PROJECT ABSTRACT
Pandemic preparedness requires strengthening surveillance for emerging viruses, but also a plan for public
health response when the next pathogen rapidly infects humans on a global scale. In order to ensure that the
disproportionate disability and death experienced among disadvantaged populations in the US does not repeat
in a future pandemic, public health agencies will need to validate resource allocation and surveillance tools
within a health disparities framework. The RADx-UP Consortium enables such as an evaluation, since this
NIH-funded Consortium of over 130 projects, with over 370,000 nationwide participants, focused on improving
test access, and eliciting COVID19 stress and vaccine perception among underserved persons. Using RADx-
UP data as the ground truth, we will test whether three area level vulnerability indices—the Social Vulnerability
Index, the Minority Health Social Vulnerability Index, and the Community Vulnerability Index—identify persons
experiencing food or housing insecurity, or gaps in healthcare access during the pandemic (Aim 1). We will
leverage methods from clinical trial literature to assess RADx-UP data generalizability. We will link to American
Community Survey, and generate county-standardized estimates of pandemic stress and vaccine concerns for
the more than 900 US counties with participants in the RADx-UP consortium. We will then assess the
association of these standardized estimates with the three area level vulnerability indices. A second aim of the
proposed work will be to assess the predictive performance of the promising tool of wastewater surveillance
among underserved populations. We will link RADx-UP data with the publicly available National Wastewater
Surveillance System data, and compare wastewater infection prevalence metrics with the test positivity rate
among RADx-UP performed tests, and county-level hospitalizations and deaths. We will evaluate changes in
predictive performance over time (e.g., before versus after vaccine availability), and with integration of area-
level vulnerability indices and other census demographic variables. With the ultimate aim of reducing health
disparities in the future pandemic, our team of epidemiologists, statisticians, nephrology and infectious disease
clinicians, and health policy experts will evaluate existing and emerging pandemic preparedness tools. In doing
so, we hope to promote a public health infrastructure responsive to groups most vulnerable to the health and
social turbulence inherent to a pandemic.
