Abstract
Background
Community pharmacies are largely recognized as geographically accessible; yet concerns arise regarding inequitable access to COVID-19 vaccination, especially during early vaccine availability.
Objectives
This study aims to investigate the accessibility of COVID-19 vaccination from Ontario's community pharmacies from April to December 2021 considering community-level rurality, material deprivation, and ethnic concentration.
Methods
Data from the Ontario Ministry of Health website COVID-19 vaccination pharmacies were analyzed. Pharmacy addresses were geocoded using Environics Analytics Business Data and the Postal Code Conversion File (PCCF+). Material deprivation and ethnic concentration at the Dissemination Area (DA) level were based on Public Health Ontario's marginalization data and organized into quintiles. Mean accessibility was calculated for each quintile using the 2-Step Floating Catchment Area method using service areas of 1000, 1500, or 3000 metres for urban DAs and 10000 m for rural DAs. Analysis of Variance (ANOVA) was used to compare mean accessibility across eight selected dates reflecting vaccine eligibility and availability changes.
Results
Of 15,174 pharmacies identified, 92.9% were successfully linked to geographic coordinates. Three eras of vaccine availability were identified: (1) Intermediate; (2) Scarcity (May 2021); and (3) Abundance (November and December 2021). During vaccine shortages, more deprived and ethnically concentrated urban areas had greater vaccine accessibility than less deprived areas, while rural areas had no access. During other periods, more deprived urban areas either showed higher accessibility or no significant difference compared to less deprived areas; however, rural deprived areas generally had lower accessibility than urban areas.
Conclusions
During COVID-19 vaccine scarcity or abundance, deprived and ethnically concentrated urban areas had similar or enhanced access compared to less deprived areas. However, rural deprived areas experienced lower accessibility. Access to pharmacies can be enhanced in rural deprived areas by incentivization and outreach. Further research examining whether this accessibility variance influenced vaccine uptake and infection rates.