Structural disadvantage for priority populations: the spatial inequity of COVID-19 vaccination services in Aotearoa.

ABSTRACT

AIM: To examine the spatial equity, and associated health equity implications, of the geographic distribution of COVID-19 vaccination services in Aotearoa New Zealand. METHOD: The distribution of Aotearoa's population was mapped, and the enhanced two-step floating catchment method (E2SFCA) applied to estimate spatial access to vaccination services. The Gini coefficient and spatial autocorrelation measures assessed the spatial equity of vaccination services. Additional statistics included an analysis of spatial accessibility for priority populations, and by District Health Board (DHB) region. RESULTS: Spatial accessibility to vaccination services varies across Aotearoa, and appears to be better in major cities than rural regions. A Gini coefficient of 0.426 confirms that spatial accessibility scores are not shared equally across the vaccine-eligible population. Furthermore, priority populations including Maori, Pasifika, and older people have statistically significantly lower spatial access to vaccination services. This is also true for people living in rural areas. Spatial access to vaccination services also varies significantly by DHB region as does the Gini coefficient, and the proportion of DHB priority population groups living in areas with poor access to vaccination services. A strong and significant positive correlation was identified between average spatial accessibility and the Maori vaccination rate ratio of DHBs. CONCLUSION: COVID-19 vaccination services in Aotearoa are not equitably distributed. Priority populations, with the most pressing need to receive COVID-19 vaccinations, have the worst access to vaccination services.