‘Vaccine Deserts’ Threaten to Prolong COVID-19 Vaccine Rollout and Widen Disparities
Key takeaways:
Where you live may determine how quickly you’re able to receive the COVID-19 vaccine, according to research from GoodRx.
Much of the country lives in an area with low pharmacy density, meaning residents have to share their local pharmacy with more people.
With pharmacies the main site for vaccinations, many low-pharmacy areas could also become vaccine deserts, where the rate of vaccinations is slower.
According to new research from GoodRx, much of the country is at risk of falling behind in line for the COVID-19 vaccine because they live in a “pharmacy desert,” an area defined by limited access to pharmacies. These pharmacy deserts could in turn create “vaccine deserts” — where the rate of vaccination is slower simply because there aren’t enough vaccination appointments available due to limited pharmacy capacity.
Get detailed information on each county here.
The GoodRx Research team set out to identify counties that may be at risk for strained pharmacy capacity and longer wait times for the vaccine, in an effort to highlight areas where additional vaccination sites are needed. We looked at counties with relatively low pharmacy density, defined as the number of local and chain pharmacies in a county per 10,000 people. We then modeled how 100 million vaccines could be distributed across the U.S., based on state population and local pharmacy density.
We found that counties with pharmacy deserts are at risk of becoming vaccination deserts, where fewer people are able to get vaccinated at a time. While 100 million vaccines would fully vaccinate roughly 16% of the currently unvaccinated population in the U.S., nearly half of all counties would have a slower local vaccination rate, generating further healthcare access inequities in areas that are already more likely to be under-resourced in the fight against COVID-19.
The map below calls out vaccine deserts by estimating the percent of residents in each county that would receive the full two-dose vaccine if 100 million vaccinations were made available today.
Get detailed information on each county here.
Pharmacy deserts across the U.S.
In total, 56,802 local and chain pharmacies are spread throughout the United States, and on average, there are 1.83 pharmacies per 10,000 people. But these pharmacies are dispersed unevenly, and many residents reside in “pharmacy deserts,” or areas that lack proper access to a pharmacy.
While there is no set definition of a pharmacy desert, researchers define a pharmacy desert two ways: (1) areas where residents have to drive a long distance to the closest pharmacy, or (2) areas with low pharmacy density per person — in other words, too many people sharing the same one.
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When pharmacy deserts are identified by distance to the closest pharmacy, rural areas top the list and residents are forced to drive longer to access the closest pharmacy. But with most Americans living within 2 miles of a pharmacy, according to GoodRx Research, distance may not be the only issue for COVID-19 vaccine distribution. Even in areas with pharmacies nearby, pharmacy capacity issues can also prolong the vaccination process in many counties.
From a pharmacy density perspective, rural areas, in addition to big cities, can be classified as pharmacy deserts. Los Angeles County, for instance, is home to more than 10 million people. But there are only 1.61 pharmacies per 10,000 residents. That’s below the national average of 1.83 pharmacies per 10,000 residents. Cook County, home to 5.2 million residents, including those living in Chicago, only has 1.50 pharmacies per 10,000 residents. And other populated areas like San Diego County, San Bernardino County, and Jefferson County lack proper access to pharmacies as well.
On the other side of the spectrum, residents in less populated counties also lack adequate pharmacy resources. In fact, 177 counties have zero pharmacies, affecting 635,000 residents who may find themselves driving hundreds of miles to access a vaccine, or foregoing one altogether. In a scenario like this, every county, no matter the population, matters.
In any normal year, living in an area with low pharmacy density could increase wait times, decrease supply, and make it harder to shop around for prescription medications. But this year, as the country eagerly awaits the vaccine, the implications of living in a pharmacy desert are much more dire.
How pharmacy deserts could lead to vaccine deserts
Since November, when Pfizer and Moderna released promising results from their vaccines’ clinical trials, the CDC has called on pharmacies to administer the bulk of the vaccines to the general public. But because of the unequal distribution of pharmacies, many residents living in a pharmacy desert may also be living in a vaccine desert, meaning that they will likely have to wait longer for the vaccine to become available than others.
Just last week, President-elect Joe Biden announced that his administration is aiming to vaccinate 100 million Americans during his first 100 days of office. These first 100 million vaccines will likely be given to priority groups like hospital workers, essential workers, and those 65 years of age or older. This number provides a good framework to identify areas that may need additional resources to adequately vaccinate the general public.
According to our research, providing 100 million vaccines translates to a full (two-dose) national vaccination rate of 15.7%, based on the current unvaccinated population. But because of pharmacy density issues, the vaccine would be distributed unevenly throughout the U.S.
We estimated the percent of residents in each county that would receive the full two-dose vaccine if 100 million vaccinations were made available today. Counties with vaccination rates below the national average of 15.7% make up roughly half of the country and would roll out the vaccine slower than expected. These counties have fewer pharmacies per person and therefore lower vaccination capacity.
In general, 423 counties, home to over 8.3 million people, would only be able to vaccinate up to 10% of their populations, with 177 of those counties unable to vaccinate any of their 635,000 residents.
How specific counties would fare
Not surprisingly, many pharmacy deserts are also vaccine deserts, and again, some big cities are in the red. San Mateo County near San Francisco, which only has 1.06 pharmacies per 10,000 residents, is also at risk of becoming a vaccination desert. Assuming 100 million vaccines are distributed, only 11.2% of its population would receive the full dosage. This is well below the national target vaccination rate of 15.7%, and with such a large population (over 767,000), the risk for continued COVID-19 transmission would remain high for longer. Just across the bay, in Alameda County, California, things are the same: Only 11.7% of the unvaccinated population would be vaccinated if 100 million vaccines were made available.
Other more populated vaccine deserts include Shelby County, Tennessee (11.6% vaccinated), El Paso County, Texas (11.6% vaccinated), Pinal County, Arizona (10.9%), Clayton County, Georgia (8.22% vaccinated), and Ottawa County, Michigan (8.0% vaccinated), among others. In addition to prolonging the vaccine rollout, these vaccination deserts could likely widen disparities, both across and within counties. Areas without proper access to pharmacies are also more likely to lack essential services like healthcare, education, and more.
But it’s not all bad news. Many counties are in the blue. Los Angeles County, despite its relatively low pharmacy density, may fare OK, vaccinating 17.7% of its population for every 100 million doses. Chicago is in the same boat, vaccinating 15.4% of its population for every 100 million doses. While this is below the targeted national vaccination rate of 15.7%, it’s not by much. Additionally, much of the Midwest is in the blue as well, including many counties in Kansas. And two counties, Kiowa County, Colorado and Foard County, Texas, would be able to vaccinate more than 80% of their populations if 100 million doses were made available.
The bottom line: More vaccination sites are necessary
While the vaccine is currently being administered in health centers and nursing homes, the CDC has placed much of the onus on pharmacies to administer the vaccine once it becomes available to the wider public. Most Americans live within 2 miles of a pharmacy. However, they may be sharing that pharmacy with thousands of others eagerly waiting for the vaccine, which could overwhelm pharmacies and ultimately slow vaccine rollout.
So dispensing the COVID-19 vaccine through pharmacies alone is not going to cut it. Additional mass vaccination sites are going to be required, across much of the country, and in many big cities.
Encouragingly, steps are being taken. Los Angeles, which currently only has 1.61 pharmacies for each 10,000 residents, has already taken measures to expand vaccine capabilities. On Monday, officials announced that Dodger Stadium will be switching from a testing facility to a mass vaccination site. California will also be opening mass vaccination sites at Petco Park in San Diego and the CalExpo in Sacramento. New York is also opening mass sites across the state that will operate 24 hours a day according to Governor Andrew Cuomo.
In addition to supporting large cities with mass vaccination sites, infrastructure in more rural and less populated counties needs to be prioritized. With no pharmacies available in many counties, residents have virtually no options to obtain a vaccine, other than to drive. And a mass vaccination site may not make sense with such a low population. As such, vaccine messaging, transportation, or even in-home vaccinations may need to be considered.
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Co-contributors: Sara Kim, MS, Amanda Nguyen, PhD, Jeroen van Meijgaard, PhD
Methodology:
For this research, we considered 56,802 community retail pharmacies. Data was sourced from DataQ and the GoodRx Database. It was read in early January 2020 and excludes retail pharmacies in U.S. territories. The pharmacy counts per county were acquired by matching pharmacy geolocation to census tract boundary shapefiles. To calculate pharmacy density, we used population per county data from 2019 American Community Survey 5-year data.
The estimated number of full vaccinations available in each county is based on 100 million vaccines made available nationally. The number of COVID-19 vaccines available in each county is calculated assuming the initial allocation across states is based on state population share, and vaccines are distributed equally across every community retail pharmacy within a state. The number of vaccines available in each county is based on the number of local and chain retail pharmacies in that county, and the average number of vaccines expected to be distributed to each pharmacy. The number of currently unvaccinated people in each county excludes those who received the first vaccine dose as of January 8, 2021. The share of currently unvaccinated people that will have both vaccine doses available is calculated as the number of full (2-shot) vaccinations available in a given county, divided by the population in that county.
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