To extend vaccines' reach, distribute them through dollar stores

In March, the CDC confirmed that it was in discussions about the distribution of the COVID-19 vaccines through the Dollar General retail chain. A study co-authored by Yale SOM's Judith Chevalier and Kevin Williams finds that such a partnership could bring vaccination sites substantially closer to low-income, Black, and Hispanic households in many parts of the United States.

Dollar stores have spread rapidly through the United States, with the total number of stores from the biggest chains doubling since 2005. Some policymakers have been dismayed by the growth of dollar stores in low-income areas, arguing that the stores are pushing out grocery stores and leaving vulnerable populations without access to fresh foods. But the stores' locations in these areas may make them valuable as distribution sites for the COVID-19 vaccines, according to a new study co-authored by Yale SOM's Judith Chevalier and Kevin Williams.

In March, the Centers for Disease Control, which already works with a variety of drug stores and supermarkets to help administer vaccines, confirmed that it was in talks with Dollar General, the largest chain of dollar stores. In their paper, Chevalier and Williams, with Jason Schwartz and Yihua Su of the Yale School of Public Health, considered whether that partnership could increase equity in vaccine distribution by bringing more vaccination sites within reach of low-income, Black, and Hispanic households.

The authors used census data, the locations of current vaccination sites, and the locations of Dollar General stores to estimate the potential impact of such a partnership. They found that nationally, adding all of the Dollar General stores to the vaccination network (in reality, it is likely that not all stores would be added) would increase the percentage of all Americans within one mile of a pharmacy partner by 8 percentage points and the percentage of Black Americans by 12.5 percentage points.

The improvement in access would be even larger in some areas of the country, including the Southeast and Midwest. For example, in Arkansas, the addition of Dollar General stores would increase the percentage of Black Americans within one mile of a pharmacy partner from 10% to 53.5%.

The authors suggest that establishing distribution through dollar stores during the current rollout of the COVID-19 vaccine could pay additional dividends should booster shots be required, and in the longer term to help increase uptake of annual flu vaccines among older low-income Americans.

Bringing vaccination locations closer to vulnerable populations is only one part of increasing vaccine equity, the authors acknowledge. "But it is an important component of approaches to reduce barriers to vaccination, alongside efforts to build support and enthusiasm for the vaccines and address sources of vaccine hesitancy."