Community social vulnerability and access to medications for opioid use disorder within the continental US: A cross-sectional study

The COVID-19 pandemic, like past natural disasters, was associated with significant disruptions in medications for opioid use disorder services and increased opioid overdose and mortality. We examined the association between community vulnerability to disasters and pandemics and geographic access to each of the three medications for opioid use disorder within the continental US and if this association was impacted by urban, suburban, or rural classification. We found communities with greater vulnerability did not have greater geographic access to medications for opioid use disorder and the mismatch between vulnerability and medication access was greatest in suburban communities. Rural communities had poor geographic access to all three medications regardless of vulnerability. Future disaster preparedness planning should include anticipation of access to medications for opioid use disorder and better match the location of services to communities with greater vulnerability to prevent inequities in opioid overdose deaths.

Travel distance to flu and COVID-19 vaccination sites for people with disabilities and age 65 and older, Chicago metropolitan area

PurposeHaving easy access to the flu and COVID-19 vaccination sites may be important for controlling the spread of the infection. Chicago implemented a broad strategy of opening COVID-19 vaccination locations across the city in a variety of locations.Design/methodology/approachWe defined access as having vaccinations within one mile. Data came from the American Community Survey (ACS), Centers for Disease Control and Prevention (CDC), Social Vulnerability Index (SVI), Illinois Department of Public Health (IDPH) and the Chicago Data Portal. We calculated the street-network distance from the population-weighted centroid of census tracts to the nearest vaccination sites before, during and post COVID-19 pandemic. We compared the demographics of census tracts within one mile to those greater than one mile during each period.FindingsPeople age 65 and above and with disabilities saw significant decreases in flu vaccination site access to locations within one mile of their census tract in 2020–2021 compared to 2018–2019. The COVID-19 vaccination sites mimic these flu vaccination site patterns, suggesting a severe lack of geographic access for a group likely to experience limited mobility. Results combining instances of both flu and COVID-19 vaccination sites suggest that making COVID-19 vaccination sites available at flu shot site locations would significantly reduce the number of people with limited mobility lacking geographic access.Originality/valuePolicymakers should explore how this expanded network of vaccination locations could facilitate permanent improvements to access to vaccination sites for people with disabilities.

How geographic access to care shapes disease burden: The current impact of post-exposure prophylaxis and potential for expanded access to prevent human rabies deaths in Madagascar

Background Post-exposure prophylaxis (PEP) is highly effective at preventing human rabies deaths, however access to PEP is limited in many rabies endemic countries. The 2018 decision by Gavi to add human rabies vaccine to its investment portfolio should expand PEP availability and reduce rabies deaths. We explore how geographic access to PEP impacts the rabies burden in Madagascar and the potential benefits of improved provisioning. Methodology & principal findings We use spatially resolved data on numbers of bite patients seeking PEP across Madagascar and estimates of travel times to the closest clinic providing PEP (N = 31) in a Bayesian regression framework to estimate how geographic access predicts reported bite incidence. We find that travel times strongly predict reported bite incidence across the country. Using resulting estimates in an adapted decision tree, we extrapolate rabies deaths and reporting and find that geographic access to PEP shapes burden sub-nationally. We estimate 960 human rabies deaths annually (95% Prediction Intervals (PI): 790–1120), with PEP averting an additional 800 deaths (95% PI: 640–970) each year. Under these assumptions, we find that expanding PEP to one clinic per district (83 additional clinics) could reduce deaths by 19%, but even with all major primary clinics provisioning PEP (1733 additional clinics), we still expect substantial rabies mortality. Our quantitative estimates are most sensitive to assumptions of underlying rabies exposure incidence, but qualitative patterns of the impacts of travel times and expanded PEP access are robust. Conclusions & significance PEP is effective at preventing rabies deaths, and in the absence of strong surveillance, targeting underserved populations may be the most equitable way to provision PEP. Given the potential for countries to use Gavi funding to expand access to PEP in the coming years, this framework could be used as a first step to guide expansion and improve targeting of interventions in similar endemic settings where PEP access is geographically restricted and baseline data on rabies risk is lacking. While better PEP access should save many lives, improved outreach, surveillance, and dog vaccination will be necessary, and if rolled out with Gavi investment, could catalyze progress towards achieving zero rabies deaths.