Facilities in Non-Hispanic Black, Rural Counties Less Likely to Administer Early COVID-19 Vaccines

Decreased access to vaccination sites may be an overlooked barrier to COVID-19 immunizations among minority populations and rural areas, according to research recently published in PLOS Medicine.

Health care facilities in counties with higher Black composition, in rural areas, and in hardest-hit communities were found to be less likely to serve as COVID-19 vaccine administration locations in May 2021, which may have contributed to lower vaccine uptake. Equitable and timely distribution of COVID-19 vaccines was a public health priority in 2021, with spatial access to health care as a major consideration especially for underrepresented minority populations.

However, few studies on this topic differentiate whether lower access to vaccination facilities in underserved neighborhoods is a product of the lower concentration of health care facilities in these areas or of inequities in the distribution of COVID-19 vaccines to facilities.

Researchers conducted, to their knowledge, the first nationwide study to quantify disparities in the early distribution of COVID-19 vaccines to health care facilities across the United States. They conducted a study to test whether the likelihood of a health care facility administering COVID-19 vaccines in May 2021 differed by county-level racial composition and degree of urbanicity.

Researchers spatially matched locations of eligible and actual COVID-19 administration locations to determine whether eligible facilities actually administered vaccination during May 2021. This outcome was regressed against county-level mortality, 2020 election results, and availability of nontraditional vaccination location.

Nontraditional settings for vaccination, such as stadiums and convention centers, were excluded as non-health care facilities. Results of the analyses showed that 61.4% of eligible health care facilities and 76% of eligible pharmacies across the United States provided COVID-19 vaccinations as of May 2021.

Facilities in counties with >42.2% non-Hispanic black population were found to be less likely to serve as COVID-19 vaccine administration locations compared to facilities in counties with <12.5% non-Hispanic Black population (OR, 0.83; 95% CI, 0.7-0.98; P =0.03). Location of a facility in a rural county was found to be associated with decreased odds of serving as a COVID-19 vaccine administration location (OR, 0.82; 95% CI, 0.75-0.90, P <.001, versus metropolitan county).

Facilities in counties in the top quintile of COVID-19 mortality were also associated with decreased likelihood of serving as COVID-19 vaccine administrators (OR, 0.83; 95% CI, 0.75-0.93, P = .001, versus bottom 4 quintiles).

Researchers determined that there was a significant interaction of urbanicity and racial/ethnic composition. In metropolitan counties, facilities in counties with >42.2% non-Hispanic Black population had 32% lower odds of serving as COVID vaccine administration facilities compared to facilities in counties with below the US average Black population.

However, the association between Black composition and odds of a facility serving as a vaccine administration facility was not observed in rural or suburban counties.

In rural counties, facilities in counties with above the US average Hispanic population had 26% lower odds of serving as a vaccine administration facility (95% CI 11%-38%, P = .002) compared to counties with below US average Hispanic population.

Researchers did not observe this association between Hispanic ethnicity and odds of serving as a vaccine administration facility in metropolitan or suburban counties.

Overall, health care facilities in counties with higher non-Hispanic Black composition, in rural areas, and in hardest-hit communities were less likely to serve as COVID-19 vaccine administration locations. These findings suggest disparities in the early distribution of COVID-19 vaccines, according to the investigators.

“Regardless of whether a smaller share of facilities is able to adequately cover the population through higher volume, the variation in the proportion of available healthcare facilities used associated with the sociodemographic characteristics of the population suggests structural inequities in the design of the early COVID-19 vaccine rollout,” the authors wrote.

They suggest that their analysis identified additional systemic barriers to vaccine uptake among racial and ethnic minority groups beyond commonly discussed mistrust and misinformation.

In addition to recommending community engagement efforts to address vaccine hesitancy and improve spatial access to vaccines, the authors encourage public health authorities to review COVID-19 vaccine distribution plans to identify reasons for the inequitable distribution observed in May 2021.

The study had some limitations. The authors note that their analysis did not include nontraditional vaccination sites. Additionally, as the findings represent early distribution of COVID-19 vaccines, they may not be generalizable to later phases of the vaccine distribution process.

Reference

Hernandez I, Dickson S, Tang S, Gabriel N, Berenbrok L A, Guo J. Disparities in distribution of COVID-19 vaccines across US counties: A geographic information system–based cross-sectional study. PLOS Med. 2022;19(7):e1004069. https://doi.org/10.1371/journal.pmed.1004069