As 13 million in US get COVID vaccine, minority uptake uncertain

Older woman getting COVID-19 vaccine
Older woman getting COVID-19 vaccine

Maryland GovPics, Patrick Siebert / Flickr cc

About 13 million Americans—about 5% of the population 16 years and older—received at least the first of their two COVID-19 vaccine doses in the first month of availability, but limited data paint a foggy picture of how many doses reached key demographics like blacks, according to a report yesterday in Morbidity and Mortality Weekly Report (MMWR).

Another MMWR study homes in on skilled nursing facilities (SNFs), finding that more than three quarters of residents and almost 40% of staff members have received at least one vaccine dose during the first month. Both studies were led by scientists with the Centers for Disease Control and Prevention (CDC).

While the researchers note that the number of vaccinated people could equate to 50% coverage of the CDC's phase 1a priority groups of healthcare workers and long-term care facility (LTCF) residents, they say this is unlikely as some jurisdictions expanded vaccine eligibility, such as to anyone aged 65 and older.

Lack of data makes equity difficult to track

From Dec 14, 2020, through Jan 14, 2021, 12,928,749 people received a COVID-19 vaccine and were entered into a vaccine tracking system. Sex and age was reported to the CDC for 97.0% and 99.99% of the people, respectively, but only 59.1% of people have their race or ethnicity recorded.

The racial/ethnic information that has been collected has not been standardized nationwide, resulting in even more surveillance difficulties, say the researchers. For instance, people of multiple or non-listed races reportedly received 14.4% of the vaccinations even though this demographic represents 2.8% of the country.

Even with the limited data, blacks appear to have a lower rate of vaccine coverage than what is proportional for healthcare workers and long-term care facility residents. The CDC found that 5.4% of vaccinated Americans were black, compared with the number of black US healthcare workers (16%) or nursing home residents (14%). Hispanics, Asians, American Indigenous/American Natives (AI/AN), and native Hawaiians/Pacific Islanders received 11.5%, 6.0%, 2.0%, and 0.3% of the vaccines, respectively.

"Because persons who are Black, AI/AN, or Hispanic have been found to have more severe outcomes from COVID-19 than persons who are White, careful monitoring of vaccination by race/ethnicity is critical," the researchers write. "Equitable and sustainable COVID-19 vaccine administration in all populations requires focus on groups with lower vaccine receipt who might face challenges with access or vaccine hesitancy."

Nursing homes may need to focus on staff

As for SNFs, the CDC researchers estimated that a median of 77.8% of residents and 37.5% of staff members per facility have received at least one COVID-19 vaccine dose. Coverage ranged from 65.7% to greater than 100% (possibly due to turnover or errors) for residents and 19.4% to 67.4% for staff. Overall, 713,909 residents and 582,104 staff members were vaccinated from Dec 18, 2020, through Jan 17, 2021.

The researchers say staff rates may be underreported if the workers received vaccinations outside of their SNFs. However, they say, a December 2020 survey showed that 29% of healthcare workers in delivery settings were hesitant about receiving a COVID-19 vaccine.

"Communications resources developed to increase vaccine confidence among LTCF staff members can be employed for public health outreach," the researchers write, "and strategies to address structural barriers, such as scheduling around shift work or provision of paid medical leave for possible postvaccination side effects, should be encouraged." Plus, if SNFs can increase staff coverage, the vaccinated staff may help persuade more residents to get vaccinated, the researchers add.

SNFs are being served by the Pharmacy Partnership for Long-Term Care Program, which is a public-private partnership among CDC, CVS, Managed Health Care Associates Inc., and Walgreens to alleviate burden on facility workers and health departments. The researchers found that 90.2% of facilities certified by the Centers for Medicare & Medicaid Services had at least one vaccine clinic during the first month of the program.

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