The Institute for Global Health and Development
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Item P-2068. Assessing New York City’s COVID-19 Vaccine Rollout Strategy: A Case for Risk-Informed Distribution [Poster](Oxford University Press, 2025-01-29) Schwalbe, Nina; Nunes, Marta C; Cutland, Clare; Wahl, Brian; Reidpath, DanielBackground: This study reviews the impact of eligibility policies in the early rollout of the COVID-19 vaccine on coverage and probable outcomes, with a focus on New York City (NYC). Methods: A retrospective ecological study was conducted assessing age 65+, area-level income, vaccination coverage, and COVID-19 mortality rates, using linked Census Bureau data and NYC Health administrative data aggregated at the level of modified zip code tabulation areas (MODZCTA). The population for this study was all individuals in 177 MODZCTA in NYC. Population data were obtained from Census Bureau and NYC Health administrative data. The total mortality rate was examined through an ordinary least squares (OLS) regression model, using area-level wealth, the proportion of the population aged 65 and above, and the vaccination rate among this age group as predictors. Results: Low-income areas with high proportions of older people demonstrated lower coverage rates (mean vaccination rate 52.8%; maximum coverage 67.9%) than wealthier areas (mean vaccination rate 74.6%; maximum coverage 99% in the wealthiest quintile) in the first 3 months of vaccine rollout and higher mortality over the year. Despite vaccine shortages, many younger people accessed vaccines ahead of schedule, particularly in high-income areas (mean coverage rate 60% among those 45–64 years in the wealthiest quintile). Conclusion: A vaccine program that prioritized those at greatest risk of COVID-19-associated morbidity and mortality would have prevented more deaths than the strategy that was implemented. When rolling out a new vaccine, policymakers must account for local contexts and conditions of high-risk population groups. If New York had focused limited vaccine supply on low-income areas with high proportions of residents 65 or older, overall mortality might have been lower. Disclosures: All Authors: No reported disclosuresItem Assessing New York City's COVID-19 Vaccine Rollout Strategy: A Case for Risk-Informed Distribution.(2024-04-05) Schwalbe, Nina; Nunes, Marta C; Cutland, Clare; Wahl, Brian; Reidpath, DanielThis study reviews the impact of eligibility policies in the early rollout of the COVID-19 vaccine on coverage and probable outcomes, with a focus on New York City. We conducted a retrospective ecological study assessing age 65+, area-level income, vaccination coverage, and COVID-19 mortality rates, using linked Census Bureau data and New York City Health administrative data aggregated at the level of modified zip code tabulation areas (MODZCTA). The population for this study was all individuals in 177 MODZCTA in New York City. Population data were obtained from Census Bureau and New York City Health administrative data. The total mortality rate was examined through an ordinary least squares (OLS) regression model, using area-level wealth, the proportion of the population aged 65 and above, and the vaccination rate among this age group as predictors. Low-income areas with high proportions of older people demonstrated lower coverage rates (mean vaccination rate 52.8%; maximum coverage 67.9%) than wealthier areas (mean vaccination rate 74.6%; maximum coverage 99% in the wealthiest quintile) in the first 3 months of vaccine rollout and higher mortality over the year. Despite vaccine shortages, many younger people accessed vaccines ahead of schedule, particularly in high-income areas (mean coverage rate 60% among those 45-64 years in the wealthiest quintile). A vaccine program that prioritized those at greatest risk of COVID-19-associated morbidity and mortality would have prevented more deaths than the strategy that was implemented. When rolling out a new vaccine, policymakers must account for local contexts and conditions of high-risk population groups. If New York had focused limited vaccine supply on low-income areas with high proportions of residents 65 or older, overall mortality might have been lower. [Abstract copyright: © 2024. The Author(s).]Item External validation of the RISC, RISC-Malawi, and PERCH clinical prediction rules to identify risk of death in children hospitalized with pneumonia(International Society of Global Health, 2021-10-09) Rees, Chris A.; Hooli, Shubhada; King, Carina; McCollum, Eric D.; Colbourn, Tim; Lufesi, Norman; Mwansambo, Charles; Lazzerini, Marzia; Madhi, Shabir Ahmed; Cutland, Clare; Nunes, Marta; Gessner, Bradford D.; Basnet, Sudha; Kartasasmita, Cissy B.; Mathew, Joseph L.; Zaman, Syed Mohammad Akram uz; Paranhos-Baccala, Glaucia; Bhatnagar, Shinjini; Wadhwa, Nitya; Lodha, Rakesh; Aneja, Satinder; Santosham, Mathuram; Picot, Valentina S.; Sylla, Mariam; Awasthi, Shally; Bavdekar, Ashish; Pape, Jean-William; Rouzier, Vanessa; Chou, Monidarin; Rakoto-Andrianarivelo, Mala; Wang, Jianwei; Nymadawa, Pagbajabyn; Vanhems, Philippe; Russomando, Graciela; Asghar, Rai; Banajeh, Salem; Iqbal, Imran; MacLeod, William; Maulen-Radovan, Irene; Mino, Greta; Saha, Samir; Singhi, Sunit; Thea, Donald M.; Clara, Alexey W.; Campbell, Harry.; Nair, Harish; Falconer, Jennifer; Williams, Linda J.; Horne, Margaret; Strand, Tor; Qazi, Shamim A.; Nisar, Yasir B.; Neuman, Mark I.Background Existing scores to identify children at risk of hospitalized pneumonia-related mortality lack broad external validation. Our objective was to externally validate three such risk scores. Methods We applied the Respiratory Index of Severity in Children (RISC) for HIV-negative children, the RISC-Malawi, and the Pneumonia Etiology Research for Child Health (PERCH) scores to hospitalized children in the Pneumonia REsearch Partnerships to Assess WHO REcommendations (PREPARE) data set. The PREPARE data set includes pooled data from 41 studies on pediatric pneumonia from across the world. We calculated test characteristics and the area under the curve (AUC) for each of these clinical prediction rules. Results The RISC score for HIV-negative children was applied to 3574 children 0-24 months and demonstrated poor discriminatory ability (AUC = 0.66, 95% confidence interval (CI) = 0.58-0.73) in the identification of children at risk of hospitalized pneumonia-related mortality. The RISC-Malawi score had fair discriminatory value (AUC = 0.75, 95% CI = 0.74-0.77) among 17 864 children 2-59 months. The PERCH score was applied to 732 children 1-59 months and also demonstrated poor discriminatory value (AUC = 0.55, 95% CI = 0.37-0.73). Conclusions In a large external application of the RISC, RISC-Malawi, and PERCH scores, a substantial number of children were misclassified for their risk of hospitalized pneumonia-related mortality. Although pneumonia risk scores have performed well among the cohorts in which they were derived, their performance diminished when externally applied. A generalizable risk assessment tool with higher sensitivity and specificity to identify children at risk of hospitalized pneumonia-related mortality may be needed. Such a generalizable risk assessment tool would need context-specific validation prior to implementation in that setting.