The Washington PostDemocracy Dies in Darkness

Who’s getting vaccinated? The answer has changed since the first wave.

At first, areas dense with Black and Latino Americans were left behind. Now, counties dominated by Whites are the laggards.

Margaret LaRaviere gets a flu shot Sept. 9 in Chicago.

Since the beginning of September, the federal government has been rolling out the latest coronavirus shots, tailored to combat the most recent omicron subvariants. But who will actually get the boosters — or for that matter, the original vaccine? Growing evidence shows that in many parts of the United States, racial and ethnic minorities most likely to be exposed to the virus have been vaccinated at lower rates.

But we find something more complicated if we look county by county, over time. My research finds that at first, counties with more racial and ethnic minorities had lower vaccination rates; since then, counties with more Whites have been falling behind. Let’s explore why.

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How I did my research

To look at how a county’s racial composition was related to vaccination rates, I looked at two sources: weekly covid-19 vaccination rates of adults 18 and over from the Centers for Disease Control and Prevention; and the racial composition of more than 3,000 U.S. counties, looking at Asians, Blacks, Hispanics, and Whites, as shown in the U.S. Census Bureau’s 2019 American Community Survey. Then I compared the vaccination rates of counties dominated by each different racial or ethnic group, and how that changed over time.

Counties with higher percentages of Asians were more likely to have had higher vaccination rates — and that increased over time. By contrast, counties with higher percentages of Blacks had lower vaccination rates at first, although those rates increased over time. At first, counties with higher percentages of Hispanics had low vaccination rates, but that flipped by the end of 2021. Finally, counties with higher percentages of Whites at first had high vaccination rates, but that flipped by late 2021.

You can see all these changes in the figure below.

Who gets to roll up their sleeves?

How do we make sense of these patterns? First, it’s clear that at first, vaccination rates rose more slowly among socioeconomically disadvantaged Black and Hispanic counties than among more affluent Asian and White counties.

Perhaps this is not so hard to understand. The supply of the coronavirus vaccines was limited during the initial phase of the rollout. The uneven rise showed which areas were allocated enough vaccine supply for those who wanted it. Across the country, vaccines were distributed at a much lower rate in disadvantaged areas.

In the United States, residential areas that are disproportionately populated by racial and ethnic minorities have long been disadvantaged in ways that harmed their health, in such ways as living farther from stores selling healthy food to having a harder time reaching hospitals and health care facilities. Perhaps not surprisingly, a recent study documented the fact that Black- and Latino-clustered Zip codes were less likely to include vaccine distribution sites and that proportionately fewer vaccine doses were distributed to areas with more Black residents. My analysis finds a similar pattern.

Paul Farmer's last book teaches us still more about pandemics

Once vaccines were widely available, political ideology mattered more

But why did heavily Black and Hispanic counties start showing higher vaccination rates — and heavily White counties showing lower rates — by the end of 2021? My analysis suggests that the answer comes from those different groups’ political ideologies.

Since April 2021, coronavirus vaccines have become widely available in the United States. But not all Americans want a shot — in large part because of political ideology. Political conservatives tend to be much more skeptical toward science, vaccines and government, a tendency that many conservative media figures have encouraged toward coronavirus vaccines. Republicans are much less willing than Democrats to get vaccinated. Across the country, communities with a high percentage of Republican voters show lower vaccination rates.

Political ideology varies significantly by race. Racial minorities, especially Black Americans, are much more likely to identify as liberal Democrats; and many White Democrats live in urban areas that have more racially diverse populations. In contrast, Whites are more likely to identify as conservative Republicans and to cluster in rural and suburban areas. As a result, counties with higher percentages of Whites who are more conservative have had vaccination rates slow down as time goes on. Meanwhile, when vaccines became widely accessible, counties with higher percentages of racial minorities — many of whom are more liberal — have had a faster increase in vaccination rates.

The pandemic hurt gender equality. A lot.

Omicron booster shots are ready

One key takeaway: Although many observers speculated early on that Black communities were skeptical about the vaccine because of a history of medical mistreatment, in fact, unequal access to vaccines was the biggest reason that, at first, those communities had lower coronavirus vaccination rates. Distributing the omicron booster shot equitably in disadvantaged communities should result in more widespread protection from the next coronavirus wave.

Second, political ideology is probably now the single best predictor of who will be ready to roll up their sleeves for the next shot. Getting everyone vaccinated will require effective political communication. As Robb Willer and David G. Rand explained here at TMC a year ago, having Republican elites endorse vaccination could make a difference.

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Cary Wu (@carywoo) is a sociology professor at York University in Ontario, Canada.

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