Targeting Social Inequities and Vaccine Skepticism in Georgia

Roughly one year ago, state officials confirmed Georgia’s first cases of COVID-19. Two members of the same household were diagnosed in March 2020 after returning home from a trip to Italy. Both people isolated at home with mild cases of the disease.

Now, as of February 2021, more than 960,000 Georgians have tested positive for COVID-19. Of these people, more than 17,000 have died.

As the coronavirus spread like wildfire across the country in 2020, no state or U.S. territory was spared. But some areas were harder hit than others, including Georgia, which ranks among the top 10 states for confirmed COVID-19 cases and deaths.

Sharecare’s Community Well-Being Index (CWBI), in partnership with the Medical College of Georgia at Augusta University (AU), explored the social factors that have exacerbated the risk of severe disease and death in specific communities across the state. CWBI findings also help identify what strategies are needed to guide vaccine distribution efforts and prioritize at-risk or marginalized groups.

“Social determinants of health, which may be influenced by social policies and programs, shape health in powerful ways. These findings add to mounting evidence that certain groups have been disproportionately affected by the pandemic due to disparities among the conditions in which they live and work,” says Michael Rickles, PhD, Sharecare’s Executive Director of Research.  “These inequities in social determinants of health, such as education and healthcare access, influence quality of life and a wide range of health risks. Removing these barriers would help achieve health equity, in which all people would have the opportunity to be as healthy as possible and maximize their overall well-being.” 

Social Inequalities Exposed During the Pandemic

Using an unsupervised machine learning (ML) algorithm, Sharecare and AU identified four distinct cluster predictors related to COVID-19 case and death rates across Georgia. 

Clusters 1 and 2 included areas in and around metro Atlanta and tended to be urban or suburban in nature.  Only one county was in cluster 3, which included an army base, and cluster 4 tended to be in middle and Southern Georgia and coincided with the areas with the highest risk for COVID-19 prevalence and mortality rates. 

Notably, these counties have lower on average social determinants of health predictors across college education and home values, as well as proprietary indices across Sharecare’s Social Determinants of Health Index (SDOHi) and the educational attainment cluster variable than clusters 1, 2 and 3.

These findings reflect longstanding social inequalities, such as poverty and reduced access to quality education and health resources. These inequalities have contributed to health consequences, further dividing those with the most resources from those with the least, according to Dr. David Hess, dean of the Medical College of Georgia.

Some racial and ethnic minority groups are disproportionately affected by COVID-19, which has compounded the effects of longstanding social inequities. 

Black people have died at nearly 1.5 times the rate of white people and have accounted for 15% of COVID-19 deaths in the United States, according to the Centers for Disease Control and Prevention (CDC).

Researchers from the National Center for Primary Care at Morehouse School of Medicine who studied sociodemographic factors as predictors of COVID-19 found that Georgia counties with a larger percentage of black population had higher COVID_19 case rates, regardless of the proportion of people who were poor or uninsured. The researchers reported that 80% of coronavirus hospitalizations in Georgia in March 2020 involved non-Hispanic Black people and as of late April 2020, 35% of positive cases in Georgia were among African Americans.

Communities of color are also less likely to have been vaccinated in most reporting states, although existing data has gaps and limitations due to missing information with regard to race and ethnicity, according to the CDC

So, why is it that the COVID-19 vaccine is not reaching those that need it the most? 

Understanding and Overcoming Vaccine Skepticism 

A September 2020 CWBI snapshot revealed that 57% of Caucasian or white respondents indicated that they would get the vaccine immediately, or as soon as it became available, compared to only 45% of Hispanic or Latino respondents and 38% of Black or African American respondents. 

Hesitancy in communities of color stems from generations of betrayal by the U.S. health care system and longstanding systemic racism and discrimination. Inequalities in American infrastructure, including inadequate access to transportation as well as economic and education systems, lend to the potential for widening gaps in health disparities. This may be particularly true when it comes to vaccine uptake among vulnerable populations. 

Targeting Hardest-Hit Communities 

AU will deploy 900 Medical College of Georgia students to cluster 4 communities across Georgia. The strategic public-private partnership will work toward reducing COVID-19 cases and deaths by providing more equitable access to health information about vaccinations. 

“Vaccine hesitancy is a leading global health threat. In the United States, it could offset progress that’s been made in slowing the spread of COVID-19, which has had a particularly devastating impact on certain communities,” says Dr. Hess.  “Transparency and culturally appropriate communication are needed to counter vaccine hesitancy. The students deployed in Georgia engaged in cultural awareness, conflict avoidance and de-escalation training to enable them to effectively and appropriately address vaccine questions and concerns within these communities, which have been disproportionately affected by disparities in health and healthcare.”

Working alongside trusted community figures in neighborhood churches and other religious institutions, the MCG students will educate residents on the vaccines available in the United States and answer questions, debunk misinformation, and ease concerns about immunization.

Each student group will carry portable WIFI devices and data capture tablets with information to share at the point of education. Students will have the ability to direct community members to vaccine distribution sites. This will help ensure that individuals without internet access have equal opportunity to make an appointment and be vaccinated.