Vaccinations so far are perpetuating existing inequity

Two weeks ago, I wrote that only 19 states were reporting vaccinations by race and/or ethnicity. This demographic information is key to evaluating the vaccine rollout: both government officials and watchdogs should be able to see how well this process is serving vulnerable populations. Without good data, we can’t see the true picture—making it harder to advocate for a more equitable system.

Demographic vaccine data has improved since then, but not by much. The federal government is still not reporting these data on a national level. 23 states are reporting some form of vaccinations by race and ethnicity—but the data are difficult to standardize, as every state is reporting slightly different demographic categories. Several states are reporting in percentages, rather than whole numbers, which makes the data less precise.

And a lack of federal standards for these data means it’s easy for states to change things up: Indiana, which started reporting vaccinations by race/ethnicity early in January, is now only reporting vaccinations by age and gender. New York City also reported demographic data for vaccinations in December, then removed the figures after disparities were revealed, according to Gothamist. (NYC’s demographic data are back, as of this morning, but they still show white residents getting vaccinated at disproportionately high rates compared to the city’s population.)

(For more detail on which states these are and how to navigate their vaccination data, see the COVID-19 Data Dispatch’s annotations.)

Meanwhile, the data we have so far continue to show significant disparities. In 23 states with available data, white Americans are being vaccinated at higher rates than Black Americans, a recent analysis by Kaiser Health News’ Hannah Recht and Lauren Weber found. This analysis followed a similar study that I cited two weeks ago—Recht and Weber write that “disparities haven’t significantly changed” with two more weeks and several more states reporting.

In all but six of the states Recht and Weber analysed, white residents had been vaccinated at double (or more) the rate of Black residents. In Pennsylvania, this rate rises to 4.2 times. Indiana reported white residents vaccinated at 2.6 times the rate of Black residents—before the state took these data off its dashboard. Polling from the Kaiser Family Foundation continues to show that Black Americans are more hesitant; 42% of those surveyed said they want to “wait and see” how the vaccines are working for others before getting a shot.

This vaccination news builds on the continued, deep strain that COVID-19 has placed on Black communities. Alice Goldfarb provided an update this week in an analysis post for the COVID Tracking Project. While the piece maps out disparities in COVID-19 cases for Black, Hispanic or Latino, and Indigenous populations in every state, Goldfarb also provides a stark comparison for the toll this pandemic has taken:

More Black Americans have died of COVID-19 since the pandemic began than there are names on the Vietnam Memorial. More Black or Latinx people have died than the number of people commemorated on the AIDS Memorial Quilt.

The urgency of fixing our vaccine system is clear. And politicians are starting to take note: Massachusetts Representative Ayanna Pressley and Senators Elizabeth Warren and Edward Markey called for better demographic data in a letter to the Department of Health and Human Services this week. They urged the department to better work with states, local public health departments, and labs to collect more data and publish it publicly.

In a statement to the Associated Press, Pressley says:

That which gets measured gets done, and the first step towards ensuring we are able to effectively address these disparities and direct lifesaving resources to our hardest-hit communities is for our government to collect and publish anonymized demographic data, including race and ethnicity, of vaccine recipients.

White Massachusetts residents are getting vaccinated at 1.4 times the rate of Black residents, according to KHN.

Dr. Marcella Nunez-Smith, the chair of Biden’s new COVID-19 equity task force, similarly discussed the need for better data and equitable vaccination at briefings this week. She mentioned leveraging existing data sources, removing barriers to vaccination in underserved communities, sharing ideas between states, and generally making vaccines more accessible, along with a vaccine communications campaign. But she didn’t go into many specifics.

The federal government may be able to make vaccine distribution more equitable, if it can provide the funding that state and local public health departments—along with health clinics, community centers, churches, and so many other possible vaccine providers—need right now. But one thing it can do is require race and ethnicity data, and make it standardized. We need that, like, a month ago.

More vaccination data updates

There were a couple of great features this week on problems with America’s vaccine data system(s), as well as updates to major sources. Here are the highlights:

  • STAT’s Nicholas St. Fleur wrote about the struggle to find a vaccine appointment, highlighting a viral Twitter thread from intensive care physician Dr. Arghavan Salles. Convoluted online systems are simply not working for seniors and many other vulnerable populations.
  • In another STAT piece, Mario Aguilar described vaccination data challenges in Utah as a microcosm of similar issues across the country. Even within this single state, he writes, some counties with robust IT already in place were able to adapt their tech for COVID-19 vaccination, while in others, exhausted healthcare workers must enter every data point by hand.
  • KHN’s Rachana Pradhan and Fred Schulte describe how a lack of standards for race and ethnicity data collection have led some states to leave this field optional, while others aren’t tracking it at all. Similar problems persist for occupation data, which should be crucial when we’re supposedly prioritizing essential workers for earlier vaccination!
  • Cat Ferguson at MIT Technology Review gives the full picture of Vaccine Administration Management System, or VAMS, a brand-new vaccine data system that the CDC commissioned for COVID-19 vaccination—and that is completely failing to do its job. Most states in the country have chosen not to use this free system, as it is difficult to use, arbitrarily cancels appointments, and confuses patients.
  • A team from POLITICO laid out Biden’s journey to locate 20 million vaccine doses. The White House briefings were “short on details,” these authors claim, because behind the scenes, the Biden team was still struggling to get their hands on basic information that should’ve been communicated during the transition. Once doses are delivered to states, the state public health systems are fully responsible for tracking these doses until they are officially recorded as “administered”; this makes it difficult for the federal government to track the overall vaccine rollout.
  • KFF has a new dashboard for its COVID-19 Vaccine Monitor, which is tracking public opinions of and responses to vaccines. The organization is also running a dashboard of state COVID-19 vaccine priorities, which makes it easy to compare strategies across states.
  • Vaccine Finder, a tool developed at Boston Children’s Hospital which makes it easy for Americans to find vaccine providers in their communities, is partnering with Google Maps to “bring wider awareness and access to COVID-19 vaccines,” according to John Brownstein, Chief Innovation Officer at the hospital.

Related posts

  • Vaccine requirements are the next big strategy
    After vaccine incentives largely failed to drive up vaccination numbers, government agencies and corporations alike are now opting for requirements. Hundreds of thousands of Americans learned this week that, in order to keep their jobs, they need to get their shots—or go through a more arduous process like weekly COVID-19 testing.
  • Breakthrough case reporting: Once again, outside researchers do the CDC’s job
    Now, Delta is causing the vast majority of cases—and the CDC still isn’t reporting on non-severe breakthroughs. As a result, entities outside the federal government are once again compiling data from states in order to fill in gaps left by the national public health agency. On Friday, both Bloomberg and NBC published breakthrough case analyses.
  • Unpacking Delta numbers from this week’s headlines
    It’s no surprise that Delta (B.1.617.2) is bad news. From the moment it was identified in India, this variant has been linked to rapid transmission and rapid case rises, even in areas where the vaccination rates are high. This week, however, the CDC’s changed mask guidance—combined with new reports on breakthrough cases associated with Delta—has triggered widespread conversation about precisely how much damage this variant can do.
  • The booster shot conversation: What you should know
    Recently, a lot of U.S. COVID-19 news has centered around booster shots—additional vaccine doses to boost patients’ immunity against the coronavirus. Questions abound: do we need these shots, when might we need them, how do they impact vaccination campaigns?

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