Inequalities in initiation of COVID19 vaccination by age and population group in Israel- December 2020-April 2021

Gorelik, Y.; Edelstein, M.

Background: In Israel, COVID19 vaccination coverage varies widely by population group and age. Despite the vaccine being locally and freely available in the entire country. Comparing crude coverage between localities and population groups is misleading because of differing age structures in different population groups. In order to describe inequalities in COVID19 vaccine initiation we determined differences in age-specific dose 1 vaccine coverage between the main population groups in Israel, and characterised the influence of age on vaccine coverage within each of these groups. Methods: We obtained daily doses administered by municipality and age from the Ministry of Health, and demographic data from the Central Bureau of Statistics. We determined whether the relative proportion of people vaccinated in each age group (15-19, 20-29, 30-39, 40-49, 50-59, 60+) changed by population group (General Jewish, Ultra-Orthodox and Arab) using ANOVA and quantified association between age, population group and vaccine coverage using binomial regression. Results: 8,507,723 individuals in 268 localities were included. Compared with the General Jewish population, vaccine coverage was lower among the Arab and Ultra-Orthodox populations and lowest in the Ultra-Orthodox population in all age groups. Gaps between population groups differed according to age group (p<0.001). In all populations, coverage decreased with decreasing age (p<0.001). The Ultra-orthodox population was the least vaccinated in all age groups relatively to those aged 60 and over. Conclusions: In all age groups, the Ultra-Orthodox population had the lowest vaccine coverage. The younger the age group, the more Ultra-Orthodox Jews are diverging from their age peers in terms of initiating COVID19 vaccination. These findings suggest generational differences in terms of vaccination behaviour in this group. Qualitative studies understanding the causes behind this divergence can inform tailored vaccination strategies.