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Evaluating the Geographical Accessibility and Equity of COVID-19 Vaccination Sites in England.

ABSTRACT: We assess the geographical accessibility of COVID-19 vaccination sites-including mass vaccination centers and community-level provision-in England utilizing open data from NHS England and detailed routing data from HERE Technologies. We aim to uncover inequity in vaccination site accessibility, highlighting small-area inequality hidden by coverage figures released by the NHS. Vaccination site accessibility measures are constructed at a neighborhood level using indicators of journey time by private and public transport. We identify inequity in vaccination-site accessibility at the neighborhood level, driven by region of residence, mode of transport (specifically availability of private transport), rural-urban geography and the availability of GP-led services. We find little evidence that accessibility to COVID-19 vaccination sites is related to underlying area-based deprivation. We highlight the importance of GP-led provision in maintaining access to vaccination services at a local level and reflect on this in the context of phase 3 of the COVID-19 vaccination programme (booster jabs) and other mass vaccination programmes.

SUBMITTER: Duffy C

PROVIDER: S-EPMC8781430 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:ObjectivesThe growth of COVID-19 infections in England raises questions about system vulnerability. Several factors that vary across geographies, such as age, existing disease prevalence, medical resource availability and deprivation, can trigger adverse effects on the National Health System during a pandemic. In this paper, we present data on these factors and combine them to create an index to show which areas are more exposed. This technique can help policy makers to moderate the impact of similar pandemics.DesignWe combine several sources of data, which describe specific risk factors linked with the outbreak of a respiratory pathogen, that could leave local areas vulnerable to the harmful consequences of large-scale outbreaks of contagious diseases. We combine these measures to generate an index of community-level vulnerability.Setting91 Clinical Commissioning Groups (CCGs) in England.Main outcome measuresWe merge 15 measures spatially to generate an index of community-level vulnerability. These measures cover prevalence rates of high-risk diseases; proxies for the at-risk population density; availability of staff and quality of healthcare facilities.ResultsWe find that 80% of CCGs that score in the highest quartile of vulnerability are located in the North of England (24 out of 30). Here, vulnerability stems from a faster rate of population ageing and from the widespread presence of underlying at-risk diseases. These same areas, especially the North-East Coast areas of Lancashire, also appear vulnerable to adverse shocks to healthcare supply due to tighter labour markets for healthcare personnel. Importantly, our index correlates with a measure of social deprivation, indicating that these communities suffer from long-standing lack of economic opportunities and are characterised by low public and private resource endowments.ConclusionsEvidence-based policy is crucial to mitigate the health impact of pandemics such as COVID-19. While current attention focuses on curbing rates of contagion, we introduce a vulnerability index combining data that can help policy makers identify the most vulnerable communities. We find that this index is positively correlated with COVID-19 deaths and it can thus be used to guide targeted capacity building. These results suggest that a stronger focus on deprived and vulnerable communities is needed to tackle future threats from emerging and re-emerging infectious disease.

Project description:ObjectiveTo use mathematical and economic models to predict the epidemiological and economic impact of vaccination with Bexsero, designed to protect against group B meningococcal disease, to help inform vaccine policy in the United Kingdom.DesignModelling study.SettingEngland.PopulationPeople aged 0-99.InterventionsIncremental impact of introductory vaccine strategies simulated with a transmission dynamic model of meningococcal infection and vaccination including potential herd effects. Model parameters included recent evidence on the vaccine characteristics, disease burden, costs of care, litigation costs, and loss of quality of life from disease, including impacts on family and network members. The health impact of vaccination was assessed through cases averted and quality adjusted life years (QALYs) gained.Main outcome measuresCases averted and cost per QALY gained through vaccination; programmes were deemed cost effective against a willingness to pay of £20,000 (€25,420, $32,677) per QALY gained from an NHS and personal and social services perspective.ResultsIn the short term, case reduction is greatest with routine infant immunisation (26.3% of cases averted in the first five years). This strategy could be cost effective at £3 (€3.8, $4.9) a vaccine dose, given several favourable assumptions and the use of a quality of life adjustment factor. If the vaccine can disrupt meningococcal transmission more cases are prevented in the long term with an infant and adolescent combined programme (51.8% after 30 years), which could be cost effective at £4 a vaccine dose. Assuming the vaccine reduces acquisition by 30%, adolescent vaccination alone is the most favourable strategy economically, but takes more than 20 years to substantially reduce the number of cases.ConclusionsRoutine infant vaccination is the most effective short term strategy and could be cost effective with a low vaccine price. Critically, if the vaccine reduces carriage acquisition in teenagers, the combination of infant and adolescent vaccination could result in substantial long term reductions in cases and be cost effective with competitive vaccine pricing.

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Evaluating the Geographical Accessibility and Equity of COVID-19 Vaccination Sites in England.

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