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The Covid-19 Vaccine-Development Multiverse


We are writing in response to the editorial by Heaton (Nov. 12 issue)1 on Covid-19 vaccines. Currently, Blacks, Native Americans, and Hispanic or Latino persons are disproportionately affected by Covid-19,2 and testing to detect SARS-CoV-2 is lagging in low-income and minority neighborhoods.3 New approaches will be needed to safely and equitably distribute Covid-19 vaccines.

Demographic Characteristics of Persons Who Were Tested for SARS-CoV-2 at Multiple Drive-through Testing Sites and of Those Vaccinated against Influenza at One Drive-through Testing Site in Los Angeles County in 2020.

Variable Persons Who Were Tested or Vaccinated
Testing for SARS-CoV-2 from June 26–Oct. 14 at multiple sites
Race or ethnic group — no./total no. (%)*
Hispanic or Latino 295,063/686,191 (43)
White 164,686/686,191 (24)
Black 178,409/686,191 (26)
Asian or other 48,033/686,191 (7)
Vaccinations against influenza from Oct. 6–Nov. 5 at one site
Age — yr
Median 38
Range 1–86
Race or ethnic group — no./total no. (%)*
Hispanic or Latino 430/661 (65)
White 126/661 (19)
Black 13/661 (2)
Asian or other 92/661 (14)

Race or ethnic group was reported by the participants on a survey.

Drive-through SARS-CoV-2 testing sites in Los Angeles County are widely used by persons from racial and ethnic groups that are representative of that county (Table 1). A pilot influenza vaccination program was conducted at one SARS-CoV-2 drive-through testing site in an underserved neighborhood. Vaccines were refrigerated before administration, and trained health care professionals administered them. During the period from October 6 through November 5, 2020, vaccinations were offered on 9 days, and 661 persons were vaccinated (Table 1). The highest daily number of vaccinations was 148. SARS-CoV-2 testing was completed by 599 of the 661 persons who were vaccinated (90.6%).

It is feasible to administer influenza vaccines at drive-throughs. Now that vaccines against SARS-CoV-2 are available, drive-through vaccination clinics should be considered, especially in underserved areas and health care deserts.

Noah Kojima, M.D.
University of California, Los Angeles, Los Angeles, CA

Isaac Turner, Ph.D.
Curative, San Dimas, CA

Jeffrey D. Klausner, M.D., M.P.H.
University of California, Los Angeles, Los Angeles, CA

Drs. Kojima and Klausner report receiving consulting fees from Curative; and Dr. Turner, being an employee of Curative. No other potential conflict of interest relevant to this letter was reported.

This letter was published on January 27, 2021, at

  1. 1.Heaton PM. The Covid-19 vaccine-development multiverse. N Engl J Med 2020;383:19861988.

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  2. 2.Tai DBGShah ADoubeni CASia IGWieland ML. The disproportionate impact of COVID-19 on racial and ethnic minorities in the United States. Clin Infect Dis 2020 June 20 (Epub ahead of print).

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  3. 3.Servick K. ‘Huge hole’ in testing data blurs racial, ethnic disparities. Science 2020;369:237238.

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The author replies: I am inspired by Kojima and colleagues’ account of integrating an influenza vaccination program into a SARS-CoV-2 drive-through testing site in an underserved neighborhood. Programs that are successful at improving vaccination coverage enhance community access to immunization services (e.g., by incorporating school-based immunizations, home visits, or links to existing programs).1-3 Successful delivery of Covid-19 vaccine is no exception. Neighborhoods must be the center of vaccination campaigns and must involve local pharmacies, satellite clinics, mobile outreach units, home visits, and — as Kojima and colleagues describe — drive-through clinics. The successful rollout of Covid-19 vaccines rests on how well this lesson has been learned.

The unique challenges of Covid-19 vaccination, including the mismatch between supply and demand, the sheer scale and urgency, the ultra–cold chain requirements, and the trust gap in the highest-risk communities, warrant broad innovation at every level. Kojima et al. are encouraging just that in the scientific ecosystem. In addition, when vaccination clinics are hosted in nontraditional settings, diligence is essential to ensure patient safety and vaccine effectiveness; best practices such as those defined by the Centers for Disease Control and Prevention should be followed.4 Vaccinating the world’s population against Covid-19 is not a one-size-fits-all problem, and the problem will not have a one-size-fits-all solution.

Penny M. Heaton, M.D.
Bill and Melinda Gates Medical Research Institute, Cambridge, MA

Since publication of her editorial, the author reports no further potential conflict of interest.

This letter was published on January 27, 2021, at

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  2. 2.Isaac MRChartier MBrownell M, et al. Can opportunities be enhanced for vaccinating children in home visiting programs? A population-based cohort study. BMC Public Health 2015;15:620620.

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  3. 3.Thomas TNKolasa MSZhang FShefer AM. Assessing immunization interventions in the Women, Infants, and Children (WIC) program. Am J Prev Med 2014;47:624628.

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  4. 4.Centers for Disease Control and Prevention. Influenza (flu): resources for hosting a vaccination clinic. 2020 ( opens in new tab).

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