Contributor: It’s the Zip Code, Not the Genetic Code—The Need for an Equitable Vaccination Strategy

There is an urgent need to accelerate vaccination distribution for vulnerable Americans by overcoming problems involving social determinants of health.

The coronavirus disease 2019 (COVID-19) vaccination supply chain has so far rightfully focused on health care workers and the elderly, but there is not a strategy to reach underserved and marginalized populations representing the highest risk for mortality. COVID-19 exposed the lack of health equity that has existed for decades. While the world has grappled with responding to the pandemic, the evidence shows that the most vulnerable Americans are those with significant social determinants of health (SDOH) issues. These populations most disproportionately affected by SDOH include ethnic minorities with low socioeconomic status. These 5 key determinants include economic stability, education, social and community context, health and health care, neighborhood, and built environment. SDOH issues constitute 70% of health care outcomes, revealing that it’s not the genetic code, it’s the zip code.

Beyond the health equity issues and morality, the pandemic’s economic cost includes enormous financial burden in hospital care costs ranging from $51,000 to $78,000 per admission, based on age. With hundreds of thousands of deaths in 2020, the CDC estimates 4.1 million hospitalizations, which would represent more than $200 billion dollars.

There is an urgent need to accelerate vaccination distribution for vulnerable Americans by overcoming SDOH problems. Americans residing in certain urban and rural regions are often ill-equipped to navigate the health care system complexities or have no local access to care. COVID-19 has magnified this issue with respectively higher hospitalization rates and now lack of accessible vaccination. How can tens of millions of our most vulnerable be reached and supported to ensure health equity is achieved to improve the direst outcomes in the nation? An innovative combination of available technology, timely data, local social services, and outbound telehealth could rapidly overcome these issues. Further, an emphasis on addressing SDOH is critical, which includes health literacy regarding the importance of the vaccination. For example, in North Carolina, Black Americans represent 22% of the state’s population and 26% of the health care workforce but only 11% of the vaccine recipients so far. White Americans, a category that North Carolina classifies as Hispanic and non-Hispanic Whites, represent 68% of the population and 82% of those who are vaccinated. The CDC data show that Black, Hispanic, and Native American Americans are dying from COVID-19 at nearly 3 times the rate of White Americans.

How can the government and private organizations accelerate vaccinations for high-risk, vulnerable individuals? By converging together, public-private partnerships can rapidly increase vaccination distribution by prioritizing the underserved, engaging these marginalized populations through intelligent telehealth, and resolving SDOH issues.


Governments and private health plans have timely, accessible health care claims and demographic data that can be used to create analytics to prioritize higher risk, underserved individuals. Are the individual’s chronic conditions placing them at higher risk for COVID-19 hospitalization? What is the individual’s medication adherence rates for these conditions? Where does the individual live?


Utilization of telehealth is up by an incredible year-over-year increase of 3000%, yet the capabilities are largely inbound health calls lacking analytics or training to overcome SDOH issues. Telehealth clinicians can be trained in COVID-19 vaccination prescreening, health literacy education, and social services. With all the odds stacked against them, high-risk Americans need support to get vaccinated. Many of these vulnerable Americans have other life priorities that require additional support to overcome barriers to care that deprioritize vaccinations until addressed. What many people take for granted are unsurmountable problems that will get in the way of scheduling and traveling to a vaccination appointment.


Telehealth clinicians need training and access to transportation services that meet the individual’s needs (eg, rideshare, paratransport, companion) to ensure vaccination can safely occur. Other SDOH issues such as medication adherence, access to a physician, or food insecurities are more urgent issues than a preventive vaccination. A well-trained clinician with intelligent clinical workflow technology and access to social services can address SDOH issues in real time.

It is morally ethical and fiscally responsible to vaccinate the most vulnerable. The solution needs to be a combination of public-private partnership to pivot our nation from a dark period in history. With the supply of vaccinations more readily available over the next few months, all adult Americans can be vaccinated in the first half of 2021. However, by focusing on the SDOH as a central issue for COVID-19 vaccination, the highest-risk and marginalized populations would overcome deep-rooted mistrust in the health care system to overcome barriers of care. Vaccinating the most vulnerable populations could be our nation’s catalyst to finally prioritizing health equity issues and improving value-based outcomes.

Author Information

Jason Z. Rose, MHSA, is CEO of AdhereHealth.

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