COVID-19 Data Dispatch

Tag: vaccination disparities

  • COVID-19 vaccine issues: Stories from COVID-19 Data Dispatch readers across the U.S.

    COVID-19 vaccine issues: Stories from COVID-19 Data Dispatch readers across the U.S.

    Last year, just 17% of the U.S. population received a bivalent booster. Will this year’s uptake be better?

    Last week, I asked you, COVID-19 Data Dispatch readers, to send me your stories of challenges you experienced when trying to get this fall’s COVID-19 vaccines. I received 35 responses from readers across the country, demonstrating issues with insurance coverage, pharmacy logistics, and more.

    I’ve published the full responses in the table below. Here are a few common themes that I saw in these stories:

    • Pharmacies aren’t receiving enough vaccines. Several readers shared that their pharmacies had inadequate vaccine supply to accommodate all the people who made vaccination appointments, or who wanted appointments. Vaccine supply may also be unpredictable—a pharmacy may think they’re getting more shots, but in fact not receive them—leading to appointment cancellations.
    • Insurance providers weren’t prepared for this vaccine rollout. Despite months of advance notice that a fall COVID-19 vaccine was coming, many insurance companies apparently failed to prepare billing codes or other system updates that would allow them to cover the shots. A couple of people who shared insurance issue stories are on Medicare—representing a population (i.e. seniors) who should be at the front of the vaccine line.
    • Very limited, confusing vaccine availability for young kids. Several readers shared that they were able to get vaccinated, but their children under 12 have not received a vaccine yet. While the FDA and CDC have authorized this fall’s COVID-19 vaccines for all Americans ages six months and older, younger children require a different vaccine formulation from adults. And this formulation appears either entirely unavailable or very difficult to access, depending on where you live.
    • People living in less dense areas may need to travel. A few readers shared that, as they searched for vaccine appointments in their areas, the closest pharmacies with doses available were miles away—over 10 miles, in one case. This is a significant barrier for people fitting vaccine appointments into their work schedules.
    • Information may be inconsistent. Vaccine availability listed in one place (such as a pharmacy chain’s website or the federal vaccines.gov website) may be inaccurate in another. Some readers shared that they spent extra time on the phone with pharmacies or health providers to get accurate information—another barrier.
    • Pharmacies don’t have enough staff for this. Even readers who were able to receive COVID-19 vaccines often had to wait a long time at their pharmacies. Several shared that their pharmacies appeared to be understaffed, dealing with the COVID-19 shots along with routine prescriptions and other duties. The days of mass vaccination sites, efficiently run by public health departments, are long over.
    • Kaiser Permanente members face delays. One company that appears to be causing outsized problems is Kaiser Permanente, one of the biggest insurers and health providers on the West Coast. Several readers shared that Kaiser was not providing new COVID-19 vaccines until early October, and would not cover the shots if their members went to another location. That’s a big delay, and it may be further impacted by a coming strike at the company.
    • These vaccines are expensive. If you decide to pay for a COVID-19 shot out-of-pocket (as some readers did), it costs almost $200. Even the federal government is paying about triple the cost of last year’s COVID-19 vaccines per shot, for the doses it is covering, STAT News reports. The U.S. may have received a “bad deal” here, STAT suggests, considering all of the federal funding that’s supported vaccine research and development.

    As I wrote last week, some news outlets have covered these challenges, but this issue really deserves more attention. The updated COVID-19 vaccines are basically the U.S. government’s only strategy to curb a surge this winter, and they should be easily, universally accessible. Instead, many people eager to get vaccinated are going through multiple rounds of appointments, phone calls, pharmacy lines, and more.

    For every one of these readers who has persisted in getting their shot, there are likely many other people who tried once and then gave up. And those people who don’t receive the vaccine will be at higher risk of severe illness, death, and long-term symptoms from COVID-19 this fall and winter. This is a public health failure, plain and simple.

    And it’s important to emphasize that this failure is not surprising. Many health commentators predicted that these challenges would arise as the federal public health emergency ended and COVID-19 tools transitioned from government-funded to covered-by-insurance. For more context on why this is happening, I recommend the Death Panel podcast’s latest episode, “Scenes from the Class Struggle at CVS.”

    If you’re a reporter who would like to connect with one of the COVID-19 Data Dispatch readers who shared a story, please email me at betsy@coviddatadispatch.com. Most of the people in the database below shared an email or other contact info.

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    more vaccine coverage

  • Sources and updates, February 5

    • CDC warns of risk to immunocompromised people: As of January 2023, there are no longer any monoclonal antibody treatments available for COVID-19, as these treatments do not provide protection against recent versions of Omicron. The no-longer-effective treatments include Evusheld, a drug used as a protective measure (to reduce risk of symptomatic COVID-19 for immunocompromised people. With Evusheld now unavailable, the CDC issued recommendations last week for people who have severely compromised immune systems. Of course, the CDC’s recommendations are largely targeted to individual action; to actually protet this vulnerable group, all Americans would need to follow collective public health measures.
    • Modeling COVID-19 as a persistent “endemic“: A recent preprint, from researchers at the drug company Fractal Therapeutics and collaborators, estimates just how challenging it is for people to avoid COVID-19 when the disease is not managed at a societal level. The researchers estimated Americans’ long-term COVID-19 risk based on an epidemiological model incorporating frequent reinfections, and limited individual-level protections. People who are vaccinated but don’t take other measures to reduce their risk of getting COVID-19 “can expect to spend an average of 6 days a year acutely sick with COVID-19 and also incur a 12% risk of long COVID (symptoms lasting more than 3 months),” the researchers write.
    • Global COVID-19 vaccination rate: Another new study, published in the CDC’s Morbidity and Mortality Weekly Report, provides an update on global vaccination rates, calculated by researchers at the World Health Organization. According to the WHO team, about 76% of older adults (ages 60 and older) have received a primary series of COVID-19 vaccines. (The study doesn’t report on booster rates, which are likely much lower worldwide.) As the vast majority of COVID-19 deaths worldwide have occurred among this age group, it should be a priority for vaccination, including the primary series and booster doses.
    • COVID-19 litigation database: I recently learned about this database of COVID-related legal documents, run by researchers at the University of Trento in Italy. The database aims to publish case documents from around the world reflecting challenges to COVID-19 policies. As of February 4, it includes documents from 1,978 cases, which can be searched by country, year, type of human rights issue, vulnerable group involved, and more.
    • Flu vaccine works well this year: A bit of non-COVID good news: this season’s flu vaccine is well-matched to the flu strain currently circulating in North America, according to a recent study from Canadian researchers and public health officials. Receiving a flu shot halved an individual’s risk of a severe flu case that needed medical care, the study found. Flu shots often have an effectiveness below 40%, explained STAT’s Helen Branswell on Twitter, as the vaccines do not always perfectly match up to circulating viral strains. But this year, the shot appears to be working well.
    • NYC declares end of mpox epidemic: And one more bit of good news: New York City officials have declared that the city’s epidemic of mpox (formerly called monkeypox) is now over. The city was a hub for mpox transmission last summer and became a center of the U.S. outbreak; but NYC has reported low case numbers since early fall. The federal public health emergency for mpox also recently ended.

    All featured sources

  • Five more things, February 20

    A few additional news items from this week:

    • Omicron has caused more U.S. COVID-19 deaths than Delta. Despite numerous headlines proclaiming the Omicron variant to be “milder” than previous versions of the coronavirus, this variant infected such a high number of Americans that it still caused more deaths than previous waves, a new analysis by the New York Times shows. Between the end of November and this past week, the U.S. has reported over 30 million new COVID-19 cases and over 154,000 new deaths, the NYT found, compared to 11 million cases and 132,000 deaths from August 1 through October 31 (a period covering the worst of the Delta surge).
    • 124 countries are not on target to meet COVID-19 vaccination targets. The World Health Organization (WHO) set a target for all countries worldwide to have 70% of their populations fully vaccinated by mid-2022. As we approach the deadline, analysts at Our World in Data estimated how many countries have already met or are on track to meet the goal. They found: 124 countries are not on track to fully vaccinate 70% of their populations, including the U.S., Russia, Bangladesh, Egypt, Ethiopia, and other large nations.
    • Anime NYC was not an omicron superspreader event, CDC says. In early December, the Minnesota health department sounded the alarm about a Minnesotan whose COVID-19 case had been identified as Omicron—and who had recently traveled to New York City for the Anime NYC convention. The CDC investigated possible Omicron spread at this event, both by contact tracing the Minnesota case and by searching public health databases for cases connected to the event. Researchers found that this convention was not a superspreader for Omicron, despite what many feared; safety measures at the event likely played a role in preventing transmission, as did the convention’s timing at the very beginning of NYC’s Omicron wave. I covered the new findings for Science News.
    • Americans with lower socioeconomic status have more COVID-19 risk, new paper shows. Researchers at Brookings used large public databases to investigate the relationship between socioeconomic status and the risk of COVID-19 infections or death from the disease. Their paper, published this month in The ANNALS of the American Academy of Political and Social Science, found that education and income are major drivers of COVID-19 risk, as are race and ethnicity. The researchers also found that: “ socioeconomic status is not related to preventative behavior like mask use but is related to occupation-related exposure, which puts lower-socioeconomic-status households at risk.” 
    • The federal government has failed to disclose how much taxpayers are spending for “free” COVID-19 tests. One month into the Biden administration’s distribution of free at-home COVID-19 tests to Americans who request them, millions have received those tests. But the government has not shared how much it spent for the tests, making it difficult for journalists and researchers to determine how much taxpayer money was paid for each testing kit. “The reluctance to share pricing details flies against basic notions of cost control and accountability,” writes KHN reporter Christine Spolar in an article about this issue. The government has also failed to share details about who requested these free tests or when they were delivered, making it difficult to evaluate how equitable this distribution has been.

    Note: this title and format are inspired by Rob Meyer’s Weekly Planet newsletter.

  • Sources and updates, February 6

    • Vaccination data from dialysis facilities: A recent addition to the CDC’s COVID Data Tracker, this dataset reports vaccination coverage among patients and staff working in dedicated dialysis facilities, which offer treatment to patients with chronic kidney diseases—a group at high risk for severe COVID-19. The vaccine coverage rates for dialysis staff are new as of this week. Overall, about 74% of dialysis patients and 79% of staff are fully vaccinated, and smaller percentages are boosted, as of late January.
    • CDC report provides vaccination data by sexual orientation and gender identity: As health equity advocates have pushed for more demographic data describing who’s been vaccinated in the U.S., the focus is often on race and ethnicity data. But it’s also important to track vaccinations among the LGBTQ+ community, as these Americans are at higher risk for severe COVID-19 due to HIV, mental health issues, and other conditions common in this group. This new CDC report provides a snapshot of these important data, sourced from the National Immunization Survey. Notably, the report found that vaccine coverage was higher overall among gay and lesbian adults compared to straight adults—but lower among Black LGBTQ+ people across all identities.
    • Association of child masking with COVID-related childcare closures: A new paper published in JAMA Network Open this week provides additional evidence showing that mask requirements can help keep schools and childcare centers open. The paper found that childcare programs where children were masked were 14% less likely to close over the course of a year than programs without child masking. For more commentary on the paper, see Inside Medicine.

    All featured sources
  • CDC says 80% of teachers and childcare workers are vaccinated, fails to provide more specifics

    CDC says 80% of teachers and childcare workers are vaccinated, fails to provide more specifics

    This past Tuesday, April 6, the Centers for Disease Control and Prevention put out a press release that I found heartening, yet confusing.

    “Nearly 80 percent of teachers, school staff, and childcare workers receive at least one shot of COVID-19 vaccine,” the release proclaims. These vaccinations include “more than 2 million” people in these professions who received doses through the federal retail pharmacy program and “5-6 million” vaccinated through state programs, all of whom received shots before the end of March.

    This CDC release is exciting because occupational data—or, figures tying vaccination counts to the jobs of those who got vaccinated—have been few and far between. As I wrote last month, state and local health departments have been unprepared to track this type of data; even getting states to report the race and ethnicity of their vaccinated residents has been a struggle.

    While you may need to be a teacher or fit another essential worker category in order to get vaccinated in your state, your provider may require you to show some proof of eligibility without recording that eligibility status anywhere. Meanwhile, school districts and local public health departments might be wary of surveying their local teachers to see who’s been vaccinated. Madeline Will explains the issue in EdWeek:

    Yet many vaccination sites do not collect or report occupation data, and many districts are not tracking vaccination rates themselves. Some district leaders say they’re wary of asking employees if they’ve gotten vaccinated because they don’t want to run afoul of any privacy laws, although the U.S. Equal Employment Opportunity Commission has said that employers can ask whether employees have gotten a COVID-19 vaccine.

    This brings us to the question: how did the CDC get its 80% figure? The agency’s press release is frustratingly unspecific; it’s all of 282 words long, with just one paragraph devoted to what a data journalist like myself would call the methodology, or the explanation of where the data come from.

    Here’s that explanation:

    CDC, in collaboration with the Administration for Children and Families, the Department of Education, and our non-federal partners, conducted surveys of Pre-K-12 teachers, school staff, and childcare workers at the end of March. CDC received almost 13,000 responses from education staff and nearly 40,000 responses from childcare workers. The responses closely matched available national race/ethnicity and demographic data on this specific workforce.

    Let’s unpack this. The CDC worked with two other federal agencies to conduct a survey of this high-priority occupation group, including 13,000 school staff and 40,000 childcare workers. The agency then extrapolated the results of this 53,000-person survey to estimate that 80% of Americans in these occupations have been vaccinated overall. While the CDC doesn’t provide any detail on how workers were chosen for the survey, the press release notes that responses match demographic data for this workforce, indicating that agency researchers did collect race, ethnicity, and other demographic information for those they surveyed.

    So, here’s my big question: is the CDC planning to release more detailed results from this survey? And if not… why?

    As we’ve noted in past CDD issues, teacher vaccination can go a long way towards inspiring confidence in school reopening programs, in school staff and parents alike. And that confidence is needed right now: February results of the Department of Education’s school COVID-19 survey, released last week, demonstrate that even though the majority of U.S. schools are now offering in-person instruction, only about one-third of students are learning in the classroom full-time. (More on those findings via AP’s Collin Binkley.)

    If the CDC released results of this vaccination survey for individual states and demographic groups, local public health and school district leadership may be able to see how their populations compare and respond accordingly. If, say, Texas is vaccinating fewer teachers than New York, Governor Greg Abbott can make a speech telling his state to step it up.

    And those states where a higher share of teachers have been vaccinated can use the information to inform school opening plans. The CDC’s press release doesn’t specify what share of that 80% vaccinated represents partially versus fully vaccinated school and childcare workers (which would also be useful data!), but even a workforce that was partially vaccinated at the end of March may be ready for in-person work by the end of April.

    All this is to say: show your work, CDC! Give us more detailed data!

    It’s also important to note, though, that while teachers are in the spotlight, they aren’t the only occupation for whom vaccination data should be a priority. Many staff in long-term care facilities have been unwilling to get vaccinated even though it would be a highly protective measure for the seniors they care for, Liz Essley Whyte wrote in late March at The Center for Public Integrity.

    The federal program that partnered with pharmacy chains to get LTC residents and staff vaccinated is now winding down, Whyte reports, even though some states still have a lot of LTC workers left who need shots. In seven states and D.C., less than a third of staff are vaccinated.

    Whyte writes:

    Low vaccination rates among staff at these facilities mean that workers continue to have greater risk of contracting COVID-19 themselves or passing the virus to their patients, including residents who can’t be inoculated for medical reasons. Low staff uptake can also complicate nursing homes’ attempt to reopen their doors to visitors like Caldwell, who are striving for some sense of normalcy.

    The Centers for Medicare & Medicaid Services are hoping to improve data on this issue. This agency proposed a new rule this week that would require nursing homes to tell the CDC how many of their health care workers are vaccinated against COVID-19, POLITICO reported on Friday. This rule would enable the CMS to identify specific facilities that are faring poorly and take appropriate action. And, if such data are made public, it would be easier for both reporters and families of nursing home residents to push for more LTC worker vaccinations.

    Still, privacy concerns continue to be a barrier for more detailed vaccination data of all types. Some of the big pharmacy chains that are administering huge shares of shots are requiring vaccine recipients to share their emails or phone numbers when they register for an appointment—then saving that data to use for future marketing. Getting patient contact information is an easy way to ensure people actually show up for their appointments, but when it’s a private company collecting your phone number instead of your public health department, it’s understandable that people might be a bit concerned about giving any information away.

    More detailed data standards, along with communication between governments and vaccine providers, could have saved the U.S. from the patchwork of vaccination data we’re now facing. But instead, here we are. Asking the CDC to please send out a longer press release. Maybe with a state-by-state data table included.

    more vaccine coverage

  • Federal data updates, Feb. 7

    Since our main stories this week focused on NYC, here are a couple of updates from the federal public health agencies.

    • CDC releases demographic vaccination data: This past Monday, the CDC published a MMWR report on characteristics of Americans vaccinated during the first month of our vaccine rollout, December 14 to January 14. Race/ethnicity data are missing for almost half of the vaccinations recorded here, but the existing data show white Americans getting vaccinated at higher rates than Black and Hispanic/Latino Americans.
    • CDC vaccination dashboard now includes time series: As of Thursday, the CDC’s COVID Data Tracker now includes a page called “Vaccination Trends,” which shows daily counts of total doses administered, people receiving 1 dose, and people receiving 2 doses. The doses are assigned to the date they’re administered, not the date they’re reported, so they may not match time series on other dashboards. Time series aren’t yet available for individual states.
    • KFF reports COVID-19 vaccinations by race/ethnicity: The Kaiser Family Foundation’s “State COVID-19 Data and Policy Actions” tracker now includes a dashboard with vaccinations by race/ethnicity, including data from 23 states as of Feb. 1. KFF says the data will be updated on a regular basis.
    • U.S. Department of Education surveying COVID-19’s impact for students: On Friday, the Department of Education announced that the Institute of Education Sciences would collect “vital data on the impact of COVID-19 on students and the status of in-person learning.” Data gathered in the survey will include the share of America’s schools that are open in-person vs. remote, enrollment by various demographic metrics, attendance rates, and information on the logistics of in-person and remote instruction. Notably, the survey does not promise to collect data on COVID-19 cases, hospitalizations, and deaths associated with K-12 schools.
    • At-home tests are coming: This week, the White House announced that the new administration has contracted with diagnostic company Ellume and six other suppliers to produce tens of millions of at-home tests by the end of the summer. Ellume’s test is an antigen test, and, though the other test suppliers haven’t yet been announced, we can assume they also make antigen or rapid nucleic acid amplification tests; neither test type is currently reported by the federal government. If these tests do become a significant part of America’s COVID-19 response—and some experts are skeptical that this will happen—a major change in test reporting practices will be needed.
    more federal data
  • Access barriers lead to vaccination disparity in NYC

    Access barriers lead to vaccination disparity in NYC

    27 states are now reporting race and ethnicity data for their vaccinations. This week, New York joined that number. New York City also started reporting these data last Sunday, as we noted in that day’s issue. Despite promises from city and state leadership to prioritize equity in the vaccine rollout, the numbers so far are showing white New Yorkers getting vaccinated at much higher rates than their Black and Hispanic/Latino neighbors.

    Here’s one way of visualizing the disparity: Black New Yorkers make up 25% of NYC’s population, but only 12% of those vaccinated. Latino New Yorkers make up 29% of the population, but only 15% of those vaccinated.

    Here’s another way of visualizing the disparity: about 4.6% of white NYC residents have been vaccinated, compared to 2.2% of Latino New Yorkers and only 2% of Black New Yorkers. White New Yorkers are getting vaccinated twice as fast as their neighbors. This is particularly striking when you consider that Black and Latino New Yorkers disproportionately make up our essential workers—they constitute the majority of grocery workers, public transit workers, healthcare workers, childcare workers, and cleaning services workers, according to a March 2020 report by the NYC Comptroller’s office.

    (Note: Asian American and Pacific Islanders make up a disproportionately large share of healthcare workers and Pacific Islanders have been particularly hard-hit by the pandemic; these two factors may help explain the high rate of vaccinations in the NYC Pacific Islander community.)

    As someone who lived in NYC during the height of the city’s spring surge, I’ve seen how hard the pandemic has hit my neighbors of color. Sirens screamed through my north Brooklyn neighborhood at all hours, and hundreds of requests for aid came into my local mutual aid group. About 7,400 Black New Yorkers and 8,000 Latino New Yorkers have died of COVID-19 since the pandemic hit this city. In any version of an equitable vaccine rollout, these communities should be first in line.

    So, what’s happening? Why are vaccinations for Black and Brown New Yorkers lagging? The answer is a combination of poor planning and poor access. The city didn’t set up appropriate systems to tell its most vulnerable communities about the vaccines or help them set up appointments. As a result, those NYC residents who have the time, know-how, and internet access to navigate a complex system are snapping up appointments—and you can guess which residents those are.

     “What we’re going through now with the vaccine rollout reminds me of what we were going through at the beginning of the pandemic,” said Dr. Uché Blackstock, emergency physician and founder of the organization Advancing Health Equity, at a webinar with City Councilmember Mark Levine this past week. She described how she struggled to get enough tests and PPE to care for her patients—many of whom were Black and Latino essential workers—last spring.

    Now, there’s both a supply gap and an information gap. In one example now infamous in the city, a vaccination site in Washington Heights (home to NYC’s Little Dominican Republic) was primarily catering to white patients from other parts of the city, the suburbs, and even New Jersey. Josefa Velasquez, a reporter at THE CITY who exposed the problems at this site, described how the vaccination center was ill-equipped to serve the population in its neighborhood:

    At the door, most people entering appeared to be white and unfamiliar with the neighborhood. Some asked security guards where they could find parking. Nylon Longchamp handbags and Burberry scarves stood out.

    Outside of the site, run by NewYork-Presbyterian Hospital near its Washington Heights medical center complex, Olga encountered another language barrier: None of the handful of guides and security guards outside directing people spoke Spanish.

    Velasquez herself actually helped translate for some of the seniors trying to get vaccinated. After her reporting brought the vaccination center’s problems to light, the center limited all new appointments to NYC residents and reserved 60% of slots for Washington Heights residents. But the story is still indicative of larger issues: NYC data show that 23% of vaccinations in the city have gone to non-residents, and a significant majority of those non-residents are white.

    Even when appointments are reserved for New Yorkers, barriers to vaccine access remain. Just this week, Yankee stadium opened as a vaccination site with all doses reserved for residents of the Bronx. Councilmember Levine posted on Friday that thousands of these appointments were still open, unreserved—while appointments elsewhere in the city get snapped up in minutes.

    A reply to Levine’s Tweet reveals one reason: Bronx residents can’t access these Yankee stadium appointments through the NYC vaccination website, because this clinic is run by a network of private physicians. The city website is confusing enough already for many New Yorkers—and now that website doesn’t even encompass all available appointments.

    Some residents of the Bronx also associate the stadium with invasions of their community: 

    At the same webinar that I cited earlier, Councilmember Levine announced a redesign of the official NYC vaccine appointment scheduler. The site’s design has been simplified and made more accessible. On the homepage, for example, users are provided with four options: Schedule First Dose, Schedule Second Dose, Reschedule Appointment, Cancel Appointment. But users still have to navigate through a checklist and input a lot of personal information in tiny boxes. And, while NYC does have a vaccine hotline, it “hasn’t been adequately staffed,” according to Levine—nor is there adequate translation.

    In an ideal world, Dr. Blackstock suggests that doctors should call all their patients proactively to offer vaccine appointments. Community health workers should go door-to-door. Vaccination centers should be set up in every low-income housing development. NYC clearly dedicated nor the advance planning time nor the funding to such proactive measures. But the least we can do should be setting up an easy-to-use website and phone line, right?

    (We also need more data on vaccinations by occupations, preexisting health conditions, and ZIP codes—but that’s a topic for another issue.) 

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