Pandemic and Inequities: What is Vaccine Inequity and How Does It Relate to Covid-19?
After two years of the pandemic, several waves of variants and numerous lockdowns, the United States has made vast progress in devising novel technology and medicine to slow the spread of the coronavirus. Specifically, the development and administration of vaccines has not only slowed infection and reduced the symptoms of Covid-19, but has also brought a sense of normalcy to our daily lives. In fact, the distribution of vaccines has reached a significant portion of the U.S. population. As of March 2020, 556 million Covid-19 vaccines have been given and 76.5% of the U.S. population has received at least one dose (1,2).
Though the United States has made considerable progress in vaccine distribution, the coverage has not been even, with low-resource and marginalized communities lacking access to vaccines. Given that the unvaccinated population is particularly vulnerable to infection/severe illness and eligibility for boosters are expanding, it is especially important to understand vaccine inequity in the context of the pandemic and its root causes. Thus, we can better understand why certain populations lack access to treatment that should be available to all and hopefully take a step forward in bringing more vaccine coverage across the United States.
Vaccine inequity can be defined as the lack of equitable or unfair distribution of vaccines across all populations (3). So, in order for there to be vaccine equity, communities regardless of race, socioeconomic status, background and geography must have the necessary access to vaccines. Considering this definition in the context of Covid-19, the pandemic has revealed that developing and distributing an equal amount of vaccines to each region is not enough; rather, there are existing inequities that are rooted in material circumstances such as neighborhood/transportation and structural issues such as healthcare policy and racial discrimination that impacts a community’s access to vaccines.
Before detailing the specific root causes behind the lack of access to Covid-19 vaccines, and vaccine access in general, it is important to note that this article will provide a basic outline behind the disparities in vaccine coverage in the United States. Issues such as race, socioeconomic status, and cultural values are complex issues that require a more in depth exploration beyond the introductory scope of this article.
First, structural determinants (factors that are rooted in governance and economic/social policy) such as socioeconomic status and race play a crucial role in access to vaccines. According to the Center of Disease Control (CDC), Black and Latinx communities respectively make 7.2% and 7.4% of total COVID-19 vaccinations but respectively make up 12.2% and 18.5% of the population (4). Racial inequities in vaccine access are intertwined with reasons that extend to socioeconomic status, policies and cultural values. For example, in considering the United State’s history of racial discrimination and injustices, many minority groups have been historically subjected to medical racism and even medical experimentation. As a result, Black and Latinx communities may face distrust in the medical system and hesitancy towards getting vaccinated. In fact, Covid-19 vaccination hesitancy among Black and Latinx communities was at 41.6% and 31.2% respectively in comparison to the 26.2% of the general adult population (5).
In considering the root causes behind vaccine inequities, marginalized Black, Latinx, and low-resource communities not only lack equitable access to vaccines, but they are also especially vulnerable to exposure to Covid-19. In examining the demographics of infected individuals in the United States, “Black, Hispanic, and AIAN people have experienced higher rates of COVID-19 infection and death compared to White people'' (10). Thus, it is especially important to understand vaccine hesitancy in the context of race.
Additionally, in considering socioeconomic status, lower socioeconomic populations generally receive less access to health care resources and thus exhibit lower acceptances of public health measures such as vaccination (6). Specifically, it was reported that “individuals with an annual income under $40,000 had a 68 percent partial vaccination rate, compared with 79 percent for incomes $90,000 or higher” (7). The significant vaccine disparity among socioeconomic classes exemplifies a need to bring more equitable vaccine access to low-income populations. In encouraging under-resourced populations to get vaccinated, education and community engagement is especially necessary to raise awareness on the importance of getting vaccinated and to dispel any hesitation.
Along with vaccine hesitancy, physical inaccessibility of vaccine sites and appointments are also important factors in vaccine inequity.
Material circumstances (factors such as neighborhood, work environment, financial means, and physical environment that are influenced by structural determinants) such as neighborhood and housing directly feed into vaccine access. Specifically, mass vaccination sites may not be located in low-resource communities or communities of color. According to the United States Census Bureau, vaccination sites tended to be located near predominantly white neighborhoods and were farther away from historically minority neighborhoods. The differences were most pronounced in the Southern region (9). Additionally, rural areas face a lack of healthcare in general due to scarcity of resources. If an individual does not have access to affordable and reliable transportation, it can be particularly difficult arriving on time for a scheduled appointment or even getting to a more distant vaccination site. Barriers such as disability status can also further hinder this access.
The process of signing up for an appointment also presents barriers. Online vaccination registration can be inaccessible to individuals whose primary language is not included on websites and for older populations who may have difficulty navigating the online format. In fact, according to the Pew Research Center, “27% of adults do not consider themselves to be internet users” (8). Difficulty in navigating vaccine registration is exacerbated by socioeconomic status as individuals may not even find appointments in their community or lack access to technology.
In considering the root causes behind vaccine inequities, marginalized Black, Latinx, and low-resource communities not only lack equitable access to vaccines, but they are also especially vulnerable to exposure to Covid-19. Taking next steps to closing the disparities can range from tackling issues with medical mistrust to healthcare access. Whether it is increasing racial/ethnic representation in vaccine clinical trials or creating a more equitable distribution of vaccine clinics, especially in accessible locations such as churches or housing units, there is a wide-range of solutions that can take a step forward towards bringing equity in vaccine access. Such steps can be further explored in upcoming articles.
1 “More Than 11.1 Billion Shots Given: Covid-19 Tracker.” Bloomberg.com, Bloomberg, https://www.bloomberg.com/graphics/covid-vaccine-tracker-global-distribution/.
2 Nambi Ndugga. “Latest Data on Covid-19 Vaccinations by Race/Ethnicity.” KFF, 9 Mar. 2022, https://www.kff.org/coronavirus-covid-19/issue-brief/latest-data-on-covid-19-vaccinations-by-race-ethnicity/.
3 “Vaccine Equity.” World Health Organization, World Health Organization, https://www.who.int/campaigns/vaccine-equity.
4 “CDC Covid Data Tracker.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, https://covid.cdc.gov/covid-data-tracker/#vaccinations_vacc-total-admin-rate-total.
5 Y;, Khubchandani J;Macias. “Covid-19 Vaccination Hesitancy in Hispanics and African-Americans: A Review and Recommendations for Practice.” Brain, Behavior, & Immunity - Health, U.S. National Library of Medicine, https://pubmed.ncbi.nlm.nih.gov/34036287/.
6 Caspi, Gil, et al. “Socioeconomic Disparities and Covid-19 Vaccination Acceptance: A Nationwide Ecologic Study.” Clinical Microbiology and Infection : the Official Publication of the European Society of Clinical Microbiology and Infectious Diseases, European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd., Oct. 2021, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8183100/.
7 “Income Inequity Persists in COVID-19 Vaccination Rates.” Roll Call, 28 Oct. 2021, https://rollcall.com/2021/10/27/income-inequity-persists-in-covid-19-vaccination-rates/.
8 “Demographics of Internet and Home Broadband Usage in the United States.” Pew Research Center: Internet, Science & Tech, 23 Nov. 2021, https://pewresearch-org-preprod.go-vip.co/internet/fact-sheet/internet-broadband/.
9 “Across The South, COVID-19 Vaccine Sites Missing From Black And Hispanic Neighborhoods.” National Public Records, 5 Feb. 2021.
10 “Covid-19 Cases and Deaths by Race/Ethnicity: Current Data and Changes over Time.” KFF, 22 Feb. 2022, https://www.kff.org/coronavirus-covid-19/issue-brief/covid-19-cases-and-deaths-by-race-ethnicity-current-data-and-changes-over-time/#:~:text=Discussion,across%20racial%20and%20ethnic%20groups.