Vaccine equity must go beyond securing equal vaccination for all. It needs to consider distinct populations' exposure to COVID-19 and prioritize high-risk areas by allocating more vaccines, according to a Western University inequality scholar.
A new study, led by Western University found that despite relatively small differences in vaccination rates across communities in Toronto - with low, moderate and high COVID-19 infections - inequalities in COVID-19 infection rates across these communities persisted.
Kate Choi
Kate Choi, director of Western's Centre for Research on Social Inequality, led the data analysis comparing vaccine trajectories of various communities in Toronto. The research team, which also included Western's Patrick Denice and University of Toronto's Sagi Ramaj, discovered that the number of COVID-19 infection rates continued to grow faster in hotspots even though vaccination rates in these areas had caught up to those in communities with lower infection rates.
According to the study, Toronto communities that had high COVID-19 rates in April 2021 tended to have vaccinations rates that were, on average, 5.8 percentage points lower than those with low rates of COVID-19. By mid-June 2021, when COVID-19 hotspot communities were prioritized, the differential dropped to 1.7 per cent, which is encouraging says Choi. Unfortunately, the number of new cases continued to increase faster in COVID-19 hotspots and inequalities persisted.
It appears that although Ontario prioritized vaccine allocation to hotspots for a period of two weeks in May, vaccination rates did not increase fast enough to counteract the greater exposure to COVID-19 of residents in these communities.
The study also showed that immigrant neighbourhoods in Toronto may have been left behind in Toronto's vaccination efforts.
"They had lower vaccination rates in April and their vaccination rates continued to increase at a slower pace between April and June 2021," said Choi.
She pointed out that barriers to access, such as limited English proficiency and lack of familiarity with the country's health system, may be a key reason behind their lower vaccination rates.
Choi, a social demographer, argued that a truly equitable vaccination rollout may entail prioritizing communities with greater exposure to the COVID-19 virus.
"If booster shots become necessary during the potential fourth wave of the pandemic, the rollout plan should prioritize low-income, immigrant and racialized communities with high exposures to the COVID-19 virus," said Choi. "People in these communities have greater exposure to the COVID-19 virus, and as such, infection rates are growing faster in these communities.
"An equitable vaccination and booster rollout entails that these communities get more vaccines and boosters, a bit faster."
Choi also maintained that there are systematic barriers to accessing health resources for low-income, racial minority and immigrant neighbourhoods in Toronto, Ontario and across the country.
"The COVID-19 pandemic has exacerbated these inequalities," said Choi. "In order to attain health equity, we may have to go beyond allocating more vaccines to certain areas. We need to gain a better understanding about barriers to health care access for specific communities, and systematically eliminate these barriers for marginalized populations."
