillance, and research."
Coordinated responses to emerging pathogens at hyperlocal, regional, and national levels must prioritize health equity.
The lower vaccine coverage among children aged 6 months to 4 years may be attributable to slow "diffusion of innovation" in the weeks after the COVID-19 vaccine became available for this age-group and higher parental hesitation to the vaccine for young children.
And the greater vaccine uptake among children with social vulnerability by MSL could reflect a troubling truth, the authors said: "Greater vaccination among privileged groups even when sites are located within marginalized communities, because of low vaccine confidence and other access barriers, disproportionately impacting marginalized populations," they said. "Moreover, early racial and spatial inequities in the pediatric vaccination rollout may grow further as pandemic-related coverage and reimbursement expansions are rescinded."
They recommend taking evidence-based, "low-tech/high-touch" approaches such as behavioral nudges, reminders, employer and school vaccine requirements, parental education about vaccine importance and safety, and delivery of vaccine messages by trusted community members.
"Our methods and findings may be useful for prioritizing equity in the rollout of promising new interventions like nirsevimab for respiratory syncytial virus, targeting future outbreak response efforts, and surveilling population-level disparities in chronic pediatric conditions," the researchers wrote. Nirsevimab (Beyfortus) is a monoclonal antibody that can reduce the risk of respiratory syncytial virus (RSV) in infants.
"Coordinated responses to emerging pathogens at hyperlocal, regional, and national levels must prioritize health equity, because of distributive justice, because of the many intersections of health and social conditions, and because our health is inextricably linked to the health of those around us more than ever during a pandemic," they concluded.
