Taking Vaccine to Where the Virus Is-Equity and Effectiveness in Coronavirus Vaccinations.

The urgency to accelerate vaccinations in the face of the recent coronavirus disease 2019 (COVID-19) pandemic surge and the emergence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants has led many to adopt a simplified age-based prioritization strategy for COVID-19 vaccine allocation. The rationale for this approach is that implementation will be simpler and overall deaths will be fewer, though proponents often acknowledge that equity may take a back seat because of the overriding need for efficiency. This article outlines an approach to achieve equity, efficiency, and ultimately effectiveness in the COVID-19 vaccination campaign. Black, Latino, Indigenous, and Pacific Islander populations and low-income communities generally have borne the brunt of the COVID-19 pandemic. There are several social and structural reasons for this disproportionate burden. Many individuals from these communities perform essential in-person work (often without adequate protection for workers or enforcement of workplace health orders), live in crowded housing (exacerbated in areas with existing housing affordability crises) and in poverty, and have limited access to and trust in a daunting and fragmented health care system. Without an explicit focus on equity in a vaccination strategy, these COVID-19 disparities will certainly widen both because the same structural barriers will limit accessibility to vaccines among those aged 65 years or older and because these populations are overrepresented among the deaths in those younger aged than 65 years. Moreover, strategies that ignore equity risk undermining the effectiveness of vaccination as a tool to control the pandemic, potentially increasing hospitalizations and deaths in addition to widening disparities. in housing and services, place often captures the social vulnerability at the heart of COVID-19 risk. Transmission ofSARS-CoV-2infectionisclearlypatternedbyplace,asevidencedbytheubiquitousmapsshowing unequal distribution of COVID-19 cases and deaths within cities and counties. Place also offers built-in efficiencies for community mobilization, education, and distribution, which already has been observed for community-based testing. A place-based approach can be implemented efficiently according to the principles below.