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The success of the coronavirus disease 2019 (COVID-19) vaccination effort may be limited by the ability to equitably and expediently reach the general public in the final deployment phase. Prior experience has shown that significant cultural, economic, racial, and communication barriers prevent widespread participation in public health initiatives, such as COVID-19 testing and, now, vaccination. Public health agencies would benefit from tools that identify recalcitrant refugia of infection in discrete geographic hot spots and enable targeted vaccine messaging and deployment to expand coverage. Measuring the concentration of virus in municipal sewers could help.
