With the number of Americans receiving Covid-19 vaccines each week starting to decline, it’s time to pull out the stops to reach those who are willing to be vaccinated but haven’t yet been able to do so. Enlisting dollar stores as vaccination sites is one way to make vaccines more widely and equitably available.
Every American adult is now officially eligible for to get a Covid-19 vaccine. Although the barriers to vaccination aren’t yet well-studied or surveyed, difficulty scheduling an appointment and distance to a vaccination site are widely considered to be significant obstacles.
In mid-April, the Biden administration announced that 90% of Americans now live within 5 miles of a vaccination site, in part because of the Federal Retail Pharmacy Program. Every week, in addition to allocating vaccine doses to the states to distribute, the federal government also allocates millions of vaccine doses directly to retail pharmacies like CVS, Walgreens, and Walmart. The Centers for Disease Control and Prevention considers this program critical to the success of its efforts to deliver vaccines directly to communities and achieving that 5-mile goal.
But 5 miles can be a long way to travel for low-income households with limited access to transportation and limited time off from work. In March, CDC Director Rochelle Walensky suggested another possibility to help bring the vaccine even closer to people: a possible partnership with Dollar General, one of the country’s largest retail chains.
With two of our colleagues at Yale, Yihua Su and Kevin Williams, we investigated three questions: How close are low-income households to outlets of the existing retail pharmacy partners? Are there racial or ethnic disparities in access to these partners? And would a partnership with Dollar General have a meaningful impact on improving vaccine access?
In a new preprint, we found that just under half of households earning less than $35,000 per year in the continental U.S. live less than 1 mile from a federal retail pharmacy partner. These households are only slightly less likely to live within a mile of a pharmacy partner than high-income households.
But proximity to a vaccination site may be particularly important for low-income households. Given that Dollar General’s business model is to locate stores in lower-income “retail deserts,” it’s no surprise that adding its 17,000 retail locations as vaccine sites would improve the fraction of low-income households within a mile of a federal vaccine partner from 49% to 60%.
That overall improvement in proximity to a vaccination site masks tremendously different effects in different states and regions. For example, Arkansas is currently ranked in the bottom 10 states with respect to the share of its residents who have been vaccinated. Our analysis showed that only about 9% of low-income households in Arkansas live within 1 mile of a federal pharmacy partner, and only about half are even within 10 miles. By adding Dollar General stores to the mix of available vaccination sites, about 40% of low-income Arkansans would be within a mile of a federal retail vaccine site and 87% would be within 10 miles.
The improvements from adding Dollar General stores to vaccine outreach are particularly large in the South and Midwest — areas where vaccine efforts have been lagging and recent declines in doses administered have been particularly large.
Our team also examined racial and ethnic disparities in proximity to vaccination sites. The results are particularly telling for Hispanic Americans, a group that a recent Kaiser Family Foundation study showed that, like Black Americans, they tended to receive “smaller shares of vaccinations compared to their shares of cases and deaths and compared to their shares of the total population.”
That isn’t entirely a result of the vaccine hesitancy that is the focus of so much attention these days. Another Kaiser survey found that Hispanic people are disproportionately likely to be in the group that want to get vaccines but haven’t been able to do so. More than 1 in 5 Hispanic respondents expressed concern that they would have difficulty traveling to a vaccination site, a concern our analysis supports. While 63% of non-Hispanic people live within 1 mile of a current federal retail pharmacy partner, only 45% of Hispanic people are that close to one. Vaccine distribution in Dollar General stores would help close that gap: adding all Dollar General sites would raise the share of Hispanic people within a mile of a vaccination partner to 54%.
When we’ve talked with people about this idea, they are quick to point out the challenges: Not every Dollar General store would be suitable as a vaccine site. And Dollar General stores don’t have in-store pharmacies, so vaccination staff would have to come to those to run clinics.
But these logistical and staffing challenges pale in comparison to other solutions for enhancing proximity to vaccines. Suppose the federal government decided to improve access by hosting more pop-up or mobile clinics in parking lots at just half as many sites as there are Dollar General stores. That would require identifying 8,500 opportune sites, negotiating access with up to 8,500 stadium or parking lot owners, communicating those locations to the public, and staffing them.
A partnership with a retail chain like Dollar General or other dollar store chains whose business model is to operate in lower-income areas could provide a jump-start to the hard work ahead reaching those individuals and communities willing but not yet able to get vaccines, the groups central to this critical next phase of the vaccination rollout.
Judith Chevalier is a professor of economics and finance at the Yale School of Management, a faculty advisor to the Tobin Center for Economic Policy at Yale University, and a research associate at the National Bureau of Economic Research. Jason L. Schwartz is an assistant professor of health policy at the Yale School of Public Health.