Vaccinations Have Ramped Up, But Has Distribution Been Equitable?
By Anthony P. Carnevale and Megan L. Fasules
Many Americans are eager to get back out into the world after a year of being cooped up at home because of the pandemic. The development, approval, and administration of vaccines will be major factors in the lifting of restrictions on people’s activities. Progress is slowly but steadily occurring on this front: 32 percent of US adults (84 million adults) had received at least one COVID-19 vaccine dose by March 23, 2021. However, the vaccine rollout continues to encounter problems. One is ensuring that underserved communities have fair access to vaccinations, and another is overcoming some groups’ entrenched distrust of the vaccines.
Inequities in vaccine access exist, especially in underserved communities
Adults with higher levels of education were more likely than adults with lower levels of education to have received a vaccine during the early phases of the distribution (Figure 1). This is not surprising because the first phase prioritized healthcare workers, who typically have a college degree.
Figure 1. Adults with a bachelor’s degree or higher are more likely to have received a COVID-19 vaccine than adults at other educational levels.
Source: Georgetown University Center on Education and the Workforce analysis of data from US Census Bureau, Household Pulse Survey, January 6–18, 2021; January 20–February 1, 2021; February 3–15, 2021; and February 17–March 1, 2021.
This approach may have contributed to equity gaps in vaccine access for Black/African American and Hispanic/Latino communities, which have been hit hard by COVID-19. Black/African American and Hispanic/Latino workers are overrepresented in many essential frontline jobs but are underrepresented in the healthcare professional occupations in which workers qualified earliest for vaccine eligibility. According to data from the American Community Survey, Black/African American workers account for 13 percent of the workforce but 12 percent of healthcare professional workers, and Hispanic/Latino workers account for 19 percent of the workforce but only 9 percent of healthcare professional workers. Black/African American and Hispanic/Latino workers are much more represented in healthcare support occupations, but these occupations account for a much smaller share of the workforce.
The prioritization of healthcare workers is not the only reason for disparities in access. In some states, vaccine centers are located mostly in White, higher-income neighborhoods because these are the areas where hospitals, clinics, nursing homes, and pharmacies tend to be located. In addition, limited access to broadband internet among individuals in underserved Black and Latino communities can make it harder for them to schedule vaccine appointments online. Even if they manage to snag an appointment, individuals living in these communities may not have cars they can drive to appointments or flexible work schedules that allow them to spend time in long lines waiting for the vaccines. These disparities contribute to the lower likelihood that Black/African American and Hispanic/Latino adults have received a COVID-19 vaccine (Figure 2).
Figure 2. Black/African American and Hispanic/Latino adults are the least likely overall to have received a COVID-19 vaccine.
Source: Georgetown University Center on Education and the Workforce analysis of data from US Census Bureau, Household Pulse Survey, February 3–15, 2021.
Skepticism must be overcome before the vaccines will be widely accepted
Willingness to receive a vaccine has increased since vaccines have been approved and the vaccination process has begun. As of March 1, 64 percent of adults either had received a COVID-19 vaccine or definitely planned to receive one, a large increase from the 29 percent of adults who said back in November that they would definitely get a vaccine. Still, at least 19 percent of adults say they probably or definitely will not get a vaccine. Their main reasons for avoiding the vaccines are concerns about possible side effects and safety hazards.
For some people, suspicion of government may be the reason for an unenthusiastic response to the vaccines. White adults with a high school diploma or less are among the least likely to have received a COVID-19 vaccine (Figure 2), and they are also among the least likely to say they definitely plan to receive one (Figure 3). White adults with a high school diploma or less are also among the most likely to cite their distrust of the government as the reason they don’t plan to be vaccinated: among adults with a high school diploma or less, 24 percent of White adults gave this reason, compared to 18 percent of Black/African American adults, 9 percent of Hispanic/Latino adults, and 9 percent of Asian/Asian American adults. In contrast, only 18 percent of White adults with a bachelor’s degree or higher gave this response.
Vaccine hesitancy can also be rooted in distrust of the medical establishment. Among adults of all educational levels, Black adults were the least likely to report that they will definitely receive a COVID-19 vaccine (Figure 3). They were also among the most likely to say they don’t trust the vaccines: 25 percent of Black/African American adults said they don’t trust the COVID-19 vaccines, compared to 22 percent of White adults, 17 percent of Hispanic/Latino adults, and 11 percent of Asian/Asian American adults. Racial bias and discrimination in healthcare and past unethical research like the Tuskegee syphilis experiment and the unauthorized use of Henrietta Lacks’s cancer cells have possibly fueled this reluctance.
Figure 3. Regardless of educational attainment, Black adults are the least likely of all racial and ethnic groups to definitely plan to receive a COVID-19 vaccine.
Source: Georgetown University Center on Education and the Workforce analysis of data from US Census Bureau, Household Pulse Survey, February 3–15, 2021.
The United States should try to improve vaccination equity
Vaccination has ramped up, especially since the Johnson & Johnson vaccine was approved, but more steps must be taken to ensure that vaccines are available to all racial, ethnic, and economic groups. We need to eliminate both physical and financial barriers to access so that all communities receive a fair share of the vaccines. To combat vaccine hesitancy, organizations like Partners In Health recommend that we capitalize on existing knowledge, maintain flexible feedback systems, and present information honestly and accurately. We also must think globally and ensure that vaccines are available in all countries instead of only in the countries that can afford them.
Dr. Carnevale is Director and Research Professor and Dr. Fasules is Assistant Research Professor and Research Economist at the Georgetown University Center on Education and the Workforce. CEW is an independent, nonprofit research and policy institute affiliated with the Georgetown McCourt School of Public Policy that studies the links among education, career qualifications, and workforce demands.
