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Study: Health care facilities in hard-hit communities less likely to give vaccines

People getting the COVID-19 vaccine will receive a special vaccine card to record their doses, Operation Warp Speed officials say. Here, a Department of Health and Human Services employee holds a sample card.
EJ Hersom
U.S. Department of Defense
A Department of Health and Human Services employee holds a sample vaccine card in this undated photo.

Research published today by a team of researchers led by UC San Diego scientists found that health care facilities in underrepresented, rural and hard-hit communities were less likely to administer COVID-19 vaccines during their initial rollout, partially due to not receiving enough doses to meet demand.

In a study published Thursday in PLOS Medicine, Inmaculada Hernandez, associate professor of clinical pharmacy at Skaggs School of Pharmacy and Pharmaceutical Sciences at UCSD, quantified the disparities in the early distribution of COVID-19 vaccines to health care facilities across the country.

"Both the national policy and public opinion agreed that vaccine distribution should prioritize disadvantaged communities and those hit hardest by COVID-19, but the data shows that is not what happened," Hernandez said.


According to the researchers, previous studies of vaccine accessibility had not distinguished whether lower access in underserved neighborhoods was a product of the lower concentration of health care facilities in these areas or of inequities in the distribution of COVID-19 vaccines to each health care facility.

To answer that question, Hernandez and colleagues at UCSD, University of Florida and University of Pittsburgh tested whether the likelihood of an eligible health care facility administering COVID-19 vaccines varied based on the racial/ethnic composition of counties and how rural or urban the county is.

The team focused on the initial phase of vaccine rollout, using data from May 2021 when states were officially required to make vaccines available to the public.

At that time, 61% of eligible health care facilities and 76% of eligible pharmacies across the U.S. provided COVID-19 vaccinations. When the researchers began comparing these rates with the socioeconomic features of the county each facility was located in, several patterns emerged.

Facilities in counties with a high proportion of Black people were less likely to serve as COVID-19 vaccine administration locations compared to facilities in counties with a low proportion of Black people. This was particularly the case in metropolitan areas, where facilities in urban counties with large Black populations had 32% lower odds of administering vaccines compared to facilities in urban counties with small Black populations.


The researchers also found facilities in rural counties and in counties hardest hit by COVID-19 were also associated with decreased odds of serving as a COVID-19 vaccine administration location. In rural counties with a high proportion of Hispanic people, facilities had 26% lower odds of administering vaccines compared to facilities in rural counties with a low proportion of Hispanic people.

The paper's authors claim further research is necessary to identify the reasons why vaccines were not equitably distributed to all health care facilities and how the involvement of these facilities evolved across subsequent phases of vaccine distribution.

"To achieve health equity in future public health programs, including the distribution of booster shots, it is crucial that public health authorities review these early COVID-19 distribution plans to understand how and why this happened," said senior author Dr. Jingchuan (Serena) Guo, assistant professor at University of Florida.