Monday’s Morbidity and Mortality Weekly Report provides a snapshot of the first month of the chaotic vaccine rollout, from Dec. 14 to Jan. 14. The report from the Centers for Disease Control and Prevention shows that 63 percent of the nearly 13 million people vaccinated in that period were women, 55 percent were older than 50, and 60.4 percent were White.
But race and ethnicity information was missing for about 48 percent of people who received at least one dose of the vaccine, though the data on gender and age was nearly complete.
“We must address these insufficient data points as an urgent priority,” Marcella Nunez-Smith, chair of President Biden’s covid-19 equity task force, said Monday during an administration coronavirus news briefing. “I’m worried about how behind we are. So, let me be clear: We cannot ensure an equitable vaccination program without data to guide us.”
The disease has spread through communities of color at higher rates, exposing the structural racism and inequality baked into the American health system that experts say has resulted in the virus’s disparate toll. For nearly a year, health equity experts and lawmakers have called for better data tracking to shed light on disproportionate rates of cases, hospitalizations and deaths.
That advocacy led to improved reporting on hospitalizations and deaths from the virus, Nunez-Smith said, allowing a more complete picture to emerge of the pandemic’s unequal impact. Black, Latino and Native American/Alaska Native people are up to 3.6 times more likely than White people to be hospitalized from covid-19, while people in communities of color are more than twice as likely to die as White people from the disease, Nunez-Smith said.
Higher rates of chronic diseases in communities of color, a byproduct of the generational compounding of environmental, economic and political factors that leave immune systems vulnerable to more severe covid-19 outcomes, are partly responsible for increased hospitalizations, Nunez-Smith said. Limited access to testing is another factor, she said.
In communities of color, Nunez-Smith said, testing tends to occur after someone is coughing, feverish or otherwise so sick that they require hospitalization, “which is often a function of inadequate access to testing in the first place. In these groups, we are not capturing many people who are asymptomatic or mildly symptomatic.”
Thomas A. LaVeist, dean of the Tulane University School of Public Health and Tropical Medicine, called the vaccination data collection “a bit of a muddled mess.”
In Louisiana, sites used different formats to collect information, resulting in lots of missing data or people reporting their race as “other,” said LaVeist, co-chair of Louisiana’s covid-19 health equity task force, convened by Gov. John Bel Edwards (D).
“One location instead of saying ‘African American,’ it just said ‘African,’ ” LaVeist said. “That may have been a typo, but we figure a lot of African Americans didn’t check the ‘African’ box. They checked other or left it blank.”
The state was working to fix the problem by standardizing what information should be gathered, but he said, “we need to have national standardization in how the data is collected and what data needs to be in there.”
Given how much data remains missing and the limitations in Louisiana and nationally, LaVeist said it might be too soon to determine the depth of inequities in vaccine distribution.
About 14 percent of those who received at least one shot nationally were categorized as multiple or other race/ethnicity, 11.5 percent as Latino, 6 percent as Asian, and 5 percent Black, according to the CDC report. The study notes that the demographics of those people vaccinated somewhat reflect the demographics of health-care workers and residents of long-term care facilities — the people in the Phase 1 vaccination priority group — while cautioning that the analysis is hamstrung by the missing information.
Still, Derek M. Griffith, who researches racial and gender health disparities at Vanderbilt University, said, “this pattern of race and ethnicity is pretty predictable.”
Griffith said coronavirus vaccination has become “an issue of equality versus equity. An equality strategy says we need to give everybody the same thing; give everyone the same chance. An equity strategy realizes if we give everyone the same chance, they’re not going to be able to take it up the same way.”
Vaccine distribution was supposed to be the latter. A panel of experts advising the CDC on the best way to ensure equity recommended delivering shots in phases, with the most vulnerable people — health-care workers and older people — first. But then states began to deviate from the guidelines, altering who had priority to the limited supply of vaccines.
The “inconsistent emphasis on equity” early in the vaccine rollout coupled with the lack of federal coordination by the Trump administration, “are a few reasons why we are already behind,” Nunez-Smith said. “We must address these insufficient data points as an urgent priority. They don’t just hurt our statistics, they hurt the community.”