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.

PROJECT NARRATIVE The Rapid Acceleration in Diagnostics for Underserved Population (RADx-UP) consortium recruited over 370,000 participants to generate data on COVID-19 testing, pandemic stress, and vaccination among underserved and vulnerable persons across the US. Our team of epidemiologists, and chronic disease, infectious disease, and health policy experts plans to use these data test the performance of public health resource allocation and infection surveillance tools. Our goal is to mitigate health disparities during the inevitable future pandemic.