# Using Disadvantage Indices to Address Structural Racism and Discrimination in Pandemic Vaccine Allocation and Beyond: Defining the Shape of a Novel Paradigm to Promote Health Equity

> **NIH NIH R01** · UNIVERSITY OF PENNSYLVANIA · 2022 · $721,177

## Abstract

Covid-19 exposed inequitable healthcare access and disparate health outcomes of people of color, that are
due to structural racism and discrimination (SRD)—but in an unprecedented turn, policymakers also deployed
a major novel tool to address SRD within, and likely outside of the pandemic. Rapidly and widely adopting a
proposal by the National Academies of Science, Engineering and Medicine's (NASEM), a majority of US states
(n=34) addressed SRD by including disadvantage indices (DIs) in vaccine allocation plans. DIs are place-
based statistical measures of deprivation or vulnerability that integrate Census data such as income, education
or quality of housing, to rank geographic areas as small as neighborhoods. Because one of the consequences
of SRD is that people of color face reduced economic and housing opportunities and account for larger shares
of disadvantaged communities, DIs simultaneously capture SRD impact, and offer tools for mitigation. For
example, under severe scarcity, DIs were used to increase vaccine shares for disadvantaged areas, and, by
extension, more people of color. DIs hence mitigated the risk that traditional allocation frameworks result in
SRD, even if unintended. Still, the rapid adoption and wide rangeof uses leave unclear what the optimal uses
of DIs are within and outside of health emergencies. Our goal is to determine the strengths and weaknesses of
DIs in addressing SRD in Covid-19, future pandemics, public health and clinical care.
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a highly interdisciplinary team collaborating with a community advisory board, we propose an observational
 tudy with 2 aims. First, we will identify the impact, strengths, and weaknesses of using
in Covid-19 vaccine allocation to address SRD and improve healthcare access and outcomes of
communities of color : We will evaluate t he impact of the 3 most frequently used DIs
a newly launched CDC/HHS index (the Minority Health Social Vulnerability Index ) on Covid-19
hospitalizations, deaths and vaccination rates by race and ethnicity, using predictive modeling and
analyses of states' actual vaccine-roll-out. We will also conduct ualitative interviews
facilitators and barriers of DIs with vaccine allocation and health equity leaders in the 32 CDC jurisdictions
the largest shares of disadvantaged communities. Second, we wil identify the possible strengths and
of using DIs in public health and clinical care outside of emergency settings to address
and improve healthcare access and outcomes of disadvantaged communities of color: We will use
Delphi method to identify how health department equity taskforce leaders, and equity leaders in the largest
systems in the same 32 CDC jurisdictions, rank concrete uses of DIs, identified from the literature. We
complement expert views with two innovative nationally representative survey-experiments, and engaging
communiti...

## Key facts

- **NIH application ID:** 10474777
- **Project number:** 1R01AI170137-01
- **Recipient organization:** UNIVERSITY OF PENNSYLVANIA
- **Principal Investigator:** Thomas Harald Schmidt
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2022
- **Award amount:** $721,177
- **Award type:** 1
- **Project period:** 2022-07-01 → 2027-06-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10474777

## Citation

> US National Institutes of Health, RePORTER application 10474777, Using Disadvantage Indices to Address Structural Racism and Discrimination in Pandemic Vaccine Allocation and Beyond: Defining the Shape of a Novel Paradigm to Promote Health Equity (1R01AI170137-01). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10474777. Licensed CC0.

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