COVID-19 is a contagious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Since it was first identified in December 2019, it has spread worldwide, leading to an ongoing pandemic (Zimmer, 2021). Up until August 2021, more than 36 million cases were confirmed in the U.S., causing about 6 million deaths (CDC, 2021a). With the months-long distribution of COVID-19 vaccines since the beginning of 2021, infections and deaths gradually decrease. Just when people started to feel safe, however, the emergence of the highly contagious Delta variant drove the number of infections to about a hundred thousand a day (CDC, 2021a). The currently authorized mRNA COVID-19 vaccines (Pfizer-BioNTech and Moderna) proved to be less effective against the infection caused by the variants compared with the ancestral strain. However, COVID-19 vaccinations still provide protection and are the best means to fight the pandemic (CDC, 2021d).
As of August 2021, more than 35 million vaccine doses were administered, and 167 million people were fully vaccinated in the United States. 50.3% of the total population in the U.S. is fully vaccinated, 61.3% of adults are fully vaccinated, and the percentage of fully vaccinated elderly (65 and older) is 80.5% (CDC, 2021a). Compared to the whole country, the study area-Ohio is a little behind: 46.65% of total Ohioans are fully vaccinated, and only 57.8% of adults are fully vaccinated (Ohio Dpartment of Health, 2021). Even though more and more people are getting vaccinated against COVID-19, there is still a long way to go before the whole country reaches herd immunity. The state government is promoting the process of COIVD-19 vaccination to make sure it is free and available for individuals ages 12 and over, as it is critical to help end the COVID-19 pandemic.
COVID-19 has brought health disparities and inequalities to the spotlight of public health. Health disparities refer to the situation where a segment of the population disproportionally suffers from a certain health concern or health outcome (Kilbourne, Switzer, Hyman, Crowley-Matoka, & Fine, 2006). A variety of factors drive the disparities in health, such as discrimination, health care access, occupation, education, and income gaps (CDC, 2021c). For example, discrimination leads to long-term and toxic stress and further shapes socioeconomic factors that put people from racial and ethnic minority groups at risk of catching COVID-19 (Paradies, 2006; Simons et al., 2018). Another example is that underprivileged people face various barriers to access healthcare due to the lack of health insurance, transportation access, or ability to take time off work (Berchick, Barnett, & Upton). A study shows that medical care only accounts for around 20% of the variation in health outcomes, while 80% can be traced back to health behaviors and socioeconomic factors- often referred to as social determinants of health (SDOH) (Hood, Gennuso, Swain, & Catlin, 2016). Geographic location, race and ethnicity, and socioeconomic status influence an individual’s environmental exposure and health behavior and subsequent risk of adverse health outcomes (Clark, Millet, & Marshall, 2014; Williams & Collins, 2016). Evidence shows that disparities of COVID-19 and COVID-19 vaccination among racial groups exist. For example, in Ohio, African-Americans comprise 14% of the population while they comprise18.7% of hospitalization caused by COVID (Ohio Department of Health, 2021). Furthermore, only 9% percent of the COVID-19 vaccinated people in Ohio are African American (Ohio Dpartment of Health, 2021).
Equal and adequate access to the COVID-19 vaccination is a precondition for ending the pandemic and achieving health equity within such a context. Accessibility can be understood as the relative ease by which the locations of activities can be reached from a given location (Hansen, 1959). It can also be interpreted as spatial and aspatial. Spatial access concerns distance as the barrier, whereas aspatial access emphasizes nongeographic barriers, such as social status, income, race, age, sex, etc.(Joseph & Phillips, 1984). Since the COVID-19 vaccines are free for everyone 12 and older, this greatly lowers (but does not eliminate) aspatial concerns. However, geographical accessibility remains a major problem.
Uneven distributions of COVID-19 vaccination clinics and population result in a geographical disparity in access. Studies have shown that inner-city areas tend to have more healthcare providers, shorter distances to facilities, more transportation choices, and higher healthcare quality compared to rural areas (Ghorbanzadeh, Kim, Ozguven, & Horner, 2021; Meilleur et al., 2013; Xu, Fu, Onega, Shi, & Wang, 2017). Furthermore, a higher proportion of racial and ethnic minorities suffer from poor access to healthcare facilities (CDC, 2021b). For example, African-Americans suffer from poor access to pharmacies in Baton Rouge, Louisiana (Ikram, Hu, & Wang, 2015); in Florida, seniors faced disadvantaged access to the COVID-19 vaccination sites (Tao, Downs, Beckie, Chen, & McNelley, 2020); and vulnerable populations in Chicago resided in areas where access to the COVID-19 health resources are low (Kang et al., 2020). Disparities in healthcare accessibility among different socioeconomic and race and ethnic groups correspond to differences in health outcomes (Esnaola & Ford, 2012). Research has also shown that geographically and racial and ethnic disparities are interrelated, and both could result in disparities in health outcomes (McLafferty, Wang, Luo, & Butler, 2011; Wang, McLafferty, Escamilla, & Luo, 2008).
Inspired by the aforementioned studies, this study focuses on three questions:
RQ1: Does access to permanent COVID-19 vaccination sites vary according to different urban-rural classifications?
RQ2: Does access to permanent COVID-19 vaccination sites differ by demographic groups?
RQ3: What is the relationship between the social vulnerability themes and accessibility to permanent COVID-19 vaccination sites?