Rapid, widespread vaccination coverage is needed to stop the spread of COVID-19 and contain the pandemic. As of January 6th, 2022 Pima County, Arizona has fully vaccinated 64.2% of its total population, with 75.5% having received a first dose. These figures at the county level, however, belie wide discrepancies in vaccination rates at both the census-tract and zip-code level. With scarce time and resources, an equitable COVID-19 vaccine rollout hinges on identifying which communities are falling behind, and why. This level of understanding is important in order for the Pima County Health Department (PCHD) to target effective outreach and support to specific communities within Pima County. It is important to understand where pockets of under-vaccination are located, which challenges are faced, and how vulnerable communities - those least resilient to COVID-19 impacts - are faring. While these data along with tools to understand the level and factors driving community vulnerability and concern for COVID-19 vaccine rollout challenges exist, there is not one tool that collates, visualizes, and interprets these data to guide action. With Partners in Health and Surgo Ventures, PCHD created a census-tract level dashboard to prioritize which communities need vaccine strategy support and why based on individual and community-level factors associated with low vaccination uptake.

The dashboard innovatively aggregates and interprets multiple data sources to produce actionable insights addressing COVID-19 vaccination inequities. This includes PCHD vaccination data, Surgo COVID-19 data tools on community vulnerability and vaccine rollout barriers, and data on the types of people - or personas - who are less likely to be vaccinated. Tracts requiring action are prioritized based on the level of vaccine coverage, vulnerability to pandemic outcomes, and current hotspot risk based on COVID-19 cases. Vulnerability is measured by Surgo Ventures COVID-19 Community Vulnerability Index (CCVI), which captures how and why a community is vulnerable to the health, economic, and social impacts of COVID-19. This prioritization enables PCHD to direct resources to the vulnerable, low uptake communities facing new COVID case waves that are most in need and require urgent action.

To guide what resources and strategy is needed, the dashboard contextualizes what might be driving poor vaccine uptake with Surgo Ventures COVID-19 Vaccine Coverage Index (CVAC) and COVID-19 Vaccine Persona Tool. The CVAC captures the level of concern for the underlying community-level factors that may hinder rapid, widespread COVID-19 vaccine rollout. To better understand the landscape of vaccine hesitancy in the general population and to develop an evaluation tool, Surgo Ventures developed and validated a ‘vaccine personas’ tool based upon psychosocial behavioral segmentation —a technique that segments the population based on barriers and beliefs related to vaccination. Surgo identified five different types of people living in the US who differ in their attitudes toward the COVID-19 vaccine and created a 6-question typing tool that typifies someone’s vaccine persona with over 90% accuracy. This typing tool was included within the vaccine hesitancy survey to identify the dominant personas and guide interventions and targeted messaging to improve uptake. Together, the CVAC factors and vaccine personas contextualize challenges to best guide the right type of resources to communities in need.

Communities are vulnerable for different reasons and COVID-19 vaccine rollout is dynamic with shifting demand and supply-side challenges. The dashboard was developed using ArcGIS Insights and dynamically updates to reflect the most current COVID-19 case and vaccination data. Dashboard data is innovatively visualized to compare and contrast community challenges in the context of COVID-19 vaccination rates over time. This enables users to monitor if solutions are improving uptake, as well as identify areas that are both underperforming or exceeding expectations to inform a hyperlocal community of practice in response to COVID-19 vaccine inequity. The prototype dashboard will be finalized by the end of January (currently in development as of this submission). PCHD teams report the design and functionality provide value in interpreting multiple, different datasets to generate actionable insights, and there is potential to scale to identify inequities in other public health areas of interest.

The current practice is evidence-based and was inspired by a 4-step framework to promote COVID-19 vaccine access, acceptance, and equity.¹ The COVID-19 Community Vulnerability Index (CCVI) is a validated tool recognized by the CDC as a valuable resource to guide strategic response efforts to the marginalized areas at greatest risk of COVID-19.^2,3 The COVID-19 Vaccine Coverage Index (CVAC) is strongly associated with the speed of vaccine rollout and has been featured by the CDC as a vaccine hesitancy measure.^4,5 The COVID-19 Vaccine Personas and COVID-19 Vaccine Persona Typing Tool included in the vaccine hesitancy survey were developed using psychosocial behavioral segmentation of nationally representative survey data and a CART model to narrow down a long list of psychobehavioral questions to just a few that identify persona segments with 90% accuracy.^6,7,8

References:

1. Surgo Ventures, Resolve to Save Lives (2021) COVID-19 Vaccine Precision Response Toolkit: An End-to-End Vaccination Improvement Framework to Improve COVID-19 Vaccine Uptake.

2. Smittenaar, Peter, et al. "A COVID-19 Community Vulnerability Index to drive precision policy in the US." medRxiv (2021).

3. Melvin SC, Wiggins C, Burse N, Thompson E, Monger M. The Role of Public Health in COVID-19 Emergency Response Efforts From a Rural Health Perspective. Prev Chronic Dis 2020;17:200256. DOI: http://dx.doi.org/10.5888/pcd17.200256.

4. Mishra, Anubhuti, et al. "COVID-19 Vaccine Coverage Index: Identifying barriers to COVID-19 vaccine uptake across US counties." medRxiv (2021).

5. “Vaccine Hesitancy for Covid-19.”Centers for Disease Control and Prevention, https://data.cdc.gov/stories/s/Vaccine-Hesitancy-for-COVID-19/cnd2-a6zw/.

6. Surgo Ventures (2021) The Challenge of our Time: Achieving High Vaccination Coverage during the COVID-19 Pandemic.

7. Surgo Ventures (2021) Identify a Vaccine Persona.

8. Dobilas, Saul. “CART: Classification and Regression Trees for Clean but Powerful Models.” Medium, Towards Data Science, 1 Jan. 2022.

Leveraging granular data to improve COVID-19 vaccination coverage in Pima County, Arizona

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