Characteristics of the Third COVID-19 Pandemic Wave with Special Focus on Socioeconomic Inequalities in Morbidity, Mortality and the Uptake of COVID-19 Vaccination in Hungary.

Beatrix Oroszi,Judit Krisztina Horváth,Róza Ádány,Krisztina Eszter Komlós,Attila Juhász,Gergő Túri,Martin Mckee,Csilla Nagy

doi:10.3390/jpm12030388

Abstract

Governments are increasingly looking to vaccination to provide a path out of the COVID-19 pandemic. Hungary offers an example to investigate whether social inequalities compromise what a successful vaccine program can achieve. COVID-19 morbidity, mortality, and vaccination coverage were characterized by calculation of indirectly standardized ratios in the Hungarian population during the third pandemic wave at the level of municipalities, classified into deprivation quintiles. Then, their association with socioeconomic deprivation was assessed using ecological regression. Compared to the national average, people living in the most deprived municipalities had a 15–24% lower relative incidence of confirmed COVID-19 cases, but a 17–37% higher relative mortality and a 38% lower vaccination coverage. At an ecological level, COVID-19 mortality showed a strong positive association with deprivation and an inverse association with vaccination coverage (RRVaccination = 0.86 (0.75–0.98)), but the latter became non-significant after adjustment for deprivation (RRVaccination = 0.95 (0.84–1.09), RRDeprivation = 1.10 (1.07–1.14)). Even what is widely viewed as one of the more successful vaccine roll outs was unable to close the gap in COVID-19 mortality during the third pandemic wave in Hungary. This is likely to be due to the challenges of reaching those living in the most deprived municipalities who experienced the highest mortality rates during the third wave.

Highlights

We describe the morbidity and mortality of the third pandemic wave, and we assess the spatial association between socioeconomic characteristics of the population and morbidity and mortality due to COVID-19
When we look at the spatial distribution of COVID-19 vaccination uptake7 of by15the end of the third wave, we can see significantly higher vaccination coverage in the western part of the capital, Budapest, in county towns and in larger cities
The third wave exceeded the size of the second wave in terms of both the number of cases registered and the number of COVID-19-related deaths [42,43]

Summary

Introduction

A government developing a response to a pandemic can employ a variety of approaches [1,2]. Some, such as restrictions on facilities where people mix or face mask mandates, seek to reduce transmission. Others, such as vaccine programmes, seek to increase immunity [3–6]. Others, such as financial support for those unable to work, offer help to those affected by the disease and necessary responses. The evidence, from empirical studies and models, points to a combination of measures as most likely to control disease spread and minimize collateral harms [7–10]

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Conclusion