[Journal of Clinical Epidemiology, 8 August 2023]

Background and Objective: To identify COVID-19 actionable statements (e.g., recommendations) focused on specific disadvantaged populations in the living map of COVID-19 recommendations (eCOVIDRecMap) and describe how health equity was assessed in the development of the formal recommendations.

Methods: We employed the place of residence, race or ethnicity or culture, occupation, gender or sex, religion, education, socio-economic status, and social capital-Plus framework to identify statements focused on specific disadvantaged populations. We assessed health equity considerations in the evidence to decision frameworks (EtD) of formal recommendations for certainty of evidence and impact on health equity criteria according to the Grading of Recommendations, Assessment, Development, and Evaluations criteria.

Results: We identified 16% (124/758) formal recommendations and 24% (186/819) good practice statements (GPS) that were focused on specific disadvantaged populations. Formal recommendations (40%, 50/124) and GPS (25%, 47/186) most frequently focused on children. Seventy-six percent (94/124) of the recommendations were accompanied with EtDs. Over half (55%, 52/94) of those considered indirectness of the evidence for disadvantaged populations. Considerations in impact on health equity criterion most frequently involved implementation of the recommendation for disadvantaged populations (17%, 16/94).

Conclusion: Equity issues were rarely explicitly considered in the development COVID-19 formal recommendations focused on specific disadvantaged populations. Guidance is needed to support the consideration of health equity in guideline development during health emergencies.

[BMJ, 24 July 2023]

Canada had one of the lowest rates of covid-19 cases and deaths per population than most in the G10 group of industrialised countries. But overall rates ignore underlying health inequalities—a consistent feature of the covid-19 pandemic across countries, within and outside the G10. Across every G10 country, for example, economic marginalisation was associated with twofold to fourfold higher rates of covid deaths.

Disproportionate risks of exposures and transmissions are shaped by physical and social networks: how, under what context, and with whom infectious disease contacts take place. The same context that governs these networks often defines what happens after infection occurs: access to and quality of care and treatment within a healthcare system that is built with the same tools as the social and economic system that failed to mitigate disproportionate risks. Yet early in the pandemic, Canada, like most countries, largely applied public health measures universally across its decentralised public health system with little focus on how measures and strategies would, or would not, reach and apply to those most at risk.

[SSRN, 3 September 2021]

Background: After the start of the COVID-19 pandemic and its spread across the world, countries have adopted containment measures to stop its transmission, limit fatalities and relieve hospitals from strain and overwhelming imposed by the virus. Many countries implemented social distancing and lockdown strategies that negatively impacted their economies and the psychological wellbeing of their citizens, even though they contributed to saving lives. Recently approved and available, COVID-19 vaccines can provide a really viable and sustainable option for controlling the pandemic. However, their uptake represents a global challenge, due to vaccine hesitancy logistic-organizational hurdles that have made its distribution stagnant in several developed countries despite several appeal by the media, policy- and decision-makers, and community leaders. Vaccine distribution is a concern also in developing countries, where there is scarcity of doses.

Objective: To set up a metric to assess vaccination uptake and identify national socio-economic factors influencing this indicator.

Methods: We conducted a cross-country study. We first estimated the vaccination uptake rate across countries by fitting a logistic model to reported daily case numbers. Using the uptake rate, we estimated the vaccine roll-out index. Next, we used Random Forest, an “off-the-shelf” machine learning algorithm, to study the association between vaccination uptake rate and socio-economic factors.

Results: We found that the mean vaccine roll-out index is 0.016 (standard deviation 0.016), with a range between 0.0001 (Haiti) and 0.0829 (Mongolia). The top four factors associated with vaccine roll-out index are the median per capita income, human development index, percentage of individuals who have used the internet in the last three months, and health expenditure per capita.

Conclusion: The still ongoing COVID-19 pandemic has shed light on the chronic inequality in global health systems. The disparity in vaccine adoption across low- and high-income countries is a global public health challenge. We must pave the way for a universal access to vaccines and other approved treatments, regardless of demographic structures and underlying health conditions. Income disparity remains, instead, an important cause of vaccine inequity, and the tendency toward "vaccine nationalism" and “vaccine apartheid” restricts the functioning of the global vaccine allocation framework and, thus, the ending of the pandemic. Stronger mechanisms are needed to foster countries' political willingness to promote vaccine and drug access equity in a globalized society, where future pandemics and other global health rises can be anticipated.