When reports showed that COVID-19 vaccination rates were lower among racial/ethnic minority groups, most discussions focused on mistrust and misinformation among these populations or their reduced access to health care facilities. But new research from the University of California San Diego and collaborating institutions has identified an additional barrier to equity: whether each healthcare facility actually receives and administers vaccines.
In a study published on July 28, 2022 in PLOS Medicine, researchers demonstrated that healthcare facilities serving underrepresented, rural and hardest-hit communities are less likely to administer COVID-19 vaccines in the early phase of vaccine rollout .
Led by Inmaculada Hernandez, PharmD, PhD, associate professor of clinical pharmacy at the Skaggs School of Pharmacy and Pharmaceutical Sciences at the University of California San Diego, the study is the first to examine disparities in the early distribution of COVID-19 vaccines at healthcare facilities to quantify throughout the country.
Previous studies on vaccine accessibility did not distinguish whether the low access in underserved neighborhoods was a product of the low concentration of health facilities in these areas or of inequities in the distribution of COVID-19 vaccines to each health facility.
To answer this question, Hernandez and colleagues tested whether the likelihood of an eligible healthcare facility administering COVID-19 vaccines varied based on the racial/ethnic composition and urbanicity of the local county. The team focused on the initial phase of vaccine rollout, using data from May 2021, when states were officially required to make vaccines available to the public.
At that time, 61 percent of eligible healthcare facilities and 76 percent of eligible pharmacies across the United States provided COVID-19 vaccines. When the researchers began to compare these rates with the socioeconomic characteristics of the county in which each facility was located, several patterns emerged.
Facilities in counties with a high proportion of Black people were less likely to serve as COVID-19 vaccine administration sites compared to facilities in counties with a low proportion of Black people. This was especially the case in metropolitan areas, where facilities in urban counties with large Black populations were 32 percent less likely to administer vaccines compared with facilities in urban counties with small Black populations.
Facilities in rural counties and in counties hardest hit by COVID-19 were also associated with reduced odds of serving as a COVID-19 vaccine administration site. In rural counties with a high proportion of Hispanic people, facilities were 26 percent less likely to administer vaccines compared to facilities in rural counties with a low proportion of Hispanic people.
“Both national policy and public opinion agreed that vaccine distribution should prioritize disadvantaged communities and those hardest hit by COVID-19, but the data shows that this is not what has happened,” said the Hernandez.
Further research is needed to identify the reasons why vaccines were not equitably distributed to all health facilities and how the participation of these facilities evolved over the later phases of vaccine distribution, the authors said.
“To achieve health equity in future public health programs, including the distribution of booster shots, it is crucial that public health authorities review these early COVID-19 distribution plans to understand how and why this occurred,” said the senior author. Jingchuan (Serena) Guo , MD, PhD, Assistant Professor at the University of Florida.
Co-authors include: Shangbin Tang and Nico Gabriel at UC San Diego, Sean Dickson at the West Health Policy Center and Lucas A. Berenbrok at the University of Pittsburgh.
This study is a continuation of previous work funded by the West Health Policy Center.
Materials are provided by the University of California – San Diego. Originally written by Nicole Mlynaryk. Note: Content may be edited for style and length.
