Addressing racial/ethnic disparities in the COVID-19 vaccination campaign

  1. Marissa B. Reitsma
  2. Jeremy D. Goldhaber-Fiebert
  3. Joshua A. Salomon

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Abstract

Background

As of April 19, all adults aged 16 years and older are eligible for COVID-19 vaccination. Unequal vaccination rates across racial/ethnic groups may compound existing disparities in cases, hospitalizations, and deaths among Black, Indigenous, and Hispanic communities.

Methods

From state websites, we extracted shares of people receiving ≥1 vaccine dose, stratified by age and separately by race/ethnicity, through March 31, 2021. Combining these data with demographic data from the American Community Survey, we estimated relative uptake rates by race/ethnicity within each state as the observed share of vaccinations for a racial/ethnic group, divided by the expected share if uptake across racial/ethnic groups within each age group were proportional to population size, an approach that allowed us to control for historical age-based eligibility. We modeled vaccination scale-up within each census tract in a state under three scenarios: 1) a scenario in which unequal uptake rates persist, 2) a scenario in which uptake rates are equalized across race/ethnicity groups over six weeks, and 3) a scenario in which uptake is equalized and states employ place-based allocation strategies that prioritizes disadvantaged census tracts.

Results

White adults received a disproportionate share of vaccinations compared to Black and Hispanic adults through March 31, 2021. Across states, relative uptake rates, adjusted for eligible population size, were a median 1.3 (IQR, 1.2-1.4) times higher for White compared to Black adults, and a median 1.4 (IQR, 1.2-1.8) times higher for White compared to Hispanic adults. Projecting vaccination coverage under persistence of current disparities in uptake, we found that Black and Hispanic populations would reach 75% coverage among adults almost one month later than White populations. In alternative scenarios, we found that interventions to equalize uptake rates across racial/ethnic groups could narrow but not erase these gaps, and that geographic targeting of vaccine doses to disadvantaged communities may be needed to produce a more equitable convergence of coverage by July.

Discussion

Interventions are urgently needed to eliminate disparities in COVID-19 vaccination rates. Eliminating access barriers and increasing vaccine confidence among marginalized populations can narrow gaps in coverage. Combining these interventions with place-based allocation strategies can accelerate vaccination in disadvantaged communities, who have borne a disproportionate burden from COVID-19.

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  1. ScreenIT

    SciScore for 10.1101/2021.04.21.21255878: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Ethicsnot detected.
    Sex as a biological variablenot detected.
    RandomizationThis assumed that race/ethnicity was missing at random.
    Blindingnot detected.
    Power Analysisnot detected.

    Table 2: Resources

    No key resources detected.

    Results from OddPub: Thank you for sharing your code and data.

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    The findings of our study should be interpreted in the context of its limitations. First, our relative uptake rates were estimated based on a cross-sectional snapshot of vaccination data. Future work should monitor trends in uptake rates and utilize these to inform projections. Second, projection scenarios are based on a simplifying assumption that state-level vaccination rates would remain constant at the seven-day average levels observed on April 1. Although supply is likely to fluctuate in actuality, within-state disparities between racial/ethnic groups are unlikely to be markedly different under alternative supply assumptions. Third, a substantial proportion of vaccinations are attributed to individuals of either “Other” or “Unknown” race/ethnicity. Despite these limitations, our study provides important information on disparities in vaccination, the persistence of inequitable risks if unequal uptake continues, and key elements of vaccination campaigns for states to consider in order to address these inequities. States should work to achieve equitable vaccination coverage through interventions that act on both vaccine supply and demand. Multiple states have implemented place-based allocation schemes (4). Actions are also needed to eliminate transportation and language barriers, minimize unfair competition for appointments (e.g. by adopting pre-registration systems), increase vaccine confidence among marginalized populations, and accommodate work schedules and time off for...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

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  2. Version published to 10.1101/2021.04.21.21255878v2 on medRxiv
  3. Version published to 10.1101/2021.04.21.21255878v1 on medRxiv