Using Disadvantage Indices in Pandemic Vaccine Allocation and Beyond to Promote Health Opportunity

University Of Pennsylvania, Philadelphia PA

Investigators

Linked publications & trials

Abstract

Covid-19 exposed differences in healthcare access and health outcomes (health opportunities) across the population—but in an unprecedented turn, policymakers deployed Disadvantage indices (DIs), which were novel tools, to address these differences within, and outside of the pandemic. Rapidly and widely adopting a proposal by the National Academies of Science, Engineering and Medicine (NASEM), a majority of US states (n=34) used DIs in vaccine allocation plans. DIs are place-based statistical measures of advantage and disadvantage that integrate Census data such as income, education, or quality of housing, to rank geographic areas as small as neighborhoods. Due to severe scarcity, DIs were used to increase vaccine shares for disadvantaged areas. This use mitigated the risk that groups, who typically had worse health before the pandemic, would incur a further burden during vaccine allocation. At the same time, the rapid adoption and wide range of DI uses leaves unclear what the optimal uses of DIs are within and outside of health emergencies. Our goal for this study is to determine the strengths and weaknesses of using DIs for the Covid-19 pandemic, future pandemics, public health, and clinical care. As a highly interdisciplinary team collaborating with a community advisory board, we propose an observational study with 2 aims. First, we will identify the impact, strengths, and weaknesses of using DIs in Covid-19 vaccine allocation. We will evaluate the impact of the 3 most frequently used DIs on Covid-19 hospitalizations, deaths, and vaccination rates, using predictive modeling and analyses of states' actual vaccine-roll-out. We will also conduct qualitative interviews of key stakeholders to identify facilitators and barriers to using DIs with vaccine allocation. Second, we will identify the possible strengths and weaknesses of using a wider range of DIs in public health and clinical care outside of emergency settings, including for health-related social needs. From the fourth year of the study, we focused on analyzing the intersection of DIs and central health outcomes and opportunities, such as life expectancy, cancer rates, and access to basic needs such as electrical or other utilities. We will use interviews and other methods to determine how key stakeholders, including public health, hospital, and research leaders, have used and rank concrete uses of DIs, identified from the literature. We complement expert views with two innovative nationally representative survey-experiments, and engaging communities in group deliberations.