California's COVID-19 Vaccine Equity Policy: Cases, Hospitalizations, And Deaths Averted In Affected Communities

Health Aff (Millwood). 2024 May;43(5):632-640. doi: 10.1377/hlthaff.2023.01163.

Abstract

In March 2021, California implemented a vaccine equity policy that prioritized COVID-19 vaccine allocation to communities identified as least advantaged by an area-based socioeconomic measure, the Healthy Places Index. We conducted quasi-experimental and counterfactual analyses to estimate the effect of this policy on COVID-19 vaccination, case, hospitalization, and death rates. Among prioritized communities, vaccination rates increased 28.4 percent after policy implementation. Furthermore, an estimated 160,892 COVID-19 cases, 10,248 hospitalizations, and 679 deaths in the least-advantaged communities were averted by the policy. Despite these improvements, the share of COVID-19 cases, hospitalizations, and deaths in prioritized communities remained elevated. These estimates were robust in sensitivity analyses that tested exchangeability between prioritized communities and those not prioritized by the policy; model specifications; and potential temporal confounders, including prior infections. Correcting for disparities by strategically allocating limited resources to the least-advantaged or most-affected communities can reduce the impacts of COVID-19 and other diseases but might not eliminate health disparities.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • COVID-19 Vaccines*
  • COVID-19* / mortality
  • COVID-19* / prevention & control
  • California / epidemiology
  • Female
  • Health Equity
  • Health Policy*
  • Healthcare Disparities
  • Hospitalization* / statistics & numerical data
  • Humans
  • Male
  • Middle Aged
  • SARS-CoV-2
  • Socioeconomic Factors
  • Vaccination / statistics & numerical data

Substances

  • COVID-19 Vaccines