COVID-era public health programs effective for vaccine access

Two new studies published in the latest issue of Health Affairs highlights public health initiatives that both boosted access to vaccine and preventive care and reduced health disparities.

The studies, which were not related to each other, looked at public health programs targeting the COVID-19 vaccine rollout, finding that intentional public health initiatives can increase uptake of preventive services, especially among traditionally underserved populations.

The first study, completed by experts from Tulane University, looked at how cash incentives affected vaccine receipt among individuals aged 16 to 35.

Cash incentives have been the center of many patient engagement initiatives, with policy experts questioning whether cash incentives are enough to compel people into a certain behavior. The Tulane researchers acknowledged that the initial COVID-19 vaccine rollout was a ripe opportunity to investigate whether incentives can be effective.

The researchers looked at a West Virginia program that provided a $100 incentive to fully vaccinated adults ages 16 to 36 and compared them to individuals aged 36 and older (treated as a control group).

Overall, the incentives worked. The analysis showed the $100 incentive was linked to an 11.82-percentage-point increase in the number of people ever being vaccinated against COVID-19.

The researchers hypothesized that this was a larger effect than the multimillion-dollar vaccine lottery in West Virginia, in which fully vaccinated adults were pooled for a single winner of a significant sum of money (in other words, getting vaccinated was your lottery ticket).

Of note, the researchers found that the $100 incentive had a bigger impact on disadvantaged populations, including folks with low income or who were unemployed. The team acknowledged arguments that cash incentives could be viewed as exploitative of this underserved population.

“Although this may raise the concern that incentive programs press disadvantaged people to get vaccinated for financial support, these cash transfers, in contrast, could also have served as reimbursement for vaccination-related costs such as transit, child care, and lost wages, making vaccines more accessible for disadvantaged populations,” they explained.

Still, the cash incentives were not a panacea, the data showed. For example, they did little to compel folks with prior COVID infection to get the shot. This is consistent with national findings, the team said, but nevertheless suggests a need for greater community outreach with this population.

That notwithstanding, the team said the cash incentives could be a key public health tool moving forward after the pandemic.

“Along with the supportive evidence from research on other vaccines such as influenza, human papillomavirus, and hepatitis B,36 guaranteed cash incentives of similar amounts may be considered for immunization efforts in the post-COVID-19- pandemic era,” they concluded.

The second study, completed separately by researchers from the California Department of Public Health (CDPH) and the University of California, San Francisco (UCSF), outlined another public health program that could improve vaccine uptake.

In particular, this report outlined a policy that could address vaccine equity.

Vaccine equity was a significant concern in 2021, after COVID-19 laid bare the health disparities plaguing the nation for centuries. When the vaccine became available, many public health experts zeroed in on strategies to ensure even traditionally underserved people had access to the shots.

In California, experts instituted a vaccine equity policy that prioritized communities considered disadvantaged based on the Healthy Places Index. The policy allocated 40 percent of the state’s total COVID-19 vaccine supply for neighborhoods flagged for the program.

Although ZIP codes in the bottom 25 percent of Healthy Places Index scores only account for a quarter of California’s total population, they accounted for 40 percent of all COVID-19 cases and deaths. Data such as that was the impetus behind the vaccine equity policy, the researchers explained.

The vaccine equity policy was effective in improving access to the shots in prioritized communities, the researchers said, highlighting a 28.4 percent increase in vaccination rates after California implemented the policy in March 2021.

Increased access to the COVID-19 vaccines had downstream benefits, they added. The researchers estimated that 160,892 COVID cases, 10,248 hospitalizations, and 679 deaths were averted in disadvantaged neighborhoods due to vaccine availability.

Despite those gains, racial health disparities in COVID disease burden remained, the researchers said. Even still, the team deemed the program successful, and said it can point to fruitful public health initiatives in the future.

Moving forward, it could be beneficial to flag prioritized communities at the smallest scale possible. For California’s vaccine equity plan, experts used the Healthy Places Index, which breaks down area advantage by ZIP code. Other similar metrics, like the social vulnerability index or the Area Deprivation Index, likewise break things down by ZIP code.

“However, even at the ZIP code level, neighborhood-level disparities may be masked, potentially leaving behind communities with higher social vulnerability that are embedded in ZIP codes with generally more advantaged conditions,” the CDPH researchers advised. “Equity-focused resource allocation strategies should therefore be implemented at the smallest scale feasible for implementation to maximize coverage,” they concluded.