key: cord-0990131-n7iixu04
authors: Vashist, Kushagra; Akintobi, Tabia; Bednarczyk, Robert A.; Narayan, KM Venkat; Patel, Shivani A.
title: Demographic Benchmarks for Equitable Coverage of COVID-19 Vaccination
date: 2021-04-28
journal: Am J Prev Med
DOI: 10.1016/j.amepre.2021.04.001
sha: e843775eaf6460649c911ad2604eee20209bb368
doc_id: 990131
cord_uid: n7iixu04

nan

After a year of unprecedented social distancing and >530,000 American deaths due to coronavirus disease 2019 (COVID-19), 3 severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccines are authorized for emergency use. Federal and state authorities based vaccination priorities on employment in high-exposure occupations essential to everyday life and vulnerability to severe COVID-19 disease. 1 By virtue of employment in high-exposure occupations 2 and experience of severe COVID-19 disease and death, 3 people of colorespecially Black, Hispanic, and Native Americans-are expected to be prioritized for early

vaccination. Yet, reports suggest that public vaccination sites are less likely to be in communities of color in the South 4 and that racial and ethnic minorities are overall more hesitant than White Americans to take the vaccine. 5, 6 Understanding the demographic composition of the U.S. population prioritized for vaccination is critical to track equity in vaccine coverage and to better tailor health communication strategies.

The authors report the racial and ethnic, age, sex, and regional distribution of noninstitutionalized populations prioritized for COVID-19 vaccination.

Immunization Practices criteria. 1 The demographic composition of non-institutionalized priority populations was estimated using the nationally representative National Health Interview Survey (n=25,417) conducted in 2018, the most recent data with necessary occupational, medical history, and demographic information. Whereas the Advisory Committee on Immunization Practices recommended essential healthcare workers at high risk of SARS-CoV-2 exposure for Phase 1a, the authors classified all healthcare workers in Phase 1a owing to data constraints.

Non-healthcare essential workers and adults aged ≥75 years were classified as Phase 1b.

Essential workers not covered in Phase 1a or 1b, adults aged 65-74 years, and adults aged 18-64 years with a high-risk medical condition for COVID-19 were classified as Phase 1c. All other individuals were in Phase 2. Analyses were conducted using SAS, version 9.4.

Approximately 85% of U.S. adults fall into Phase 1 and 15% fall into Phase 2 of the vaccine priority schedule (Table 1 ). Relative to the U.S. population, Phase 1a has a larger share of women (74%), non-Hispanic Black individuals (18%), and adults aged 25-44 years (41%).

Phase 1b has a more equal gender balance (49% women), larger proportion of Non-Hispanic Whites (70%), and by design, adults aged ≥75 years (35%). The demographic distribution of Phase 1c largely follows that of the overall U.S. population. Phase 2 consists of a larger proportion of men (54%), adults aged 18-24 years and 25-44 years, and Hispanic Americans (24%) compared with the overall U.S. population.

A relatively large fraction of individuals prioritized for the earliest distribution of the vaccine are women, non-Hispanic Black individuals, and young to middle-aged adults. Although Black adults are expected to be 17% of Phase 1a, they comprised only 5.4% of adults vaccinated in the first month of the U.S. vaccination program 7 and 6.8% of fully vaccinated adults 3 months after authorization. 8 Furthermore, the proportion of vaccinated Black adults is lower than their share of the population in at least 30 of 44 states reporting vaccination data by race. 9 Delivering vaccines to priority populations will rely on increased investments in overcoming barriers to vaccine access (such as transportation to vaccine centers, Internet access to make appointments, and time off of work) and communication strategies that address vaccine hesitancy in vulnerable groups. Native Americans-a priority group owing to exceedingly high COVID-19 mortalitycomprise a greater share of those vaccinated (~1.5% 8 ) than their representation in the U.S. population (~0.8%). This success demonstrates that systematic efforts can overcome challenges in reaching vulnerable communities. Eligibility for vaccination is ultimately determined by states, and heterogeneity in the timing of eligibility (e.g., teachers, caregivers, and co-residents of elderly) must be considered for local benchmarking. Beyond national data on vaccination demographics, 8 No financial disclosures were reported by the authors of this paper. 

The Advisory Committee on Immunization Practices' Updated Interim Recommendation for Allocation of COVID-19 Vaccine -United States

Differential occupational risk for COVID-19 and other infection exposure according to race and ethnicity

Risk for COVID-19 Infection, Hospitalization, and Death By Race/Ethnicity

Across The South COVID-19 Vaccine Sites Missing From Black And Hispanic Neighborhoods. NPR

COVID-19 vaccination hesitancy in the United States: a rapid national assessment

Demographic characteristics of persons vaccinated during the first month of the COVID-19 vaccination program -United States