scholarly journals Changing the Narrative: Structural Barriers and Racial and Ethnic Inequities in COVID-19 Vaccination

2021 ◽  
Vol 18 (18) ◽  
pp. 9904
Author(s):  
Anuli Njoku ◽  
Marcelin Joseph ◽  
Rochelle Felix
Keyword(s):  
Minority Groups ◽  
Ethnic Disparities ◽  
The United States ◽  
Vaccine Uptake ◽  
Vaccine Hesitancy ◽  
Structural Barriers ◽  
Structural Racism ◽  
Vaccination Rates ◽  
Promising Solution ◽  
The Impact

The COVID-19 pandemic has disproportionately affected racial and ethnic minority groups in the United States. Although a promising solution of the COVID-19 vaccination offers hope, disparities in access again threaten the health of these communities. Various explanations have arisen for the cause of disparate vaccination rates among racial and ethnic minorities, including discussion of vaccine hesitancy. Conversely, the role of vaccine accessibility rooted in structural racism as a driver in these disparities should be further explored. This paper discusses the impact of structural barriers on racial and ethnic disparities in COVID-19 vaccine uptake. We also recommend public health, health system, and community-engaged approaches to reduce racial disparities in COVID-19 disease and mortality.

scholarly journals A Geography of Risk: Structural Racism and COVID-19 Mortality in the United States

2021 ◽  
Author(s):  
Lauren C Zalla ◽  
Chantel L Martin ◽  
Jessie K Edwards ◽  
Danielle R Gartner ◽  
Grace A Noppert
Keyword(s):  
Minority Groups ◽  
Ethnic Disparities ◽  
The United States ◽  
Structural Racism ◽  
Public Health Response ◽  
Health Response ◽  
The Us ◽  
Racialized Minority ◽  
Racial And Ethnic Minority ◽  
Disproportionate Burden

Abstract Coronavirus disease 2019 (COVID-19) is disproportionately burdening racial and ethnic minority groups in the US. Higher risks of infection and mortality among racialized minorities are a consequence of structural racism, reflected in specific policies that date back centuries and persist today. Yet, our surveillance activities do not reflect what we know about how racism structures risk. When measuring racial and ethnic disparities in deaths due to COVID-19, the CDC statistically accounts for the geographic distribution of deaths throughout the US to reflect the fact that deaths are concentrated in areas with different racial and ethnic distributions than that of the larger US. In this commentary, we argue that such an approach misses an important driver of disparities in COVID-19 mortality, namely the historical forces that determine where individuals live, work, and play, and consequently determine their risk of dying from COVID-19. We explain why controlling for geography downplays the disproportionate burden of COVID-19 on racialized minority groups in the US. Finally, we offer recommendations for the analysis of surveillance data to estimate racial disparities, including shifting from distribution-based to risk-based measures, to help inform a more effective and equitable public health response to the pandemic.

scholarly journals Spatial Modeling of COVID-19 Vaccine Hesitancy in the United States

2021 ◽  
Vol 18 (18) ◽  
pp. 9488
Author(s):  
Abolfazl Mollalo ◽  
Moosa Tatar
Keyword(s):  
United States ◽  
Healthcare Providers ◽  
Vulnerability Index ◽  
The United States ◽  
Vaccine Hesitancy ◽  
Social Vulnerability Index ◽  
Vaccination Programs ◽  
Public Health Decision ◽  
Vaccination Rates ◽  
The Impact

Vaccine hesitancy refers to delay in acceptance or refusal of vaccines despite the availability of vaccine services. Despite the efforts of United States healthcare providers to vaccinate the bulk of its population, vaccine hesitancy is still a severe challenge that has led to the resurgence of COVID-19 cases to over 100,000 people during early August 2021. To our knowledge, there are limited nationwide studies that examined the spatial distribution of vaccination rates, mainly based on the social vulnerability index (SVI). In this study, we compiled a database of the percentage of fully vaccinated people at the county scale across the continental United States as of 29 July 2021, along with SVI data as potential significant covariates. We further employed multiscale geographically weighted regression to model spatial nonstationarity of vaccination rates. Our findings indicated that the model could explain over 79% of the variance of vaccination rate based on Per capita income and Minority (%) (with positive impacts), and Age 17 and younger (%), Mobile homes (%), and Uninsured people (%) (with negative effects). However, the impact of each covariate varied for different counties due to using separate optimal bandwidths. This timely study can serve as a geospatial reference to support public health decision-makers in forming region-specific policies in monitoring vaccination programs from a geographic perspective.

scholarly journals Socioeconomic privilege and political ideology are associated with racial disparity in COVID-19 vaccination

2021 ◽  
Vol 118 (33) ◽  
pp. e2107873118
Author(s):  
Ritu Agarwal ◽  
Michelle Dugas ◽  
Jui Ramaprasad ◽  
Junjie Luo ◽  
Gujie Li ◽  
...  
Keyword(s):  
Racial Disparities ◽  
Republican Party ◽  
Political Ideology ◽  
Adult Population ◽  
The United States ◽  
Vaccine Uptake ◽  
Vaccine Hesitancy ◽  
Median Income ◽  
Structural Inequities ◽  
The Impact

Vaccine uptake is critical for mitigating the impact of COVID-19 in the United States, but structural inequities pose a serious threat to progress. Racial disparities in vaccination persist despite the increased availability of vaccines. We ask what factors are associated with such disparities. We combine data from state, federal, and other sources to estimate the relationship between social determinants of health and racial disparities in COVID-19 vaccinations at the county level. Analyzing vaccination data from 19 April 2021, when nearly half of the US adult population was at least partially vaccinated, we find associations between racial disparities in COVID-19 vaccination and median income (negative), disparity in high school education (positive), and vote share for the Republican party in the 2020 presidential election (negative), while vaccine hesitancy is not related to disparities. We examine differences in associations for COVID-19 vaccine uptake as compared with influenza vaccine. Key differences include an amplified role for socioeconomic privilege factors and political ideology, reflective of the unique societal context in which the pandemic has unfolded.

scholarly journals Addressing Parental Vaccine Hesitancy and Other Barriers to Childhood/Adolescent Vaccination Uptake During the Coronavirus (COVID-19) Pandemic

2021 ◽  
Vol 12 ◽  
Author(s):  
Olufunto A. Olusanya ◽  
Robert A. Bednarczyk ◽  
Robert L. Davis ◽  
Arash Shaban-Nejad
Keyword(s):  
Public Health ◽  
Healthcare Providers ◽  
Policy Decision ◽  
The United States ◽  
Vaccine Uptake ◽  
Vaccine Hesitancy ◽  
Surveillance Systems ◽  
Health Crisis ◽  
Children And Adolescent ◽  
Vaccination Rates

Routine childhood immunizations are proven to be one of the most effective public health interventions at controlling numerous deadly diseases. Therefore, the CDC recommends routine immunizations for children and adolescent populations against vaccine-preventable diseases e.g., tetanus, pertussis, diphtheria, etc. This current review sought to examine barriers to pediatric vaccine uptake behaviors during the COVID-19 pandemic. We also explored the implications for parental vaccine hesitancy/delay during an ongoing health crisis and proposed recommendations for increasing vaccine confidence and compliance. Our review determined that the receipt for vaccinations steadily improved in the last decade for both the United States and Tennessee. However, this incremental progress has been forestalled by the COVID-19 pandemic and other barriers i.e. parental vaccine hesitancy, social determinants of health (SDoH) inequalities, etc. which further exacerbate vaccination disparities. Moreover, non-compliance to routine vaccinations could cause an outbreak of diseases, thereby, worsening the ongoing health crisis and already strained health care system. Healthcare providers are uniquely positioned to offer effective recommendations with presumptive languaging to increase vaccination rates, as well as, address parental vaccine hesitancy. Best practices that incorporate healthcare providers’ quality improvement coaching, vaccination reminder recall systems, adherence to standardized safety protocols (physical distancing, hand hygiene practices, etc.), as well as, offer telehealth and outdoor/drive-through/curbside vaccination services, etc. are warranted. Additionally, a concerted effort should be made to utilize public health surveillance systems to collect, analyze, and interpret data, thereby, ensuring the dissemination of timely, accurate health information for effective health policy decision-making e.g., vaccine distribution, etc.

scholarly journals COVID-19 infection and vaccination rates in healthcare workers in British Columbia, Canada: A Longitudinal Urban versus Rural Analysis of the Impact of the Vaccine Mandate

2022 ◽  
Author(s):  
Annalee Yassi ◽  
Stephen Barker ◽  
Karen Lockhart ◽  
Deanne Taylor ◽  
Devin Harris ◽  
...  
Keyword(s):  
British Columbia ◽  
Rural Areas ◽  
Healthcare Workers ◽  
Critical Role ◽  
Vaccine Uptake ◽  
Vaccine Hesitancy ◽  
Healthcare Provision ◽  
Vaccination Rates ◽  
The Impact ◽  
Urban Versus

Purpose: Healthcare workers (HCWs) play a critical role in responding to the COVID-19 pandemic. Early in the pandemic, urban centres were hit hardest globally; rural areas gradually became more impacted. We compared COVID-19 infection and vaccine uptake in HCWs living in urban versus rural locations within, and between, two health authorities in British Columbia (BC), Canada. We also analyzed the impact of a vaccine mandate for HCWs. Methods: We tracked laboratory-confirmed SARS-CoV-2 infections, positivity rates, and vaccine uptake in 29,021 HCWs in Interior Health (IH) and 24,634 HCWs in Vancouver Coastal Health (VCH), by occupation, age, and home location, comparing to the general population in that region. We then evaluated the impact of infection rates as well as the mandate on vaccination uptake. Results: By October 27, 2021, the date that unvaccinated HCWs were prohibited from providing healthcare, only 1.6% in VCH yet 6.5% in IH remained unvaccinated. Rural workers in both areas had significantly higher unvaccinated rates compared with urban dwellers. Over 1,800 workers, comprising 6.4% of rural HCWs and 3.3% of urban HCWs, remained unvaccinated and set to be terminated from their employment. While the mandate prompted a significant increase in second doses, the impact on the unvaccinated was less clear. Conclusions: As rural areas often suffer from under-staffing, loss of HCWs could have serious impacts on healthcare provision as well as on the livelihoods of unvaccinated HCWs. Greater efforts are needed to understand how to better address the drivers of rural-related vaccine hesitancy as the pandemic continues.

scholarly journals COVID-19 and Historic Influenza Vaccinations in the United States: A Comparative Analysis

Vaccines ◽  
2021 ◽  
Vol 9 (11) ◽  
pp. 1284
Author(s):  
Pranav Mirpuri ◽  
Richard A. Rovin
Keyword(s):  
Influenza Vaccination ◽  
The United States ◽  
Vaccination Rate ◽  
Primary Objective ◽  
Vaccine Uptake ◽  
Vaccine Hesitancy ◽  
County Level ◽  
Vaccination Rates ◽  
Global Challenge ◽  
Us Counties

The COVID-19 vaccination effort is a monumental global challenge. Recognizing and addressing the causes of vaccine hesitancy will improve vaccine uptake. The primary objective of this study was to compare the COVID-19 vaccination rates in US counties to historical vaccination rates for influenza in persons aged 65 and older. The secondary objective was to identify county-level demographic, socioeconomic, and political factors that influence vaccination rates. County level data were obtained from publicly available databases for comparison and to create predictive models. Overall, in US counties the COVID-19 vaccination rate exceeded influenza vaccination rates amongst those aged 65 or older (69.4.0% vs. 44%, p < 0.0001). 2690 (83.4%) of 3224 counties had vaccinated 50% or more of their 65 and older residents in the first seven months of the COVID-19 vaccination roll out. There were 467 (14.5%) of 3223 counties in which the influenza vaccination rate exceeded the COVID-19 vaccination rate. Most of these counties were in the Southern region, were considered politically “red” and had a significantly higher non-Hispanic Black resident population (14.4% vs. 8.2%, p < 0.0001). Interventions intended to improve uptake should account for nuances in vaccine access, confidence, and consider factual social media messaging, especially in vulnerable counties.

scholarly journals Factors That Influence Risk Perceptions and Successful COVID-19 Vaccination Communication Campaigns With American Indians

2021 ◽  
pp. 107554702110569
Author(s):  
Amanda D. Boyd ◽  
Dedra Buchwald
Keyword(s):  
American Indians ◽  
Risk Perceptions ◽  
Herd Immunity ◽  
The United States ◽  
Vaccine Hesitancy ◽  
Future Research ◽  
Vaccination Rates ◽  
Culturally Congruent ◽  
Communication Campaigns ◽  
The Impact

COVID-19 vaccinations are the primary tool to end the pandemic. However, vaccine hesitancy continues to be a barrier to herd-immunity in the United States. American Indians (AI) often have higher levels of distrust in western medicine and lower levels of satisfaction with health care when compared to non-Hispanic Whites. Yet AIs have high COVID-19 vaccination rates. We discuss factors that influence AI risk perceptions of COVID-19 vaccinations including the impact of COVID-19 on AI Elders, community, and culture. We conclude with future research needs on vaccination communication and how culturally congruent communication campaigns may have contributed to high COVID-19 vaccination rates.

scholarly journals Distance to Vaccine Sites is Associated with Lower COVID-19 Vaccine Uptake

2022 ◽  
Author(s):  
Asaf Mazar ◽  
Geoffrey Tomaino ◽  
Ziv Carmon ◽  
Wendy Wood
Keyword(s):  
United States ◽  
Cause Of Death ◽  
Distance Effect ◽  
The United States ◽  
Vaccine Uptake ◽  
Vaccine Hesitancy ◽  
Reverse Causality ◽  
Vaccination Rates ◽  
Wide Availability

COVID-19 remains a leading cause of death in the United States, despite wide availability of vaccines. Distance may pose an overlooked barrier to vaccine uptake. We analyzed the association between distance to vaccine sites and vaccination rates. Zip codes farther away from vaccine sites had consistently lower vaccine uptake. This effect persisted after controlling for potent covariates (e.g., partisanship, vaccine hesitancy), as well as in multiverse analyses testing across more than 1,000 specifications. Suggesting that the effect was not explained by reverse causality (i.e. proximity driven by demand), the distance effect maintained in analyses limited only to retail locations (e.g., CVS), whose location was set pre-pandemic. Findings suggest that reducing distance to vaccine sites as a powerful lever for encouraging COVID-19 vaccination.

scholarly journals A Mixed-Methods Analysis of Barriers to and Facilitators of Human Papillomavirus Vaccination Among Adolescents in Montana

2020 ◽  
Vol 135 (6) ◽  
pp. 842-850
Author(s):  
Sophia R. Newcomer ◽  
James Caringi ◽  
Beth Jones ◽  
Emily Coyle ◽  
Timothy Schehl ◽  
...  
Keyword(s):  
Human Papillomavirus ◽  
Mixed Methods ◽  
Qualitative Data ◽  
Hpv Vaccination ◽  
The United States ◽  
Vaccine Uptake ◽  
Vaccine Hesitancy ◽  
Medical Providers ◽  
Medical Provider ◽  
Vaccination Rates

Objectives Human papillomavirus (HPV) vaccination rates among adolescents are lower in rural areas than in urban areas of the United States. The objective of this study was to identify barriers to and facilitators of adolescent HPV vaccination in Montana, a large, primarily rural state. Methods Using a mixed-methods design, we integrated quantitative analyses of Montana’s National Immunization Survey–Teen (NIS-Teen) data from 2013-2017 with qualitative data collected at a statewide meeting in October 2018 and from stakeholder interviews conducted from October 2018 through June 2019. Using NIS-Teen data, we identified trends and estimated adjusted prevalence ratios (aPRs) to identify factors associated with vaccine uptake. Using directed content analysis of qualitative data, we identified themes related to vaccine uptake. Results In Montana, initiation of the HPV vaccine series among adolescents aged 13-17 increased from 34.4% in 2013 to 65.5% in 2017. We identified 6 themes related to HPV vaccination from qualitative analyses, including medical providers’ recommendation style as a facilitator of vaccination and parental vaccine hesitancy as a barrier to vaccination. In NIS-Teen 2017 data (n = 326 adolescents), receiving a medical provider recommendation was significantly associated with series initiation (aPR = 2.3; 95% CI, 1.5-3.6). Among parents who did not intend to initiate the vaccine series for their adolescent within 12 months (n = 71), vaccine safety was the top concern (aPR = 24.5%; 95% CI, 12.1%-36.9%). Conclusions HPV vaccination rates have increased in Montana but remain lower than rates for other adolescent vaccines. Future work should focus on reducing missed opportunities, increasing parents’ knowledge of and confidence in vaccination, and training medical providers on addressing common vaccine concerns.

Online misinformation is linked to COVID-19 vaccination hesitancy and refusal (Preprint)

2021 ◽  
Author(s):  
Francesco Pierri ◽  
Brea Perry ◽  
Matthew DeVerna ◽  
Kai-Cheng Yang ◽  
Alessandro Flammini ◽  
...  
Keyword(s):  
Herd Immunity ◽  
Negative Relationship ◽  
Vaccine Uptake ◽  
Vaccine Hesitancy ◽  
Causality Analysis ◽  
Vaccination Rates ◽  
Uptake Rates ◽  
Geographical Regions ◽  
Control And Prevention ◽  
The Impact

BACKGROUND Widespread uptake of vaccines is necessary to achieve herd immunity. However, uptake rates varied across U.S. states during the first six months of the COVID-19 vaccination program. Online misinformation may play an important role in vaccine hesitancy, and there is a need to comprehensively quantify the impact of misinformation on beliefs, behaviors, and health outcomes. OBJECTIVE This work investigates the extent to which COVID-19 vaccination rates and vaccine hesitancy are associated with levels of online misinformation about vaccines across geographical regions. We also look for evidence of directionality from online misinformation to vaccine hesitancy. METHODS Vaccine uptake recordings were taken from Centers for Disease Control and Prevention (CDC) data over the week of March 19 to 25, 2021. Vaccine hesitancy data and misinformation data were taken over the period, Jan 4th to March 25th, 2021. We leverage over 22 M individual responses to surveys administered on Facebook to assess vaccine hesitancy rates, and we identify online misinformation by focusing on low-credibility sources shared on Twitter by over 1.67M users geolocated within U.S. regions. Statistical analysis was done using multivariate regression models adjusting for socioeconomic, demographic and political confounding factors. RESULTS We find a negative relationship between misinformation and vaccination uptake rates. Online misinformation is also correlated with vaccine hesitancy rates taken from survey data. Associations between vaccine outcomes and misinformation remain significant when accounting for political as well as demographic and socioeconomic factors. While vaccine hesitancy is strongly associated with Republican vote share, we observe that the effect of online misinformation on hesitancy is strongest across Democratic rather than Republican counties. Granger causality analysis shows evidence for a directional relationship from online misinformation to vaccine hesitancy. CONCLUSIONS These results indicated that there are geographically located hotspots of vaccine refusal which are associated with online misinformation and unexplained by other factors. Our results support a need for interventions that address online misinformation, allowing individuals to make better-informed health decisions. COVID-19 | Facebook | misinformation | Twitter | vaccine hesitancy | vaccines

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