The Perfect Enemy | Studies reveal racial disparities in early US COVID vaccine rollout
August 11, 2022

Studies reveal racial disparities in early US COVID vaccine rollout

Jul 28, 2022

Though vaccine hesitancy plays a role, decreased access to vaccination sites may be another overlooked barrier, researchers suggest.

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COVID-19 vaccines were less likely to be distributed to US healthcare facilities if they were in counties with a high proportion of Black residents, and racial differences in vaccine uptake may be mainly due to anti-vaccine beliefs among Black adults, according to two new studies highlighting racial disparities in vaccine availability and coverage early in the country’s rollout.

Role of Black population, urbanicity

In the first study, published today in PLOS Medicine, a team led by University of California San Diego researchers studied the availability of COVID-19 vaccines at US healthcare facilities in May 2021. The study included 50,806 community pharmacies, 11,619 federally qualified health centers, 3,187 hospital-based outpatient departments, and 1,255 rural health clinics in 2,942 counties.

Nationwide, 61.4% of eligible healthcare facilities and 76.0% of eligible pharmacies provided COVID-19 vaccines. But facilities in counties in which Black residents made up over 42.2% of the population were less likely to be COVID-19 vaccination sites than those in counties with less than a 12.5% Black population (odds ratio [OR], 0.83; 95% confidence interval [CI], 0.70 to 0.98).

Similarly, sites in rural counties (versus metropolitan counties) had lower odds of administrating the vaccines (OR, 0.82; 95% CI, 0.75 to 0.90), as did counties in the top 20% for death rates (OR 0.83; 95% CI, 0.75 to 0.93).

Urbanicity and racial composition were significantly linked only in metropolitan counties. Among these counties, those in which Black residents made up over 42.2% of the population were 32% less likely to administer COVID-19 vaccines than those with less than a 12.5% Black population.

Facilities in rural counties with Hispanic populations above the US average were 26% less likely to serve as vaccine administration sites than those with below-average Hispanic populations. This link was not seen in metropolitan or suburban areas.

“Healthcare facilities in counties with higher Black composition, in rural areas, and in hardest-hit communities were less likely to serve as COVID-19 vaccine administration locations in May 2021,” the study authors wrote. “The lower uptake of COVID-19 vaccinations among minority populations and rural areas has been attributed to vaccine hesitancy; however, decreased access to vaccination sites may be an additional overlooked barrier.”

They called for more careful distribution of COVID-19 vaccines in underrepresented populations, because these groups are less likely than White Americans to live near a healthcare facility and may be more vulnerable to severe illness.

45.1% report distrust of government

Recently in Social Science & Medicine, Penn State and University of Texas at Austin researchers published a survey study of 1,936 18- to 65-year-old unvaccinated US participants in the COVID-19 and its Implications for American Communities (CIAC) study in February and March 2021. This period came before all adults became eligible for COVID-19 vaccines on Apr 19, 2021. 

The survey asked participants to rate their vaccine hesitancy on a 5-point scale, with a low score indicating high likelihood of vaccine receipt, and a high score indicating no plans to be vaccinated. Of all respondents, 61.8% were White, 14.5% were Black, 6.1% were foreign-born Hispanic, and 17.5% were U.S.-born Hispanic.

Overall, the average score for vaccine hesitancy was 2.9, indicating a higher likelihood of vaccine receipt. A total of 30.3% said they would definitely get vaccinated, while 26.2% said they did not plan to do so.

The average number of reported anti-vaccine beliefs was 1.0, and the most common of those beliefs (cited by 45.1% of respondents) was that the government can’t be trusted to be honest about vaccine risks. Nearly half (48.7%) of participants said they knew someone who was infected by or died of COVID-19, 49.5% said they worked outside the home, 30.2% said they had an underlying medical condition that put them at high risk for infection, and 27.7% indicated that they were politically liberal.

Reluctance to receive COVID-19 vaccines was significantly higher among Black respondents (average, 3.2) than among their White counterparts (2.9), and was lowest among US-born Hispanic participants (2.8). Black Americans also had significantly lower odds of saying that would definitely get vaccinated than White adults (21.6% vs 33.1%).

Similar levels of vaccine hesitancy were noted among White and Hispanic participants, regardless of where the latter were born. Hispanic adults born in the United States were significantly less likely than their White peers to say they would definitely get vaccinated (28.6% vs 33.1%), a difference offset by their significantly higher odds of saying they would very likely seek vaccination (17.2% Hispanic vs 11.1% White).

Black respondents had significantly more anti-vaccine beliefs than any other group, and along with US-born Hispanic respondents, had significantly greater odds of reporting specific anti-vaccine beliefs than their White counterparts, except for beliefs about the COVID-19 vaccine’s effects on fertility.

Foreign-born Hispanic participants were much more likely than White respondents to say that the US government is not being honest about vaccine risks (52.7% vs 37.6%). A higher proportion of Black respondents reported having a condition that placed them into a high-risk category for COVID-19 than White or US-born Hispanic participants (34.5% vs 29.8% vs 26.1%). Foreign-born Hispanic respondents also had significantly higher rates of high-risk conditions than White or US-born Hispanic participants.

“Anti-vaccine beliefs account for 70.6% of the Black-White disparity in vaccine hesitancy (0.24 of the 0.34 difference),” the researchers wrote. “Group differences in education and age also contribute to this disparity, which would be larger if not for the dampening effect of Black adults’ more liberal political leanings.”

The finding that foreign-born Hispanic participants were no more or less likely to be vaccine-hesitant was surprising, lead author Michelle Frisco, PhD, said in Penn State press release. “We thought that this was important, as we theorized that immigrants may be more vaccine hesitant than their U.S.-born peers for several reasons, including fear of being deported in a political climate where foreign-born adults were afraid of being labeled as ‘public charges’ if they received free vaccines,” she said.

The authors noted that Black and Hispanic Americans have borne greater COVID-19 pandemic burdens, including higher rates of infection, hospitalization, and death, than their White peers.

They said that education combatting anti-vaccine beliefs, as well as efforts to improve education to alleviate medical distrust and structural racism are crucial to increasing COVID-19 vaccine uptake. “The results have important implications for current Covid-19 vaccine booster efforts and future booster efforts that are almost certain to emerge as we learn more about vaccine durability and new Covid-19 variants,” they wrote.