TThe prosperous city of Woodbridge, Connecticut, has less than half the population of neighboring Ansonia, but is home to more people who received the Covid-19 vaccine. Inequality is stark: in Woodbridge, where residents have an average household income of $ 138,320 per year, 19.3% of the population had been vaccinated by February 4, according to data from the Connecticut Department of Health. In Ansonia, where the average income is $ 45,563 per year, only 7.1% received the first chance.
Connecticut has the most striking disparity in vaccination rates between the richest and poorest communities – a difference of 65% – according to a STAT analysis of vaccine data at the local level in 10 states with the largest wealth gaps. Four other states – California, Florida, New Jersey and Mississippi – have also vaccinated a significantly higher proportion of people in the wealthiest 10% of counties.
Discrepancies vary: in California, 156 vaccines were administered to residents in the wealthiest areas for every 100 vaccines in the poorest counties, while in Mississippi, 111 vaccines were administered to residents of the wealthiest counties for every 100 doses in the poorest locations.
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In Washington, DC, the vaccination rate in the two wealthiest wards is more than double that of the two least wealthy.
The findings support, with hard data, anecdotal reports from across the country that wealthy people have been able to gain access to vaccines before low-income people. “We are seeing individuals with privileges and access who are defeating those who don’t,” said Tekisha Dwan Everette, executive director of Health Equity Solutions in Connecticut and a member of the governor’s Covid-19 advisory task force in that state.
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But the analysis also reveals that some states appear to be distributing vaccines more equitably than others. Among the states with the largest wealth gaps, Texas, Tennessee, New Mexico, Pennsylvania and Illinois did not show a significant county-level income split in vaccination rates. The analysis excluded states, including Georgia, Louisiana and Massachusetts, which do not publicly share county-level data on vaccine recipients.
As counties can contain diverse populations, the analysis is not a definitive indicator of equity. Several experts said they expected more accurate data to reveal wealth inequalities, even in states with fair data at the county level. And in several of those states, racial disparities were still evident.
Olivia Goldhill / STATSources: State and Washington, DC, health departments
Any gap in the vaccination of the rich against the poor inevitably exacerbates racial divisions. Blacks and Latinos are much more likely to live in poverty than whites and, although they died at higher rates during the pandemic, they are receiving fewer vaccines than whites.
The data suggest that, in some states, the first wave of vaccines favored the wealthy. “There are actually two Conneticuts. We, as a state, need to focus more on that, ”said Tiffany Donelson, chief executive of the Connecticut Health Foundation.
Inequality has been a feature of the pandemic since the beginning, Everette said, citing Covid-19 test sites that were most accessible to the wealthiest populations. “Instead of learning from this lesson, we are recreating the privilege,” she said.
Simply locating vaccination sites in diverse, low-income areas is not enough: “People are traveling outside their own geographic region to obtain the vaccine elsewhere,” she said.
Similar problems have been seen in California. “We heard stories of people in LA driving to Compton or elsewhere where there are other locations,” said Anthony Wright, executive director of Health Access California.
State policies can help address inequalities. Texas vaccination centers are required to reserve part of the vaccines for vulnerable communities, work with local leadership and distribute the vaccine in racially diverse areas, said Imelda Garcia, president of the Texas Expert Vaccine Allocation Panel. On the other hand, in California, counties must focus on equity, but no specific requirements are provided on how to do this, said California Covid-19 vaccine task force spokesman Darrel Ng.
But the vaccine’s launch in Texas, while not reflecting income inequality, has disproportionately benefited white residents, state data show. Racial data was not recorded for all vaccinations, said Garcia, and a more complete data collection could show a more equitable distribution: “The data does not reflect what is happening. I can say that the data is missing. “
Similar concerns about missing data apply to analysis at the county level, as several states with the largest divisions have not released this information. Tracking and sharing this data is one way to improve equality, said Julie Swann, head of the department of industrial and systems engineering at North Carolina State University. “If we start to measure who they reach in terms of race, ethnicity or income, they will do the extra things needed to reach everyone.”
The rush to vaccinate people as quickly as possible probably limited equity in the first phase of implementation. “[States] they were worried about losing their allocation if they didn’t act quickly, ”said Swann. “Everyone freaked out.”
Vaccine distribution has so far been predominantly focused on health professionals and people over 75 years of age. “Equity is our northern star for vaccine distribution and as the state deploys its new vaccine distribution network, we will be able to more precisely target our efforts to disproportionately vaccinate impacted communities,” said Ng.
But the lack of equality in the first phase for health professionals is also an indication of the disadvantages faced by the poorest communities. Fewer people will be vaccinated in areas with a shortage of hospitals, which are generally poorer rural areas. California’s Central Valley, for example, has a much less robust health care system than Silicon Valley.
“These areas with more resources with health infrastructure and workers, by definition, received more of the vaccine,” said Wright of Health Access California.
Connecticut is taking several steps to address vaccine inequality, said state health department spokeswoman Maura Fitzgerald, including booking vaccines for people in vulnerable communities and creating a vaccine line for residents without internet.
In New Jersey – where STAT found the vaccination rate to be 28% higher in the wealthiest counties – the health department is working with partners, including places of worship and senior centers to provide education and access to vaccines through mobile clinics and potentially door-to-door vaccination in areas severely affected by Covid-19, said state health department spokeswoman Donna Leusner. Washington, DC, has partnered with hospitals, community health centers and other organizations to help achieve equity, wrote a spokesman for the health department, and about 20% to 30% of vaccine delivery is targeted at diverse populations, including homeless shelters and faith-based initiatives.
Meanwhile, Mississippi health department spokeswoman Liz Sharlot said the state is working with black pastors, historically black colleges and universities and prominent African-American doctors to address the disparity. And Florida – where the vaccination rate is 23.6% higher in the wealthiest counties – is working with places of worship and other locations in underserved communities where the vaccine can be administered, said a health agency spokesman. Florida vaccine allocations by county are based on the size of the population over 65.
Although the elderly are more vulnerable to Covid-19, the distribution of vaccines based on age can contribute to inequalities. In Connecticut, the northeast section of Hartford has a life expectancy of 68.9 years, compared to 84.6 years at West Hartford Center, so a smaller proportion of its residents have been eligible for vaccination so far. The state opened vaccines for people aged 65 to 75 just this week. “In Hartford, you are losing a substantial portion of the population,” said Donelson, of the Connecticut Health Foundation.
Online booking systems have also contributed to the disparities. A vaccine delivery system that gives consultations to those who can schedule them faster will inevitably reward those with time and connections. People often need to call five different health centers to try to get a vaccination list, said Georges Benjamin, executive director of the American Public Health Association. “It says a lot about the lack of planning,” he said.
Online booking systems require a computer, Wi-Fi and the ability to navigate a complicated system, Wright said. Wealthier people are more likely to be away from work and have easier access to the transportation needed to be vaccinated.
“The wealthier people will be more engaged in launching the vaccination,” he said. “It shows how much more we need to do to make proactive efforts to reach the most vulnerable.”
STAT Methodology
STAT examined the discrepancies in 10 states with the largest wealth gap, as measured by the Gini coefficient, which provided local or equivalent data on the population’s vaccination rates.
For each state, we look at vaccine distribution rates in the richest 10% and poorest 10% of counties. For most states, we use federal data on average household income. In Connecticut, we use vaccine data and average household income for cities and towns. And we looked at the average family income and vaccination rates for each ward in Washington, DC In New Jersey, which has 22 counties, we compare the three richest counties and the poorest counties.
STAT used vaccination rates published on the websites of the local health department from 6 to 10 February. Connecticut, Florida and New Jersey provided the percentage of residents who received their first doses; Mississippi provided the vaccine doses administered by the county of residence; California provided vaccine doses administered by 10,000 residents; Washington, DC provided the number of residents fully vaccinated by the ward.