Though we lack a complete picture of COVID-19 vaccine distribution, reports from states with available data suggest vaccines have not been distributed equitably across racial and ethnic groups so far. Black and Hispanic/Latinx people have been less likely to receive the vaccine than white people, despite suffering higher overall COVID-19 case and mortality rates and being more likely to work jobs that put them at greater exposure risk. Many factors have likely contributed to inequitable vaccine distribution.
Mitigating disparities in vaccine administration will require explicitly prioritizing equity to ensure communities with the highest COVID-19 risk get vaccinated. And as Marcella Nunez-Smith, chair of President Biden’s COVID-19 equity task force, stated, “We cannot ensure an equitable vaccination program without data to guide us.”
How are policymakers considering and monitoring equity in vaccine distribution?
Vaccine distribution plans are largely under state and local control, which is creating variation in vaccine rollouts. Though 25 states articulated their intention to consider racial and ethnic equity in their vaccine distributions, many have shifted to age-based criteria amid pressure to distribute vaccines quicker. States have, in turn, urged local vaccination efforts to improve expediency. Maryland has threatened to reduce the supply for providers or facilities that fail to administer 75 percent of their allocated doses (PDF). This may decrease willingness to methodically focus distribution on those at greatest risk, which could exacerbate racial health disparities.
Some localities, though, are explicitly structuring distribution plans to take equity into account. Chicago has distributed vaccines to communities based on factors such as COVID-19 impact and socioeconomic, demographic, and occupational characteristics. This can lead to tensions between localities and states. In Texas, the state threatened to withhold vaccines from Dallas County if it enacted a plan to address disparities in vaccination rates.
What steps can policymakers take to ensure more equitable vaccine distribution?
Strategies state and local governments could take to prioritize equitable vaccine distribution include the following:
Collect complete, high-quality race and ethnicity data when administering vaccinations
Collecting race and ethnicity data on disease burden and other consequences of the pandemic has helped identify disparities, but as shown in Urban’s COVID-19 resource tracker, there is substantial variation in how states are tracking COVID-19 across populations and sectors. A federal mandate to improve data collection last summer increased race and ethnicity reporting for COVID-19 cases and deaths. But the federal demographic data collection requirement does not extend to COVID-19 vaccinations; as of early February, only 23 states report race and ethnicity data for vaccinations. Even when states report data, the share missing race data can be high, and the share missing ethnicity information is far higher.
A similar data collection requirement for vaccinations could be issued and expanded to include primary language, residential location, and occupation to allow public health administrators to monitor whether vaccines are reaching priority populations, including people of color and high-exposure workers. Data collection efforts should ensure sensitive information such as Social Security numbers are never collected, explain why individual demographic data are needed and how they will be used and protected, and allow individuals to opt out of providing information to ensure vaccine uptake.
The Biden administration has declared its pandemic response will be data driven and has proposed allocating $20 billion to vaccine distribution—100 times as much as the previous administration offered—indicating potential resources and guidance for improving state and local data collection capabilities could be forthcoming. Nunez-Smith has also made it clear the administration will work to address the insufficient collection of race and ethnicity data.
Increase vaccine availability in hard-hit communities
Vaccine distribution efforts require real-time information to identify the groups most at risk of contracting COVID-19 and determine where and how to reach them. Even when vaccination sites are established in communities at greater risk of virus exposure, vaccines have sometimes been administered to residents of wealthier areas who are better able to navigate the system. Collecting geographic and demographic data from those vaccinated allows governments to respond to disparities and adjust distribution efforts. Washington, DC, analyzed vaccine uptake by location of residence, which led the city to prioritize vaccines only to communities most affected by COVID-19.
State and local governments have implemented a variety of approaches to ensure those at greatest risk of virus exposure have access to vaccines. These include setting site hours convenient to working people, including same-day and walk-in appointments; reserving vaccines for those who live in hard-hit communities; offering alternatives for signing up to people with difficulties using technology; converting churches and other facilities into temporary vaccination sites to increase capacity in areas with fewer health facilities; and training paramedics and outfitting vans to provide vaccinations to those with transportation limitations.
Address vaccine hesitancy among populations at high-risk for exposure
Surveys have documented variation in COVID-19 vaccine hesitancy by characteristics such as age, political party, and residential location, as well as by race and ethnicity. Hesitancy may stem from concerns and misinformation about potential side effects or effectiveness of the vaccines, as well as for groups such as Black adults, mistrust of a health care system that has historically exploited people of color and continues to exhibit disparities in treatment.
To strengthen trust in the vaccine’s safety and efficacy and increase vaccination rates among Black and other communities disproportionately affected by the pandemic, states and local public health authorities should consider evidence-based strategies for reaching these groups. These strategies could include seeking community input into developing culturally and linguistically effective communications campaigns that debunk vaccine myths and establishing partnerships with trusted community leaders and community-based organizations, such as faith-based organizations, community activists, advocacy groups, social services providers, schools, community health workers, academic institutions, safety net health care providers, and pharmacy networks, to distribute information and vaccines.
Monitoring inequities could become even more important as vaccine distribution moves from prioritized groups to the general population, expanding the recipient pool. As distribution continues, collecting, sharing, and using data on race, ethnicity, and other indicators—including for smaller groups such as Indigenous and Asian populations, whose data are often not separately analyzed—will be critical to reducing disparities in health outcomes during and after the pandemic.
This post was edited to clarify that DC’s approach to COVID-19 vaccine distribution prioritizes vaccines for communities most affected by COVID-19. It doesn’t restrict vaccines to these communities (edited 2/8/2021).