OBJECTIVES: Addressing disparities in vaccine uptake through equity-targeted outreach programs requires additional funding, but the cost and outcome trade-offs are not well-understood. This study compared the overall and distributional health and cost outcomes of different vaccination programs.

METHODS: A two-group (majority and minority) susceptible-infected-recovered (SIR) compartmental model was used to estimate the outcomes of two vaccine outreach programs, compared to the status quo: (1) standard and (2) equity-targeted. Both outreach programs vaccinated an additional 10% of the population compared to the status quo. The status quo and standard outreach program included standalone vaccine clinics, while standard outreach has additional sites. The equity-targeted outreach program included mobile vaccine clinics, education, and a community engagement outreach program. Vaccination uptake in the status quo, standard outreach, and equity-targeted outreach programs for the majority and minority were assumed 30% and 20%, 41% and 27%, and 38% and 38% respectively. The majority-minority vaccination ratios for the standard and equity-targeted outreach programs were 3:2 and 1:1, respectively. Inputs were derived from United States COVID-19 data.

RESULTS: While both outreach programs improved overall outcomes compared to the status quo, the equity-targeted program had the best overall and distributional outcomes. Compared to standard outreach, equity-targeted outreach reduced overall infections by 14%, hospitalizations by 6%, and deaths by 8%; inequity was reduced by 42% for infections, 43% for hospitalizations, and 38% for deaths. Costs per capita were $1,042 for the status quo, $665 for standard, and $521 for equity-targeted program. Compared to the status quo, equity consistently improved with the equity-targeted program but not with the standard outreach program.

CONCLUSIONS: Equity-targeted outreach program improved health outcomes, reduced disparities, and lowered costs compared to alternative approaches. Because the minority group had a higher contact rate, equitable vaccine allocation reduced overall transmission and saved costs.