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

BackgroundAs 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. MethodsFrom 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. ResultsWhite 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. DiscussionInterventions 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.