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Even with equal vaccination rates, COVID-19 hotspots still have higher infection rates

Hotspot neighbourhoods with greater COVID-19 risk exposure continued to have higher infection rates even when they achieved vaccination levels equal to lower-risk neighbourhoods.

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3 years ago

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Hundreds of residents of Toronto's M3N postal code, a hotspot for COVID-19 infections, line up at a pop-up vaccine clinic on In April 2021. THE CANADIAN PRESS/Cole Burston

Research shows vaccines can turn the tide of the pandemic. The emergence of deadly variants, lower initial vaccine rates among vulnerable groups, and continued surges in COVID-19 cases in communities with low vaccination rates have kindled concerns about vaccine equity.

As COVID-19 hotspots emerged in cities like Toronto, there were efforts to increase vaccine availability and uptake in those neighbourhoods. However, because neighbourhoods have different levels of risk of exposure, equal vaccination rates may not result in similar COVID-19 infection rates. Our team looked at these inequalities in Toronto’s neighbourhoods.

Click here for more articles in our series about vaccine confidence.

In Toronto, vaccination rates were lower in racial minority and immigrant communities in early April 2021. These communities were also disproportionately affected by the pandemic. This means that vaccination rates were lower in communities with higher COVID-19 infections.

Since then, the supply of vaccines in Canada has increased dramatically. The share of Canadians who received at least one dose of a COVID-19 vaccine rose from less than 14 per cent on April 1 to 69 per cent on July 7.

People in masks are vaccinated by health-care workers in protective gear inside a tent
A pop-up vaccine clinic in a Toronto hotspot neighbourhood in April 2021. THE CANADIAN PRESS/Cole Burston

The Ontario government also carried out policies aimed at a more equitable distribution of vaccines, including allocating half of all new doses to Ontario’s COVID-19 hot spots for two weeks in early May.

A recent poll in the United States also showed that vaccine hesitancy has diminished the most among racial minorities, and there are only small differences in vaccine hesitancy by race. Similarly, vaccine hesitancy decreased significantly among racial minorities in Toronto.

These developments may have increased vaccination rates in at-risk neighbourhoods and reduced disparities in vaccination rates across communities with varying COVID-19 risks. But was this the case? Did efforts aimed at more equitable distribution of the vaccine help reduce inequalities in COVID-19 rates across communities?

Our team addressed these questions by comparing the vaccination uptake of neighbourhoods in Toronto with low, moderate and high COVID-19 levels between mid-April and mid-June 2021. Our research, which is currently undergoing peer review, also examined whether inequalities in COVID-19 rates diminished during this time.

Vaccination rates grew more equal over time

In April, neighbourhoods with a higher COVID-19 risk had lower vaccination rates than those with a lower COVID-19 risk. The average difference in COVID-19 vaccination rates was 4.4 percentage points between neighbourhoods with low and moderate COVID-19 risks, and 5.8 percentage points between neighbourhoods with low and high COVID-19 risks.

Line graph showing cumulative percentage of adults with at least one COVID-19 dose.
Vaccination rates increased faster in neighbourhoods with higher COVID-19 risks. (Choi/Denice), Author provided

Vaccination rates, however, grew faster in neighbourhoods with higher COVID-19 risks. By June, the average difference in vaccination rates between neighbourhoods with low and moderate COVID-19 risks was one percentage point. The corresponding difference between neighbourhoods with low and high risks of COVID-19 was 1.7 percentage points.

These findings suggest that Ontario’s policies aimed at improving vaccine equity have been effective at increasing vaccination rates in neighbourhoods hit hard by the COVID-19 pandemic.

Persistent disparities in COVID-19 rates

COVID-19 infections spread more slowly in neighbourhoods where vaccination rates increased quickly. Yet, COVID-19 infections continued to spread more in at-risk neighbourhoods even though vaccine rates grew faster in these communities. For example, between April and June 2021, for every 100,000 residents, neighbourhoods with a high COVID-19 risk had 421 more COVID-19 cases than low-risk neighbourhoods.

Line graph showing COVID-19 infection rates in different neighbourhoods
COVID-19 infections continued to spread more in at-risk neighbourhoods although vaccine rates grew faster in these communities. (Choi/Denice), Author provided

The faster spread of COVID-19 in at-risk neighbourhoods is largely attributable to the social, economic and demographic composition of these areas. Essential workers, some racial minority groups and immigrants continue to have greater exposure to the COVID-19 virus.

The overall implication is that vaccination rates in at-risk communities did not rise fast enough to counteract their higher risk of infection. This higher risk emerges from structural disadvantages that render residents of at-risk neighborhoods more vulnerable to COVID-19 infections. Our earlier research, which is also undergoing peer review, identified some of these factors as overcrowded housing and need to travel — often via public transit — for necessities like food and health care.

Our results also reveal that immigrant neighbourhoods have been left behind in Toronto’s vaccination roll-out. Not only did they have lower vaccine rates in April, but rates in these neighbourhoods also increased at a much slower pace. Lower vaccination rates and greater exposure to the COVID-19 virus may be the reason why COVID-19 spread faster in immigrant neighbourhoods.

Implications for the vaccination roll-out

In Toronto, the average vaccination rates across neighbourhoods with varying COVID-19 risks are nearly equal. In the absence of herd immunity, having the same vaccination rate in populations with different degrees of exposure to the virus will not result in the same infection rate. Under such circumstances, COVID-19 will continue to spread faster in at-risk neighbourhoods.

With the emergence of COVID-19 variants, whether or not Canada will ever achieve herd immunity is unclear. Therefore, reducing disparities in COVID-19 infections may require greater allocation of vaccine dosages and higher vaccination rates among groups at greater risk.

Greater efforts should also be made to understand and reduce the barriers to vaccine access among immigrant communities, including travel time and language barriers. Addressing these factors may hold the key for Toronto to reduce inequalities in COVID-19 rates.

Finally, vaccines should not be viewed as a silver bullet that can end the pandemic. Equitable distribution of vaccines should occur in tandem with other safety measures to slow the spread of COVID-19. Such multifaceted strategies are our best weapon against variants and our best chance at defeating the pandemic.

Do you have a question about COVID-19 vaccines? Email us at ca‑vaccination@theconversation.com and vaccine experts will answer questions in upcoming articles.

Kate Choi receives funding from the Social Sciences and Humanities Research Council (SSHRC)

Patrick Denice has received funding from the Social Sciences and Humanities Research Council (SSHRC) and the National Science Foundation (NSF).

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Angry Shouting Aside, Here’s What Biden Is Running On

Angry Shouting Aside, Here’s What Biden Is Running On

Last night, Joe Biden gave an extremely dark, threatening, angry State of the Union…

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3 hours ago

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March 8, 2024

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Angry Shouting Aside, Here's What Biden Is Running On

Last night, Joe Biden gave an extremely dark, threatening, angry State of the Union address - in which he insisted that the American economy is doing better than ever, blamed inflation on 'corporate greed,' and warned that Donald Trump poses an existential threat to the republic.

But in between the angry rhetoric, he also laid out his 2024 election platform - for which additional details will be released on March 11, when the White House sends its proposed budget to Congress.

To that end, Goldman Sachs' Alec Phillips and Tim Krupa have summarized the key points:

Taxes

While railing against billionaires (nothing new there), Biden repeated the claim that anyone making under $400,000 per year won't see an increase in their taxes.  He also proposed a 21% corporate minimum tax, up from 15% on book income outlined in the Inflation Reduction Act (IRA), as well as raising the corporate tax rate from 21% to 28% (which would promptly be passed along to consumers in the form of more inflation). Goldman notes that "Congress is unlikely to consider any of these proposals this year, they would only come into play in a second Biden term, if Democrats also won House and Senate majorities."

Biden also called on Congress to restore the pandemic-era child tax credit.

Immigration

Instead of simply passing a slew of border security Executive Orders like the Trump ones he shredded on day one, Biden repeated the lie that Congress 'needs to act' before he can (translation: send money to Ukraine or the US border will continue to be a sieve).

As immigration comes into even greater focus heading into the election, we continue to expect the Administration to tighten policy (e.g., immigration has surged 20pp the last 7 months to first place with 28% in Gallup’s “most important problem” survey). As such, we estimate the foreign-born contribution to monthly labor force growth will moderate from 110k/month in 2023 to around 70-90k/month in 2024. -GS

Ukraine

Biden, with House Speaker Mike Johnson doing his best impression of a bobble-head, urged Congress to pass additional assistance for Ukraine based entirely on the premise that Russia 'won't stop' there (and would what, trigger article 5 and WW3 no matter what?), despite the fact that Putin explicitly told Tucker Carlson he has no further ambitions, and in fact seeks a settlement.

As Goldman estimates, "While there is still a clear chance that such a deal could come together, for now there is no clear path forward for Ukraine aid in Congress."

China

Biden, forgetting about all the aggressive tariffs, suggested that Trump had been soft on China, and that he will stand up "against China's unfair economic practices" and "for peace and stability across the Taiwan Strait."

Healthcare

Lastly, Biden proposed to expand drug price negotiations to 50 additional drugs each year (an increase from 20 outlined in the IRA), which Goldman said would likely require bipartisan support "even if Democrats controlled Congress and the White House," as such policies would likely be ineligible for the budget "reconciliation" process which has been used in previous years to pass the IRA and other major fiscal party when Congressional margins are just too thin.

So there you have it. With no actual accomplishments to speak of, Biden can only attack Trump, lie, and make empty promises.

Tyler Durden Fri, 03/08/2024 - 18:00

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United Airlines adds new flights to faraway destinations

The airline said that it has been working hard to "find hidden gem destinations."

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11 hours ago

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March 8, 2024

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Since countries started opening up after the pandemic in 2021 and 2022, airlines have been seeing demand soar not just for major global cities and popular routes but also for farther-away destinations.

Numerous reports, including a recent TripAdvisor survey of trending destinations, showed that there has been a rise in U.S. traveler interest in Asian countries such as Japan, South Korea and Vietnam as well as growing tourism traction in off-the-beaten-path European countries such as Slovenia, Estonia and Montenegro.

Related: 'No more flying for you': Travel agency sounds alarm over risk of 'carbon passports'

As a result, airlines have been looking at their networks to include more faraway destinations as well as smaller cities that are growing increasingly popular with tourists and may not be served by their competitors.

The Philippines has been popular among tourists in recent years.

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United brings back more routes, says it is committed to 'finding hidden gems'

This week, United Airlines  (UAL)  announced that it will be launching a new route from Newark Liberty International Airport (EWR) to Morocco's Marrakesh. While it is only the country's fourth-largest city, Marrakesh is a particularly popular place for tourists to seek out the sights and experiences that many associate with the country — colorful souks, gardens with ornate architecture and mosques from the Moorish period.

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"We have consistently been ahead of the curve in finding hidden gem destinations for our customers to explore and remain committed to providing the most unique slate of travel options for their adventures abroad," United's SVP of Global Network Planning Patrick Quayle, said in a press statement.

The new route will launch on Oct. 24 and take place three times a week on a Boeing 767-300ER  (BA)  plane that is equipped with 46 Polaris business class and 22 Premium Plus seats. The plane choice was a way to reach a luxury customer customer looking to start their holiday in Marrakesh in the plane.

Along with the new Morocco route, United is also launching a flight between Houston (IAH) and Colombia's Medellín on Oct. 27 as well as a route between Tokyo and Cebu in the Philippines on July 31 — the latter is known as a "fifth freedom" flight in which the airline flies to the larger hub from the mainland U.S. and then goes on to smaller Asian city popular with tourists after some travelers get off (and others get on) in Tokyo.

United's network expansion includes new 'fifth freedom' flight

In the fall of 2023, United became the first U.S. airline to fly to the Philippines with a new Manila-San Francisco flight. It has expanded its service to Asia from different U.S. cities earlier last year. Cebu has been on its radar amid growing tourist interest in the region known for marine parks, rainforests and Spanish-style architecture.

With the summer coming up, United also announced that it plans to run its current flights to Hong Kong, Seoul, and Portugal's Porto more frequently at different points of the week and reach four weekly flights between Los Angeles and Shanghai by August 29.

"This is your normal, exciting network planning team back in action," Quayle told travel website The Points Guy of the airline's plans for the new routes.

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Walmart launches clever answer to Target’s new membership program

The retail superstore is adding a new feature to its Walmart+ plan — and customers will be happy.

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11 hours ago

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March 8, 2024

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It's just been a few days since Target  (TGT)  launched its new Target Circle 360 paid membership plan. 

The plan offers free and fast shipping on many products to customers, initially for $49 a year and then $99 after the initial promotional signup period. It promises to be a success, since many Target customers are loyal to the brand and will go out of their way to shop at one instead of at its two larger peers, Walmart and Amazon.

Related: Walmart makes a major price cut that will delight customers

And stop us if this sounds familiar: Target will rely on its more than 2,000 stores to act as fulfillment hubs. 

This model is a proven winner; Walmart also uses its more than 4,600 stores as fulfillment and shipping locations to get orders to customers as soon as possible.

Sometimes, this means shipping goods from the nearest warehouse. But if a desired product is in-store and closer to a customer, it reduces miles on the road and delivery time. It's a kind of logistical magic that makes any efficiency lover's (or retail nerd's) heart go pitter patter. 

Walmart rolls out answer to Target's new membership tier

Walmart has certainly had more time than Target to develop and work out the kinks in Walmart+. It first launched the paid membership in 2020 during the height of the pandemic, when many shoppers sheltered at home but still required many staples they might ordinarily pick up at a Walmart, like cleaning supplies, personal-care products, pantry goods and, of course, toilet paper. 

It also undercut Amazon  (AMZN)  Prime, which costs customers $139 a year for free and fast shipping (plus several other benefits including access to its streaming service, Amazon Prime Video). 

Walmart+ costs $98 a year, which also gets you free and speedy delivery, plus access to a Paramount+ streaming subscription, fuel savings, and more. 

An employee at a Merida, Mexico, Walmart. (Photo by Jeffrey Greenberg/Universal Images Group via Getty Images)

Jeff Greenberg/Getty Images

If that's not enough to tempt you, however, Walmart+ just added a new benefit to its membership program, ostensibly to compete directly with something Target now has: ultrafast delivery. 

Target Circle 360 particularly attracts customers with free same-day delivery for select orders over $35 and as little as one-hour delivery on select items. Target executes this through its Shipt subsidiary.

We've seen this lightning-fast delivery speed only in snippets from Amazon, the king of delivery efficiency. Who better to take on Target, though, than Walmart, which is using a similar store-as-fulfillment-center model? 

"Walmart is stepping up to save our customers even more time with our latest delivery offering: Express On-Demand Early Morning Delivery," Walmart said in a statement, just a day after Target Circle 360 launched. "Starting at 6 a.m., earlier than ever before, customers can enjoy the convenience of On-Demand delivery."

Walmart  (WMT)  clearly sees consumers' desire for near-instant delivery, which obviously saves time and trips to the store. Rather than waiting a day for your order to show up, it might be on your doorstep when you wake up. 

Consumers also tend to spend more money when they shop online, and they remain stickier as paying annual members. So, to a growing number of retail giants, almost instant gratification like this seems like something worth striving for.

Related: Veteran fund manager picks favorite stocks for 2024

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