Yale study: COVID-19 vaccine distribution at dollar stores could improve equity
Yale researchers found that including dollar stores in the U.S. vaccine distribution process would aid in the country’s efforts to reach marginalized populations.
A Yale study found that the distribution of COVID-19 vaccines at dollar stores could increase equity in the vaccine rollout by improving distribution to low-income, Black and Hispanic households throughout the country.
The study was conducted by professor of finance and economics at the Yale School of Management, Judith Chevalier, associate professor of economics Kevin Williams and assistant professor of public health at the Yale School of Public Health Jason Schwartz. The researchers found that the distribution of vaccines at dollar stores such as Dollar General would decrease the distance that low-income and marginalized individuals would need to travel to reach vaccines and help to ultimately surpass the goal set by the Biden administration for 90 percent of the population to live within a minimum of five miles of a COVID-19 vaccination site. The study was posted on medRxiv on April 5.
“At this stage of the vaccination rollout in the United States, any barriers that keep individuals from accessing vaccines must be eliminated,” Schwartz wrote in an email to the News. “Our research shows that using dollar stores like Dollar General and Dollar Tree as vaccination sites would bring vaccines closer to low-income and minority populations [compared to] continuing to rely on pharmacies or other locations currently established by states.”
On March 9, the Centers for Disease Control and Prevention Director Rochelle Walensky announced that the organization was in conversation with Dollar General about a potential partnership to advance COVID-19 vaccination allocation efforts, especially among minority communities. Chevalier and Williams were working on a prior project focused on studying retail environments and saw an opportunity to examine the impact of Dollar General as a site for vaccinations.
To study the potential effectiveness of providing COVID-19 vaccines at dollar stores, the researchers turned to the U.S. Census. Schwartz explained that dollar stores are more likely to be found in “high-priority, high-need communities” according to the CDC’s social vulnerability index, a metric that takes into account 15 social factors including poverty and lack of vehicle access.
“What kind of retailer [is] located near low-income people? Dollar Stores,” Chevalier wrote in an email to the News. “We show that adding Dollar Stores to the strategy would dramatically improve the proximity of low-income people to vaccine[s], especially in the South and Midwest.”
Schwartz explained that large distances to the nearest vaccination site may pose a significant hurdle for many individuals with limited access to transportation.
Chevalier described that the current Federal Retail Pharmacy Partner Program for COVID-19 Vaccination — a partnership between the federal government and 21 national pharmacies to supply vaccines to the public — is already a somewhat novel concept historically in the United States and internationally.
In places such as the United Kingdom and Israel, small retail pharmacies have not played a central role in the vaccine rollout as they have in the United States, Chevalier said. In Great Britain, the National Health Service aspires to ensure that every individual will be within a minimum of 10 miles from a COVID-19 vaccination site. The Biden administration, by contrast, has achieved its goal of guaranteeing that 90 percent of people are within at least five miles of a COVID-19 vaccine, she explained. Chevalier noted that adding dollar stores to this group of retailers would simply bolster the rollout and emphasized the strategy’s effects on Black and Hispanic communities.
Chevalier emphasized that the lag in vaccine uptake among Black and Hispanic communities cannot solely be attributed to vaccine hesitancy, citing a recent survey by the Rockefeller Institute that revealed that geographic lack of access to vaccines was a significant barrier in these groups.
“[We] find that dollar stores disproportionately improve vaccine proximity for Black individuals relative to other races and for Hispanic individuals relative to non-Hispanic people,” Chevalier wrote. “This is a big deal because vaccination rates have lagged for Black people relative to other races and for Hispanic people relative to other races.”
When asked if any of the findings in her study surprised her, Chevalier said no. She explained that after the work was published, she met with A. Toni Young, an activist and researcher in West Virginia who had originally proposed the model for distributing COVID-19 vaccines at Dollar General locations.
The CDC still has not added Dollar General to the list of approved partners for the Federal Retail Pharmacy Partner Program. The researchers wrote that the delay is likely due in part to the fact that “dollar stores have been viewed with skepticism and controversy in the policy sector.”
Resource constraints pose an additional barrier to making this plan a reality. Dollar General stores do not have pharmacies, Chevalier said.
Department chair of epidemiology Albert Ko similarly noted that a lack of pharmacy space and insufficient resources or staffing at Dollar General could pose barriers to implementing this plan.
“Creative solutions are now needed to grow vaccination coverage and to address the significant disparities observed so far in vaccine access and equity,” Schwartz wrote.
As of May 2, there are a total of 17,385 Dollar General locations in the United States.