In Minnesota, vaccine campaign puts new spotlight on an old metric

Seeking to improve vaccine disparities, health officials are sending at least 40% of the state's doses to areas with high "Social Vulnerability Scores."

A COVID-19 vaccination is prepared to be administered. (Forum News Service file photo)
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ST. PAUL — For the next three weeks, the supply lines for some of Minnesota's COVID-19 vaccines will be drawn according to a measure of risk more commonly associated with tornadoes and floods.

Health officials aim to send at least 40% of the state's doses to areas that rank high on what's called the "Social Vulnerability Index" in that time. Their plan is unfolding against the backdrop of a nationwide push to make the vaccine more accessible to non-white communities and impoverished neighborhoods.

Minnesota's racial disparity in inoculations came into clearer focus Wednesday, April 5, when the state reported that 2 million residents had been fully vaccinated for COVID-19, the disease caused by the novel coronavirus, nearly 89% of them white.

"This isn't going to solve the gaps," Minnesota Medicaid Director Dr. Nathan Chomilo said in a recent interview, "but I think it is a really great first step."

Developed by the U.S. Department of Health and Human Services in 2011, the Social Vulnerability Index, or SVI, is based off census data and used to gauge the level of support that a given area will need in the event of a natural disaster or public health emergency. Generally speaking, places with high SVI scores tend to be poorer, lack transportation options and to be made up mostly of people of color.


Nationally, research from earlier in the coronavirus pandemic showed that high-scoring areas also faced higher rates of COVID-19 infections, according to Chomilo. That means the index can be used not only to predict risk but to identify burden.

Chomilo, who also serves as the State Department of Health's vaccine equity director, said the census tracts comprising Minnesota's top quartile of SVI scores are home to approximately 29% of Minnesotans yet have been the source of "39% of hospitalizations and deaths due to COVID-19."

The selection of the SVI is in line with guidance from federal health authorities and medical groups who have advocated for the use of what Chomilo called "place-based indices" in vaccine allocation strategies. Minnesota chose it partly because of its precedence of us, he said.

J.P. Leider, of the University of Minnesota, said for example that the distribution of monoclonal antibodies, which can be administered to COVID-19 patients to augment their immune systems, is informed in Minnesota by the SVI.

"These kinds of social deprivation measures are a nice way of trying to make apples-to-apples comparisons," Leider, a member of the state health department's vaccine advisory group, said in an interview. "You can get pretty clear pictures of where in the state you might expect to see the greatest impact, or an extended disaster."

Index scores are useful even outside of emergencies, Leider said, and track closely with educational, financial and general health outcomes. And while many high-scoring neighborhoods in Minnesota are clustered around the Twin Cities area, Leider said there are pockets in the northwest and southwest part of the state "that have significant level of disadvantage regardless of what you're measuring."

According to Chomilo, measures like the SVI also helps to assess the impact of COVID-19 on Black, Hispanic and Indigenous Minnesotans in a way that age alone cannot capture. In an online post calling for improved vaccine access in March, Leider and others wrote that "in a state like Minnesota, which is overwhelmingly whiter the older you get, the early focus on age alone largely meant a focus on older whites."

That's despite the fact that, as Leider and others found, non-white Minnesotans aged 50-64 "have COVID mortality risk equivalent to white Minnesotans aged 65-74."


Vaccine eligibility expanded later that month to all residents ages 16 and older, regardless of underlying health conditions.

In its current phase, Chomilo said Minnesota's vaccination campaign will use the SVI-based strategy to find and partner with local health care providers and houses of worship to host pop-up clinics in areas where access is lacking and to dispatch the state's recently unveiled mobile vaccination clinics. That will contrast with the mass-vaccination clinics that Minnesotans in some cases drove for hours to visit, he said.

"It's more about bringing shots to people versus people coming to the shots," Chomilo said.

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