COVID-19 vaccination data shows troubling inequities persist

Despite the widespread availability of COVID-19 vaccines since December 2020, sociodemographic inequities in vaccination rates—and preventable COVID-related deaths—have persisted.

A study by Jenny S. Guadamuz, assistant professor of health policy and management at UC Berkeley School of Public Health, reveals disturbing patterns in the national data gathered in 2022.

Writing in the Journal of the American Pharmacists Association, Guadamuz reports that 48% of White adults and nearly 67% of Asian adults received at least two COVID-19 vaccines and at least one booster shot. In contrast, Guadamuz found that only 35% of both Black and Latinx adults received the same number of COVID-19 inoculations.

Guadamuz also reported that people without US citizenship, experiencing food insecurity, living in poverty, or without a usual source of medical care also received fewer COVID-19 vaccines. The biggest discrepancy was present among people without health insurance. Only 17% of the uninsured received two COVID-19 vaccines and a booster shot.

“The CDC has issued guidance recommending near-universal adult vaccination, including two initial monovalent doses (issued April 2021), a monovalent booster (November 2021), and a bivalent booster (November 2022),” Guadamuz wrote. “Yet inequities—or avoidable, unnecessary, unfair and unjust differences—in COVID-related deaths have persisted.”

Guadamuz’s study is based on the 2022 National Health Interview Survey, an annual nationally representative survey conducted by the Centers for Disease Control and Prevention. It includes 27,126 adults.

It follows earlier analyses of COVID-19 vaccination of 2021 data, which suggested that sociodemographic factors such as demographics, economics, and healthcare access, may influence COVID-19 vaccination, and subsequent inequities in COVID deaths.

Many of the earlier studies, Guadamuz wrote, relied on area-level rather than individual-level economic measures, and did not capture receipt of COVID-19 boosters.

Given the ongoing rollout of the fall/winter 2023 updated bivalent COVID-19 vaccine, she called for a national, comprehensive, and up-to-date evaluation of individual-level vaccination inequities.

“This evaluation is crucial to inform policy interventions for achieving equitable COVID-19 protection and minimize preventable COVID deaths, particularly among economically/socially marginalized populations,” Guadamuz wrote.

In an interview, Guadamuz said that early in the pandemic, it was clear that many minoritized populations were not being vaccinated.

“Now we can say that it’s also low-income people, and those without enough food to eat,” she said.

One barrier, according to Guadamuz, is that most pharmacies require people to show identification before getting vaccinated—even though the federal government has no such requirement. Another problem is the logistical difficulties of getting to a pharmacy, which might be far away.

She suggests that improving reimbursement to pharmacies would encourage more non–chain stores to participate in vaccination.

“Chain pharmacies [brands] are more likely to be located in Whiter and higher income neighborhoods,” Guadamuz said.

No funding was reported for this study. Dr. Guadamuz reported previous employment with Flatiron Health Inc., an independent subsidiary of the Roche group, within the past year.

People of BPH found in this article include: