UChicago Medicine study looks at COVID vaccination equity

The study, published this morning in JAMA Network Open, analyzed Chicago Department of Public Health data, focusing on COVID-19 deaths and vaccination rates in 52 of Chicago’s nearly 70 zip codes during the alpha wave from March to June 2021 and the delta wave from August to November 2021.

Parker said the study demonstrates vaccines were effective because during both waves, 68 COVID-related deaths occurred in the most-vaccinated zip codes, while 342 deaths occurred in the least-vaccinated zip codes.

Statistical modeling showed there would have been a 75% reduction in the number of deaths during both waves if the least-vaccinated zip codes had followed a similar trend as the most-vaccinated zip codes, UChicago said in a statement.

The demographics of the least-vaccinated zip codes show 80% of those residents were Black, while in the most-vaccinated zip codes, 70% were white.

CDPH Commissioner Dr. Allison Arwady said the numbers in the UChicago study are “why we have had equity at the center of our efforts the whole time.”

At the start of the pandemic, health officials knew poorer and Black and Hispanic populations would bear a higher level of risk for severe COVID-19 outcomes, Parker said. And efforts were made to emphasize underserved communities, such as the Protect Chicago initiative.

Chicago continues to pursue strategies that specifically target and try to push vaccinations out to communities with the highest vulnerability to COVID-19, which correlate to the predominantly Black zip codes in the study, Arwady said.

Early in the vaccine rollout, the city created the Chicago Covid Vulnerability Index, splitting Chicago’s 77 community areas into high, medium and low vulnerability. A rollout that prioritized getting shots to people in high-vulnerability areas was at times controversial, and “not entirely aligned with the Centers for Disease Control guidelines,” she said.

“At every stage of the way, the low vulnerability group was the last to see vaccines when they became available,” Arwady said. The city’s Protect Chicago Plus program set aside extra vaccines for 15 areas and opened up eligibility earlier there than in other areas of the city, she said. 

“We took a lot of heat for some of these efforts,” Arwady said. “But it was a real-world application of how do you put racial equity and rapid response together.” 

In March of this year, Arwady talked about many aspects of pandemic politics on Crain’s Juice podcast.

UChicago’s Parker acknowledges the city’s efforts.

“In some ways, we had the most equitable vaccination program of any large city in the country,” Parker said. “But the study shows what happened despite all our efforts.”

“Our study doesn’t tell us why there were disparities in vaccine coverage; they only show the consequences,” Parker said.

The study did discuss, but did not study, the causes of low vaccination rates. 

“Whether through barriers to access, medical distrust or other factors influencing the decision to pursue vaccination, vaccination efforts in Chicago failed to provide equitable coverage to Black and Hispanic communities,” the study said. “This inequality in vaccination coverage is likely to have played a major role in exacerbating the racial and ethnic disparity in deaths during the alpha and delta waves of COVID-19.”

“People with lower vulnerability will almost always be the most vaccinated,” Arwady said. The most well off have resources to get vaccinated, where others don’t, she said. For example, at the beginning of vaccinations, when supplies were hard to come by, people drove all over the state to get theirs.

But Parker said result from the city’s equity efforts were uneven, with white communities vaccinated at much higher levels.

“For me, it underscores how much investment we need in public health and how aggressive public health policy should be,” Parker said. The study “shows how big the problem is, how important the problem is and, in the next go around, we’re going to have say something like, ‘Hey, we’re going to give five times the number of vaccines to Englewood as we are for Streeterville.’ “

“We’re still not there, and there are a lot of reasons,” Arwady said, but Chicago had one the most aggressive efforts among cities aiming to reach vulnerable populations. Much of the work still needed is to tackle the issue of trust in communities with low vaccination rates.

“You have to look at opinions about vaccination and hesitancy,” she said. “Once you get over issues of access, the question is one of whether there is trust in the community.”

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