Barriers to Immunization: Beyond Vaccine Hesitancy

By Jessica Scott, PhDMarch 1, 2021

A recent Research!America blog post discussed the issue of vaccine hesitancy as an obstacle to ensuring that enough U.S. residents receive a COVID-19 vaccine. However, vaccine hesitancy is far from the only barrier to achieving equitable vaccine distribution. Although recent surveys show that historically mistreated groups are somewhat less willing to take the vaccine, a majority of Americans across all racial and ethnic groups say they would take the vaccine if it were available to them today. In spite of this, white Americans are being vaccinated at far higher rates than Americans in other racial groups – rates that reflect more than just vaccine hesitancy.

According to the most recent analysis by Kaiser Health News, only 26 states have reported vaccinations rates by race and ethnicity. In virtually all of these states, vaccines are going to white residents at substantially higher rates than Black and Hispanic residents. Nationwide, the report found that white residents are being vaccinated at twice the rate of Black residents and three times the rate of Hispanic residents.

Issues of Access

Disadvantaged communities, which are disproportionately composed of people of color, often lack the tools they need to schedule and get to COVID-19 vaccine appointments. People in wealthier communities are more likely to have access to high-speed Internet, allowing them to more easily sign up for scarce vaccination slots. They are more likely to hold jobs that permit them to take paid time off for vaccinations, and they are more likely to have adequate transportation to reach vaccine clinics.

In an Alliance for Health Policy Webinar, Board Chair Dr. Reed Tuckson shared stories of members of majority-white communities coming into majority-Black communities for vaccine appointments, simply because they were able to secure those slots more quickly. A recent New York Times story covered similar occurrences around the country. Dr. Tuckson also spoke of the need for federal dollars to reach majority-Black communities. He points out that white-led philanthropies with pre-existing government relationships often receive far higher funding than Black-led organizations, which are left to complete enormous undertakings with few resources.

Working Toward Equity

One of President Joe Biden’s first actions in office was to establish a COVID-19 Equity Task Force, led by Dr. Marcella Nunez-Smith and charged with “mitigating the health inequities caused or exacerbated by the COVID-19 pandemic” and “preventing such inequities in the future.” While the recently-established task force is still evaluating the best course of action, leaders advocating for health equity have been sharing their own ideas.

A COVID-19 vaccine equity working group led by Johns Hopkins University and Texas State University published their recommendations for conducting a vaccination campaign focused on equity for hard-hit Black, Indigenous, and People of Color (BIPOC) communities. The plan calls for consistent engagement with BIPOC communities, direct involvement of community leaders, clear communication, allocation of resources to BIPOC neighborhoods, and ongoing investment in equitable public health. Experts also advocate for explicit prioritization of Black communities, better community access to vaccination sites, and improved demographic data collection.

The United States needs quick but sustained action on racial equity when it comes to COVID-19 vaccines. In order to avoid exacerbating the health inequalities exposed and amplified over the course of the pandemic, we must continue to address issues of access within underserved communities, looking to experts and community leaders for guidance.