• Pre-Collegiate Global Health Review

Bridging the U.S. COVID-19 Vaccination Gap: Beyond Red and Blue

Vikram Sundaram, Solon High School, Solon, Ohio, USA



When the coronavirus pandemic unfolded in November of 2019, American citizens were oblivious as to what they were up against. With no recorded cases in the U.S. at the time, many Americans could not even fathom that they would eventually be on the receiving end. Just two months later, when the U.S. recorded its first COVID-19 case, modest calls to flatten the curve and social distance began to emerge. Fast forward to January of 2021 and the United States was seeing upwards of 4,000 COVID-19 deaths per day (Katkov, 2021). To put that into perspective, we were recreating the death toll of the 9/11 terrorist attacks every day for two months.

For the majority of the year 2020, we found our country in shambles from an enemy that we could not even see. With workers losing their jobs, families unable to see each other, and students sitting in front of screens for months on end, Americans were desperately looking for a silver lining. Fortunately, one was on the way.

In the month of April, nearly 3.5 million vaccines were put into the arms of American citizens on the daily. Inoculations were at a peak, and America was gradually beginning to reopen, with citizens resuming the lifestyle that they were longing for the entire year. Unfortunately, by the end of June, vaccination rates had dropped by 80% (Engber, 2021). Now, COVID-19 cases have risen in all 50 states, fueled by a raging Delta variant that ostensibly emerged due to an un-immunized population. America was back to square one.

In times of crisis, it is human nature to look for someone to blame. Across our country, much of the blame for declining vaccinations has been pinned on Republican majority states. Indeed, as of July just 35% of people in counties that voted Trump in 2020 were vaccinated, compared to 46% in Biden counties (Kates, 2021). However, what people fail to realize is that there is far more to the story. Amidst this entire vaccine debacle, many of us have failed to consider the barriers that are preventing people from getting vaccinated in the first place.

Some of the most prominent barriers to U.S. vaccination are particularly apparent within our minority communities. A study conducted by the Kaiser Family Foundation (2021) notes that as of August, the vaccination rate for African American adults was less than 50% in 38 reporting states, compared to a rate of 72% in the overall US adult population. A similar trend was seen among Hispanics, whose vaccination rate was below 50% in 32 reporting states.

So, the question is: why does this problem exist chiefly in minority communities? There are a couple answers to that. The first concerns their warranted distrust of America’s healthcare system after decades upon decades of intentional neglect. A common example is the 40-year Tuskegee study, which intentionally denied hundreds of African American men a treatment for syphilis, all to track the natural evolution of the disease (Newkirk II, 2016). However, once again, there is far more to the story. The most prevalent barrier to vaccination within minority communities is the socioeconomic disparities linked to these existing racial inequalities. One of the most prominent socioeconomic barriers concerns the physical isolation minority communities have experienced for centuries now. According to The University of Pittsburgh Medical Center (2021), in a study with 26 million people over 69 counties, it was discovered that “Black individuals are significantly more likely than White individuals to live more than a mile from the closest vaccination facility”. These families are thus forced to sacrifice valuable time and money on transportation alone when seeking vaccination. What makes this even more alarming is the fact that three fourths of these counties with distinct racial barriers had some of the highest rates of new COVID-19 cases (Hernandez, 2021). To put this into perspective, minority communities are being further punished for their socioeconomic hardships in the form of a deadly pandemic -- a problem that is unfortunately receiving very little response.

There is no denying that the racial barriers and the socioeconomic disparities linked to them are significant drivers of the U.S. COVID-19 vaccination gap. However, if we zoom out a bit, we also begin to realize that there are significant socioeconomic impediments which exist in poorer communities in general. Whether it be fatigue, aches, or fever, side effects have been a major deterrent to COVID-19 vaccination. The typical argument is that individuals do not get vaccinated because they want to avoid those side effects, which they perceive as drastic. While this may be the case for some, once again, there is far more to the story. Many financially unstable Americans fear that these side effects will keep them out of work or put their job on the line, causing them to miss out on valuable income needed for their families, bills, and expenses (Lopez, 2021). On a more troubling note, some Americans are even being charged for vaccinations when they are supposed to be free. Martin Gola, an individual who received the two-dose Moderna vaccine at a hospital in Northeast Philadelphia, went into his COVID-19 vaccination appointment thinking it would be free. Little did he know, this could not be further from the truth. In July, he received a bill for $32. A few days later, another for $79 (Gantz, 2021). While scenarios like this do not typically occur, they are creating an atmosphere of skepticism surrounding vaccinations and their potential cost, which is reasonably preventing many low-income Americans from registering to get a vaccine.

The problems surrounding the COVID-19 vaccination gap are immense. However, these problems are not without solutions as there is a lot that can be done. Concerning racial barriers, vaccine sites could be placed in areas that are generally trusted by minority communities, like “community centers, faith based organizations, or schools” (Blackstock, 2021). Additionally, to tackle the problem of accessibility, American policy makers should emulate the vaccine efforts that Maine implemented not too long ago. Maine, with the largest proportion of rural Americans, was able to implement a system of mass public vaccination clinics across the state. The use of a large number of “pop-up sites” throughout communities largely eliminated travel as a complication. As a result, “Maine’s vaccine rates are among the highest in the country among all age groups,” and there are few observed racial and ethnic disparities (Mills, 2021). If the rest of the country were to learn from this, we could be well on our way to the normality Americans have been yearning for.

Considering the socioeconomic hardships that many have endured during the pandemic, American workplaces should also provide paid time off for those who miss work for vaccine side effects. As a result, lower income Americans would still be able to maintain a degree of financial stability, thus mitigating a potential fear driving vaccine hesitancy. Finally, America needs to alleviate fears of the financial burden of vaccination. Vaccine sites should be required to publicize through signage that vaccines are free of charge to all, regardless of insurance status. Furthermore, the government should set up a system by which individuals can report erroneous charges.

It is clear now that America's COVID-19 vaccination gap runs much deeper than partisan politics. Indeed, underlying vaccine hesitancy are entrenched and often ignored gradients of racial and socioeconomic disadvantage. It is critical for our nation to address these inequities if we hope to mount a competent and robust vaccination campaign to finally bring us out of this pandemic.


References


Anne Mills, D. J., & Boomsma, J. (2021, July 27). Lessons learned FROM Maine's Nation-Leading Vaccination efforts: Health AFFAIRS BLOG. Health Affairs. https://www.healthaffairs.org/do/10.1377/hblog20210722.638604/full/.


Blackstock, U., & Blackstock, O. (2021, February 10). Opinion | White Americans are being vaccinated at higher rates than Black Americans. Such inequity cannot stand. The Washington Post. https://www.washingtonpost.com/opinions/2021/02/01/racial-inequality-covid-vaccine/.


Engber, D. (2021, July 31). Vaccination in america might have only one tragic path forward. The Atlantic. https://www.theatlantic.com/health/archive/2021/07/america-covid-19-vaccine-decline/619474/.


Gantz, S. (2021, August 25). Covid-19 vaccine is free, yet some are getting bills. doctors worry this is slowing immunization. https://www.inquirer.com. https://www.inquirer.com/health/coronavirus/coronavirus-covid-19-vaccine-bill-cost-free-20210818.html.


Hernandez, I. (2021, February 4). Where black Americans will travel farther than whites FOR COVID-19 Vaccination. UPMC. https://www.upmc.com/media/news/020421-vaxmap-2.


Kates, J., Tolbert, J., & Orgera, K. (2021, July 8). The red/blue divide IN COVID-19 vaccination rates is growing. KFF. https://www.kff.org/policy-watch/the-red-blue-divide-in-covid-19-vaccination-rates-is-growing/.


Katkov, M. (2021, January 8). U.S. records more than 4,000 dead in 1 day From COVID-19, a GRIM new record. NPR. https://www.npr.org/sections/coronavirus-live-updates/2021/01/08/954848161/u-s-records-more-than-4-000-dead-in-1-day-from-covid-19-a-grim-new-record.


Lopez, G. (2021, June 2). The 6 reasons Americans aren't getting vaccinated. Vox. https://www.vox.com/2021/6/2/22463223/covid-19-vaccine-hesitancy-reasons-why.


Ndugga, N. F., Hill, L., Artiga, S., & Parker, N. (2021, August 18). Latest data On COVID-19 Vaccinations by Race/Ethnicity. KFF. https://www.kff.org/coronavirus-covid-19/issue-brief/latest-data-on-covid-19-vaccinations-race-ethnicity/.


II, V. R. N. (2021, July 13). An unethical medical study took a year off the lives of black men. The Atlantic. https://www.theatlantic.com/politics/archive/2016/06/tuskegee-study-medical-distrust-research/487439/.


Article Thumbnail: County, A. (2021, January 5). Covid-19 vaccine. Flickr. https://www.flickr.com/photos/alachuacounty/50802098581.