Could Partnerships with Places of Worship Improve COVID-19 Vaccine Access in the US?

INTRODUCTION

Continued vaccination efforts in the United States (US) remain critical to curbing the spread of COVID-19. Furthermore, increasing access to vaccination in trusted community sites, such as primary care offices, has been proposed as a crucial way to reach the most vulnerable unvaccinated people.[1] However, not everyone has access to primary care and other healthcare facilities. Places of worship are often trusted places in a community and have long partnered with the healthcare system to engage local communities’ health needs.[2] Prior research has found that local partnerships between academic medical centers and religious sites have been valuable for public health messaging and vaccine delivery during COVID-19.[3] These partnerships have also shown promise in relieving disparities in vaccine delivery.[4] Yet, to our knowledge no studies have analyzed, nationally, the scale of the potential opportunity to improve vaccine access by using places of worship as vaccination sites. Thus, we sought to determine the frequency of places of worship versus medical sites within vaccine deserts, how this varied by region and urban/rural status, and the demographics of counties surrounding each type of site using national, publicly available datasets.

METHODS

We used Google’s COVID-19 Vaccination Access dataset, powered by Google Maps Directions API, which identified “vaccine deserts” as areas within which a known vaccination site could not be reached within a 15-min drive.[5] All currently known vaccination sites were identified by VaccineFinder, a web-based tool containing all known vaccine providers, and Google data. Potential new vaccination sites were identified by various open-source data sets according to their type and compiled by the Vaccine Equity Planner.[6] We accessed the data through the Vaccine Equity Planner on August 27th, 2021. To assess urban/rural differences, we used rural-urban commuting area codes (RUCA) from the U.S. Department of Agriculture. Sites were assigned a RUCA code according to county, with RUCA codes 1.0-3.9 classified as metropolitan, 4.0-6.0 as micropolitan, and 7.0-10.6 as rural/small town. Region determination was made by state according to US Census Bureau classification. Demographics were determined by 2010 population data, by county. A map containing national raw site location data (Fig. 1A) and a bivariate map with aggregation to the county level (Fig. 1B) were created using ArcGIS Pro version 2.8.2 (Esri). A two-sided χ2 test to compare differences in proportions was performed in GraphPad Prism 9.0.0 (GraphPad Software) after aggregation in ArcGIS. P<.05 was considered statistically significant.

Fig. 1

Geospatial distribution of places of worship and medical sites within vaccine deserts in the US. A Map showing raw site location for each potential new vaccination site analyzed. All sites mapped here are located inside a vaccine desert. Included categories of sites are places of worship and healthcare sites (FQHCs, pharmacies, urgent cares, and primary care offices). B Bivariate choropleth map showing concentration of places of worship within vaccine deserts compared to healthcare sites within vaccine deserts. Displayed are site counts aggregated to the county level and normalized by 2010 population.

FINDINGS

Among the 15,255 total sites (medical and places of worship) analyzed within all vaccine deserts nationally, 12,548 (82.3%) were places of worship (Table 1). The ratio of places of worship to medical sites within vaccine deserts nationally was 4.64:1. This measure varied regionally, with the Midwest (5.75:1) slightly higher than the South (5.38:1, P=.2086), but significantly higher than in the Northeast (2.98:1, P<.001) and West (3.29:1, P<.001). Urban/rural analysis showed that the ratio of places of worship to all medical sites within vaccine deserts was highest in metropolitan (5.48:1) and micropolitan (5.25:1, P=.4528) areas as compared to small town/rural areas (3.77:1, P<.001). Demographic analysis showed that the population of the counties surrounding places of worship was more Hispanic (25.9%) and less White (69.8%), than the population of the counties surrounding medical sites (20.5% Hispanic, 73.3% White).

Table 1

Frequency and Ratio of Places of Worship and Medical Sites According to Region and Urban/Rural Status, with Additional Demographics. Except Where Otherwise Noted, Data Are Presented as No. (%). All Sites Are Located Within Vaccination Deserts and Not Currently Being Utilized as Vaccination Sites

	Pharmacies	Primary care sites	FQHCs	Urgent cares	Total medical sites	Total places of worship	Ratio places of worship: medical sitesa
National	879 (5.8)	981 (6.4)	793 (5.2)	54 (0.35)	2707 (17.7)	12548 (82.3)	4.64
Regional
Northeast	68 (6.7)	110 (10.9)	75 (7.4)	1 (0.1)	254 (25.1)	756 (74.9)	2.98
Midwest	340 (6.4)	321 (6.0)	115 (2.2)	10 (0.2)	786 (14.8)	4523 (85.2)	5.75
South	311 (5.7)	270 (5.0)	260 (4.78)	14 (0.3)	855 (15.7)	4599 (84.3)	5.38
West	160 (4.6)	280 (8.0)	343 (9.9)	29 (0.8)	812 (23.3)	2670 (76.7)	3.29
Urban/rural
Metropolitan (population >50,000)	224 (4.6)	299 (6.2)	217 (4.5)	10 (0.21)	750 (15.4)	4107 (84.6)	5.48
Micropolitan (smaller cities between 10,000 and 50,000 population)	262 (5.3)	310 (6.3)	193 (3.9)	27 (0.5)	792 (16.0)	4160 (84.0)	5.25
Small town/rural (less than 10,000 population)	382 (7.3)	347 (6.6)	350 (6.7)	17 (0.3)	1096 (21.0)	4134 (79.0)	3.77
Demographicb
%Black	8.3	6.3	7.5	9.6	7.1	7.9	NA
%Hispanic	14.6	22.0	22.7	19.3	20.5	25.9	NA
%Non-Hispanic White	78.9	71.6	72.1	69.8	73.3	69.8	NA
%Age >65	14.5	13.4	13.3	12.9	13.6	12.8	NA

aRatio of places of worship to all medical sites within vaccine deserts is also shown for relative comparison.

bDescriptive demographic variables are presented as the percentage of the demographic group in the total population of the counties surrounding each type of site. Since the population counts overlap, ratios and statistical significance of differences cannot be determined.

DISCUSSION

These results demonstrate significant numbers of places of worship in vaccine deserts in the US, suggesting the potential for partnerships with places of worship to improve both primary series and booster vaccine access for vulnerable unvaccinated people. Since there is a lack of quantitative data regarding how many religious sites are currently utilized for vaccination and vaccination levels based on the presence of such partnerships, further research might include survey studies to assess these questions. We are aware that a limitation of our study is that places of worship were not individually evaluated for suitability for vaccine delivery, and some may not have the necessary capacity, community influence, or resources. Different faith traditions and denominations may also be variably amenable to collaboration in vaccination delivery. Further studies will also clarify the characteristics associated with successful utilization of places of worship for vaccination sites. Despite these limitations, the demonstration of high ratios of houses of worship to health care facilities in vaccine deserts suggests a foundation for future efforts to improve vaccine delivery.