Drawing primarily from CDC data along with study results from medical journals and information from various public and private agencies, the issue brief examines the pandemic’s effects on vaccination equity in three categories:
The brief also features a series of recommendations that can be implemented to reduce gaps in vaccine disparities and ensure that more people have broad access to all vaccines, not just those for COVID-19.
The issue brief cited results from analyses of CDC data and other research in each category. Among the more notable findings:
COVID-19 vaccination disparities. Although the brief focuses on vaccination disparities in general, it also acknowledges the critical role that social determinants of health, institutional racism and other forms of discrimination, and lack of trust have played in creating obstacles to vaccination access and acceptance in communities of color. It also cites information from the CDC’s COVID-19 Health Equity webpage which indicates that Black and Hispanic Americans are more likely to become seriously ill and die from COVID-19 due to factors such as those listed above.
Turning to individual reports, an analysis of CDC data published by the Kaiser Family Foundation found that in the majority of states, white individuals had higher COVID-19 vaccination rates than Hispanic or Black individuals, but that the differences shrank between late April and mid-November. For example, the gap in vaccination rates between white and Black individuals narrowed from 14 percentage points to 7 percentage points, while the gap in vaccination rates between white and Hispanic individuals was reduced from 13 percentage points to 2 percentage points.
Another analysis of CDC data published in the Journal of Rural Health showed a substantial disparity among adults living in rural and urban areas, with 46% of adults in rural counties considered fully vaccinated against COVID-19 compared with 60% of adults in urban counties.
Finally, studies of health or Medicaid data found that in general, Medicaid enrollees had lower COVID-19 vaccination rates than adults not enrolled in Medicaid.
Declines in routine vaccination rates. An analysis of vaccination data from eight health systems in the U.S. found that childhood vaccination rates declined sharply from the start of the pandemic through May 2020 and remained low through September 2020, the period during which data was analyzed.
According to the analysis in September 2019, 81% of infants age 7 months and 61% of infants age 18 months were considered up to date on all recommended vaccines. By September 2020, those rates had decreased to 74% and 57%, respectively.
A separate analysis of routine vaccination rates at the state level found that in Michigan, rates declined across all age groups through age 24 months and for all vaccines except hepatitis B (which is typically administered in a hospital setting) in May 2020 compared with data from 2016 to 2019. Only 50% of infants age 5 months in Michigan were up to date for all routine vaccines in May 2020 compared with rates of 66% to 68% from 2016 to 2019.
Pre-pandemic vaccination disparities. According to the issue brief, substantial vaccination rate disparities were in effect before the COVID-19 pandemic.
In children, a review of the administration of a combined seven-vaccine recommended series during the first 24 months of life showed that Black or Hispanic race, living below the federal poverty level, and lack of insurance coverage were all associated with lower vaccination rates.
In adults, a review of vaccination trends from 2010 to 2019 found strong associations between race, ethnicity, household income level, education level and insurance status with vaccination rates. The review also found that in adults receiving Medicare, influenza vaccination rates were more than 10% lower for Black individuals than for Asian or white individuals, while pneumococcal vaccination rates were all considerably lower for Asian, Black and Hispanic individuals compared with white individuals.
To expand vaccine access and reduce gaps in vaccine disparities, the issue brief’s authors suggested that solutions to vaccination equity be approached from three perspectives: accessibility/availability, affordability and awareness.
For issues of accessibility and availability, they called for the creation of policies that would ensure the availability of adult vaccines at pharmacies across state Medicaid programs, ensure financial viability for clinicians to stock and administer vaccines, and expand the reach of vaccines into disadvantaged communities by working with federally qualified health centers.
For affordability, they suggested specific policies that would eliminate cost-sharing in Medicare Part D, eliminate copays across Medicaid programs and ensure coverage for all Advisory Committee on Immunization Practices-recommended vaccines across all Medicaid programs.
For awareness, they called for making more people aware of the Vaccines for Children program, encouraging physicians across specialties to participate in vaccine education, and investing in culturally competent and respectful communication about the importance of vaccines.
The AAFP’s Immunization & Vaccines webpage provides members with dozens of resources in one convenient location. These include links to the latest immunization schedules from the CDC, patient educational materials, CME programs, and the Shots Immunizations App developed by the Academy and the Society of Teachers of Family Medicine.
For COVID-19, the Academy also has created a COVID-19 Vaccine webpage designed specifically to give members the latest news and information.
The Academy has also been a longtime proponent of affordable, easy access to vaccines as way of providing optimal patient care. The AAFP’s Advocacy Focus: Vaccines and Immunizations webpage allows members to see the organization’s latest communications to federal agencies and members of Congress on the topic, as well as letter and other materials sent as part of joint efforts with other organizations.