COVID-19 vaccine effectiveness, hesitancy, incentives, and mandates in the Deep South
Young people living in the Deep South currently have the lowest COVID-19 vaccine uptake in the United States. Moreover, low vaccine effectiveness against infection can lessen vaccine uptake. As such, the study of vaccine effectiveness against infection, hesitancy, and methods to promote vaccine uptake among young healthy adults living in the Deep South is critical to mitigating the effects of COVID-19 and preventing further emerging variants. In this analysis, I examined vaccine effectiveness against SARS-CoV-2 infection, COVID-19 vaccine hesitancy, and methods to boost COVID-19 vaccine acceptance rates (e.g., incentives and mandates) among Tulane University affiliates (students, faculty, and staff; n~36,000) residing in New Orleans. In Paper 1, I assessed vaccine effectiveness against infection by comparing rates of COVID-19 infection between individuals who had and had not received a vaccine, using Cox Proportional Hazards models to yield an adjusted effectiveness estimate. There was a 87.5% (p<0.0001) lower risk of infection among those vaccinated under the wildtype/Alpha variant compared to the unvaccinated, and no reduction in risk among those vaccinated under the Delta variant compared to unvaccinated; however, those who were unvaccinated had far lower testing rates. In Paper 2, I used Cox Proportional Hazards models to compare vaccine uptake timing by demographic factors within the university; students were slower to initiate vaccination and younger people accessed vaccines more quickly than older individuals. In Paper 3, I used interrupted time series to assess the differences between vaccine uptake rates before and after the announcement of university- and city-wide mandates, finding that University mandates were associated with staff and faculty initiating vaccination, but city-wide mandates were associated with students initiating vaccination. Additionally, I used synthetic controls to assess the impact of the New Orleans vaccine mandates on vaccination rates in Orleans, finding that mandates were associated with roughly 760 additional vaccinations per week.