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updated_de-Winton Cummings Dissertation (Epidemiology)2.34 MB
Embargoed Access, Embargo ends: 06/26/2026
Dissertation
Analyzing COVID-19 pandemic response through case studies on testing and vaccination strategies in the Midwestern United States and introducing an equity framework for future disease emergency responses
University of Iowa
Doctor of Philosophy (PhD), University of Iowa
Spring 2025
DOI: 10.25820/etd.007955
Abstract
Recent outbreaks of infectious diseases have revealed significant gaps in public health responses, particularly in the context of rapidly disseminating pathogens. This research aims to enhance response to large-scale infectious disease outbreaks by prioritizing equity as a fundamental component of response. The dissertation is structured into two components. First, it emphasizes the importance of effectively utilizing outbreak resources by examining access to testing and vaccination resources in the Midwest during the COVID-19 pandemic. This examination is conducted through two distinct quantitative studies that employ a variety of epidemiological methodologies and analytical approaches. Second, recognizing the pressing need for a renewed emphasis on health equity in both epidemic and pandemic responses, this work introduces an action-oriented equity framework. This framework is designed to guide future responses to disease emergencies, ensuring that equity is a fundamental principle in addressing public health challenges.
The first study uses spatial epidemiology techniques to analyze the distribution and accessibility of SARS-CoV-2 testing sites established by a statewide initiative. By employing spatial methods such as Two-Step Floating Catchment Area (2SFCA) analysis and hotspot analysis, the findings reveal that metropolitan counties and several census tracts in central Iowa benefitted from better access to testing within 30 minutes and 45 minutes travel distances. Areas with clusters of low accessibility scores were more likely to have a higher proportion of older residents, households without vehicle ownership, and households lacking internet access.
The second study employs a community-engaged cross-sectional design to examine the social and structural factors that impact both the uptake and intention to receive the SARS-CoV-2 vaccine among frontline workers. Using multinomial logistic regression models, the analysis revealed several factors that influence vaccine intention. These factors include the absence of transportation to vaccine appointments, lack of time off work for vaccine appointments, lack of time off work in the event of side effects, lack of cash, gift cards, or other forms of incentives, inflexible vaccine appointment options, and concerns regarding vaccine effectiveness.
The third study introduces an equity framework aimed at guiding responses to future major disease outbreaks. This framework was developed through a thorough review of existing models, enhanced by insights from experts in Epidemiology, Medicine, Mental Health, Community Health, and Health Policy. It consists of four key components: (1) high-impact areas that focus on major domains essential for emergency response; (2) key actions aimed at promoting fairness and inclusivity; (3) an assessment indicator tool designed to assist in planning and implementing effective responses; and (4) a post-response evaluation tool that identifies strengths and areas for improvement in response initiatives.
This research emphasizes the critical need for equity-driven approaches in health system preparedness and public health responses during infectious disease outbreaks. The quantitative studies identify key social, structural, and logistical barriers to accessing testing and vaccination resources, providing actionable insights to improve resource allocation and uptake during disease emergencies. The framework accentuates the importance of equity-focused strategies and continuous assessment of response efforts. This work underscores the importance of ensuring equitable access to essential resources, utilizing data-driven planning to address disparities, and strengthening health system infrastructure to better support vulnerable populations.
Details
- Title: Subtitle
- Analyzing COVID-19 pandemic response through case studies on testing and vaccination strategies in the Midwestern United States and introducing an equity framework for future disease emergency responses
- Creators
- Precious-Junia de-Winton Cummings
- Contributors
- Michael Pentella (Advisor)Kelly Baker (Advisor)Martha Carvour (Committee Member)Whitney Zahnd (Committee Member)Margaret Carrel (Committee Member)Christine Petersen (Committee Member)
- Resource Type
- Dissertation
- Degree Awarded
- Doctor of Philosophy (PhD), University of Iowa
- Degree in
- Epidemiology
- Date degree season
- Spring 2025
- DOI
- 10.25820/etd.007955
- Publisher
- University of Iowa
- Number of pages
- xiv, 144 pages
- Copyright
- Copyright 2025 Precious-Junia de-Winton Cummings
- Language
- English
- Date submitted
- 01/07/2025
- Description illustrations
- Illustrations, tables, graphs, charts
- Description bibliographic
- Includes bibliographical references (pages 112-125).
- Public Abstract (ETD)
When a health crisis arises, a swift and effective public health response is essential for limiting its spread and minimizing its impact. However, recent events have revealed weaknesses in our strategies for mitigating the effects of large-scale outbreaks. This research is divided into two parts, highlighting both lessons learned and pathways forward for strengthening public health responses. The first part identifies lessons learned from the COVID-19 pandemic by quantitatively assessing access to testing and vaccination resources in the Midwest to identify social and structural barriers and facilitators, thereby informing future disease response strategies. The second part proposes a pathway forward through an action-oriented framework designed to guide the planning and implementation of equitable response efforts.
Key findings indicate that metropolitan counties enjoyed better spatial access to SARS-CoV-2 testing through a statewide initiative. However, areas with low accessibility scores had a higher percentage of older residents and households without internet or vehicle access. Furthermore, the lack of intention to get vaccinated was linked to transportation challenges, insufficient time off work, lack of incentives, inflexible appointment options, and concerns about vaccine effectiveness. Finally, the action-oriented equity framework encompasses six essential components of response, with key actions and assessment indicators focused on equity.
This work highlights the necessity of health equity considerations in outbreak mitigation strategies. The findings presented in this dissertation can inform several practical implications for health system preparedness and future response strategies, including allocating testing sites in underserved areas, addressing barriers related to technology and transportation, offering flexible options for vaccination and testing appointments, and ensuring access to culturally appropriate vaccine information.
- Academic Unit
- Epidemiology
- Record Identifier
- 9984831024002771
Metrics
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