COVID-19 Vaccine Distribution and Health Equity

As the Center for Medicare Advocacy has highlighted throughout the pandemic, communities of color are disproportionately affected by COVID-19, in terms of rate and severity of illness. At the end of 2020, the news of the COVID-19 vaccine’s efficacy in studies brought much needed optimism that the end of the pandemic was possible. However, actual rates of vaccinations and equity of vaccine distribution were uncertain. Some states developed distribution plans that specifically considered these disproportionate impacts.

Now that vaccinations have begun across the country, some initial research has been published. The overall vaccination rate has remained low in the United States; as of the beginning of February 2021, just over 8% of the population has been partially vaccinated and only 2% have been fully vaccinated. Though eligibility guidelines vary, in most areas vaccines have primarily been reserved for health care workers and residents and staff of facilities. Data on vaccination rates by race/ethnicity is limited. Though analysis of vaccination access and equity is limited in scope, some early data points are troubling.

This week the Kaiser Family Foundation released analysis from early vaccination rates, which reveals some warning signs about racial disparities in access and administration of COVID-19 vaccines. Across the 23 states reporting vaccination data by race and ethnicity, there was a consistent pattern of Black and Hispanic people receiving smaller shares of vaccinations compared to their shares of cases and deaths and compared to their shares of the total population.

The CDC also released demographic data this week reflecting vaccinations in the US from the first month (December 14-January 14), which also raised concerns. The report found that of those receiving vaccinations, where CDC had demographic data, about 60% were White, 11% were Hispanic/Latino, 6% were Asian, and 5% were Black, though it stressed limitations due to lack of comprehensive data.

The CDC report called on additional data collection efforts in order to identify and address potential disparities. “…[F]indings underscore the need for more complete reporting of race and ethnicity data at the provider and jurisdictional levels to ensure rapid detection of and response to potential disparities in COVID-19 vaccine administration. Jurisdictions should monitor the demographic characteristics of vaccinated persons to identify emerging disparities.”

A New York Times report had similar findings. “Although low-income communities of color have been hit hardest by Covid-19, health officials in many cities say that people from wealthier, largely white neighborhoods have been flooding vaccination appointment systems and taking an outsized share of the limited supply.” One example of this contrast provided was Philadelphia, where only 12% of those inoculated were Black, even though the city’s population is 44% Black.

Due to this early data, some areas are attempting to target vaccinations directly to communities most in need. The article cited plans in various cities aimed at increasing vaccinations for those in hardest hit areas. Baltimore will offer the vaccine in housing complexes for the elderly, going door-to-door, and Washington, DC began offering vaccine appointments for zip codes with highest rates of infection and death, before opening up appointments for other portions of the city, as well as increasing the number of workers helping people get appointments.

The new approaches based on the available data underscore the need for more detailed, standardized, comprehensive data on vaccination rates by race and ethnicity. Without more detailed data, required of all states, it will be challenging to address and adjust vaccine distribution to ensure communities suffering disproportionately from COVID-19 have access to vaccines.  Vaccine hesitancy, particularly among groups hardest hit by the virus, is another issue that must be considered in policies that target vaccines to communities most in need. Polling from fall 2020 showed that vaccine concerns were prevalent in communities of color. Though support for the vaccine has increased over the last few weeks, these concerns, as well as the historical context in which they arise, must be considered when striving to increase vaccination rates.