Most states are not publicly reporting racial data on people receiving coronavirus vaccines, despite disproportionate covid-19 death rates for Black and Hispanic people and rising concerns about who has access to – and is willing to take – the vaccine.
Seven weeks after the first shots were administered, just 20 states include race and ethnicity data on their vaccine dashboards, even though it is required by the federal government. And even those states have major gaps in their data, with “unknown” being the first or second most-frequent category in almost every state.
Virginia Gov. Ralph Northam, a Democrat, on Wednesday said the state was working to improve reporting on its dashboard, while D.C. Health Director LaQuandra Nesbitt said the city has not yet published its data because so many pharmacies and health-care providers are failing to report the race and ethnicity of those they are vaccinating.
“It completely flies in the face of the level of data quality” that the health department finds acceptable, she told members of the D.C. Council, adding that she has threatened some health-care systems with being shut out of the vaccine program if they don’t start reporting the data.
Health equity experts say that while they understand public health officials and vaccinators are swamped, the data is essential to make sure the vaccine is distributed equitably, and to find out the reasons if it isn’t.
The information is a matter of life and death, they say, given that Black people are nearly three times more likely than White people to die of covid-19.
“There is no public health department anywhere in America that does not, and did not, understand the importance of data-driven public health programs,” said Reed Tuckson, the founder of the Black Coalition Against Covid-19 and a former D.C. health director.
“None of us should be comfortable with excuses,” Tuckson said. “We need to solve the problem, and you cannot solve this problem without the will to do it.”
The Washington Post has confirmed an analysis of data from the states that are reporting, which showed that of the 3 percent of Americans who received the vaccine by early January, the doses went disproportionately to White people.
In some places, including both the District of Columbia and Maryland, vaccine appointments are being snapped up by residents of majority-White areas, who often have more access to the internet, transportation to vaccine clinics and flexibility about taking off work. To improve equity, officials have canceled some of those appointments and restricted a portion of future slots for those who live in majority-Black areas.
At the same time, large majorities of nursing home and hospital workers in the Washington area – a group that is predominantly Black and Latino, with many immigrants – declined to take the vaccine, health officials say. Many cited mistrust of the medical establishment based on generations of mistreatment.
States “need to be able to compare these data at various different levels to understand how to respond,” said Nancy Berlinger, a research scholar at the Hastings Center. “We can’t just wait until after the fact and make it an academic exercise.”
Across the country, people of color make up 38 percent of medical workers, census data shows. And 52 percent of workers in long-term health-care facilities are people of color, according to the Kaiser Family Foundation. Both groups were among the first to be offered the vaccine. As the rollout continues, health experts fear there will be a repeat of what happened early in the pandemic, when states and the federal government initially failed to collect race and ethnicity data on coronavirus testing, hospitalizations and deaths.
President Joe Biden signed an executive order prioritizing an equitable response to the pandemic and establishing a Covid-19 Health Equity Task Force, which will recommend how best to mitigate health inequities and where funding should go, and also build an equity data dashboard. The leader of the task force, Marcella Nunez-Smith, spoke at a town hall meeting on Wednesday, and said collecting data for the hardest-hit communities was “essential.”
“We are making a call to get better, more consistent data, particularly around some of these demographic points,” Nunez-Smith said. She said that the data was “incomplete” and that the task force will also look at metrics on neighborhoods and social vulnerability that are gathered by the Centers for Disease Control and Prevention.
States are taking a variety of approaches. In Alabama – one of 11 states that the National Institutes of Health has identified as having both high populations of communities of color and coronavirus case loads – the health department’s vaccine dashboard does not include data on race. Health officials said they are collecting the data but have not made it public because not all providers have learned how to input the information into the state’s ImmPRINT vaccine-reporting system.
“We are still working with providers to ensure that they capture all the required data,” said Karen Landers, the assistant state health officer for the Alabama Department of Public Health. “We wanted to make sure that all of the demographic data was correct before we did a publicly facing dashboard with our percentages.”
In the meantime, the department’s chief medical officer has been reaching out to leadership groups that serve communities of color to ensure that they are educated about the vaccine and know when it is their turn to get it.
North Carolina, another one of NIH’s priority states, has been providing thorough racial breakdowns of vaccine recipients, even though state health officials say some vaccinators have not provided complete information, particularly the drugstore chains CVS and Walgreens that are providing shots for nursing homes.
As of next week, the state hopes to display the information by county, as well as statewide.
“It’s not just nice data to have,” said Mandy Cohen, secretary of the state’s Department of Health and Human Services. “We use this data very actively to make operational decisions on vaccines, to better target our vaccination efforts.”
She said the public can use the data to see how the state is performing, and the state uses it to correct inequalities.
Data showing the vaccination rate for Black people is lower than for Whites was expected, Cohen said, due to higher “vaccine hesitancy” because of distrust of the medical system in Black and Hispanic communities.
As of late last year, more than 40 percent of Black people were unwilling to get the vaccine, according to a December survey from the Pew Research Center. Black doctors and physicians have been working to lessen vaccine hesitancy in the Black community.
“We need to make sure we are helping our communities who are traditionally underserved to get access,” Cohen said.
Health experts say missing data will become a much larger problem as more of the general public becomes eligible for the vaccine.
“This lack of information makes it very difficult to be able to track performance, to be able to identify specific locales of concern, to target resources,” Tuckson said. “And above all, it speaks to a lack of either organizational competence or willful disregard for the importance of ensuring that programs meet the goals of equity, fairness and justice.”
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The Washington Post’s Julie Zauzmer and Jenna Portnoy contributed to this report.