State’s vaccine equity lagging
CDC report highlights vulnerable communities
California ranks among the five worst states in getting its poorest and most vulnerable residents vaccinated against the coronavirus, according to a report released Wednesday by the U.S. Centers for Disease Control and Prevention.
California is one of 31 states falling short on equitable vaccine coverage, according to the CDC’s Morbidity and Mortality Weekly Report, which analyzed vaccines administered during the first twoandahalf months of the U.S. vaccination campaign, from Dec. 14 to March 1. It is the first report using national vaccination surveillance data focused on social vulnerability to look at equity, said the report’s lead author, CDC epidemiologist Michelle Hughes.
“While this is just a first look at how the vaccine is being administered nationwide, it tells us we need to continue to ramp up our efforts to ensure fair and equitable access to COVID19 vaccine,” Hughes said Wednesday.
The analysis ranks each state in terms of the proportion of vaccines that have gone to the most vulnerable counties, measured by a socalled social vulnerability index — which looks at income, unemployment, education level, housing and other socioeconomic factors.
The states doing the best on equitable vaccinations are Montana, Alaska, Arizona and West Virginia, according to the report. This means they have vaccinated their most vulnerable residents, who tend to be poorer, at higher or similar rates as they have the least vulnerable — typically wealthier — residents. Other states that rank low on the list, below California, are New Hampshire, Idaho, Maryland and Kansas.
Public health experts say it is critical to vaccinate the poorest, most vulnerable communities faster because that is where the virus is more widespread, and where residents are at higher risk of contracting and spreading the virus for a number of reasons — including not being able to work from home or living in crowded households.
California’s Department of Public Health was not surprised by the CDC’s findings.
“Vaccines are the light at the end of the tunnel, but we need to make sure that light is equally bright for all,” said a spokesman. “This report reinforces California’s own data showing that those most impacted by the pandemic aren’t receiving vaccines at a rate commensurate with the rest of the population. That’s why the state announced on March 4 that it would be doubling the allocation of vaccines to hardest hit areas, when compared to the rest of the state.”
The report showed states that are struggling with equity are vaccinating at higher rates in the areas where vulnerability is not as much an issue and people are largely wealthier. The opposite is true for states that are performing better on equity — they had better vaccination rates in vulnerable areas. In California, for instance, 18.4% of people in low vulnerability areas were vaccinated, compared with 14.2% of people in the more vulnerable communities. By contrast, in Alaska, 22% of people in areas characterized as low vulnerability were vaccinated, compared with 32.2% of people living in the vulnerable areas.
“States showed a wide range of success in vaccinating their highvulnerability populations,” Hughes said. “The majority had the lowest (vaccine) coverage in counties with the highest levels of social vulnerability.”
The report did not look at why these disparities occurred. But it noted that betterperforming states had prioritized people in racial or ethnic minority groups during early stages of the vaccine rollout, addressed barriers to vaccination and directed vaccines to vulnerable communities, offered free transportation to vaccination sites, and collaborated with community partners.
“More investigation is needed to understand these differences to identify best practices to achieve COVID19 vaccination equity,” the report said.
The CDC’s findings mirror California vaccination data that shows wealthier communities are getting inoculated at higher rates than poorer areas. In California’s wealthiest areas — defined by the California Healthy Places Index, which looks at income, housing, education and health care access — about 19% of people are fully vaccinated, and 16% have received their first shot. In the poorest communities, just 9% of people are fully vaccinated and 12% have received a first shot. The Pfizer and Moderna vaccines are twodose regimens, while Johnson & Johnson’s entails just one shot.
To combat vaccine disparities, California this month started a new vaccine equity plan that allocates 40% of vaccines to the state’s poorest ZIP codes.