After targeted campaigns helped narrow a racial divide in US vaccination rates last autumn, that gap has reopened for booster shots.
Advocates say that distrust in public health systems, problems with access, and staff shortages have hindered black and Hispanic residents from receiving boosters in the same proportions as their white peers.
The disparities are significant as black and Hispanic populations have died from Covid-19 at disproportionately higher rates than whites, and officials worked hard to promote the vaccine in those communities. Health officials worked with religious leaders and community organisations to address concerns around the vaccine and make it more accessible.
Eleven states plus Washington DC track booster recipients by race and ethnicity. In those places, booster rates for white people (as a share of the fully vaccinated population) were among the highest, while rates for black and Hispanic populations trailed.
In Illinois, for example, more than half of fully vaccinated white residents received their booster doses by January 19, compared to 38 per cent of black residents and 33 per cent of Hispanic residents. The US white population also skews older, meaning that more white residents were recommended to receive boosters earlier.
The gap calls into question whether booster rollout campaigns are reaching some of the most vulnerable populations as cases of Omicron, the new variant of the virus, rise.
“When we see disparities in the primary series administration, we know that that’s going to have a trickle-down effect on the proportion of the population that’s boosted,” said Joe Coyle, director of Michigan’s Bureau of Infectious Disease Prevention. “There’s obviously a cascade effect.”
White residents disproportionately received the original doses of the vaccine when the rollout began last spring. Limited vaccine supply and complex online scheduling systems made shots less accessible in low-income communities of colour, who also expressed hesitancy about the vaccine. In May, just 56 per cent of black adults and 57 per cent of Hispanic adults said they had received at least one dose, compared to 65 per cent of white adults, according to a Kaiser Family Foundation survey.
By September, Marcella Nunez-Smith, head of Joe Biden’s Covid-19 Equity Task Force, cited survey data showing roughly equal percentages of white, black and Hispanic adults reporting that they had received at least one dose of the vaccine, saying the numbers were “very, very encouraging”.
But then Omicron caused record-high infections and led the CDC to recommend an additional vaccine dose.
Omicron also sparked staff shortages in care facilities across the country that forced much of the previously established outreach work to be scaled back, according to Monica Schoch-Spana, a medical anthropologist at Johns Hopkins University who also runs a research coalition, Community Vax, that studies black and Hispanic communities.
“There is a return to the focus on more centralised clinics, as opposed to meeting people where they are in the community in places such as the barbershops that have hosted vaccine clinics in the past,” said Schoch-Spana.
She added: “The scarce resource now is personnel. There are less health professionals to staff clinics, where it isn’t about large numbers, it’s about targeted populations and smaller numbers, but with significant public health impacts.”
It is also difficult to track booster shot uptake by racial groups in a consistent way. The CDC does not report the race or ethnicity of booster shot recipients under 65, as it does with the initial vaccine doses.
Among those aged 65 and older, federal data show that white people make up a slightly larger share of booster dose recipients in that age group relative to their share of the fully vaccinated population, while black and Hispanic people make up a slightly smaller share.
The gaps are more substantial at the state level.
In Michigan, there is a more than 15-point gap along racial lines, with 52 per cent of fully vaccinated white residents having received the booster dose as of January 18, compared to 37.3 per cent of fully vaccinated black residents and 33.6 per cent of fully vaccinated Hispanic residents. The disparities are widest among young people.
Surveys suggest the same pattern nationwide. Among the 30 to 39 age group, 42 per cent of fully vaccinated white residents between 30 and 39 had received the booster dose, compared to 21 per cent of black residents and 28 per cent of Hispanic residents.
It often does not take much to convince fully vaccinated patients to get a booster shot, said Brittani James, who practises at a medical clinic that serves primarily black residents on Chicago’s Southside. The challenge, she said, is ensuring that they know they are eligible to receive one and know where to find it. Three in ten black and Hispanic adults are unsure or unaware that they need a booster, a survey found.
“When the CDC finally decided to make that switch and [recommend boosters for everybody over 18] . . . Who knows how well that was communicated?” said William Parker, a University of Chicago medical professor.
Céline Gounder, an epidemiologist who served on the Biden administration’s Covid-19 transition team advisory panel, said that high booster take-up rates among the elderly were a good sign, because they were the demographic that benefited the most from boosters.
However, Gounder also pointed to data showing that white and higher-income, educated people were among the most likely to have received boosters.
“People who are getting boosters, setting aside the older demographic, are largely people who are relatively speaking at lower risk than others,” she said. “That means that your yield in terms of actual impact on hospitalisations and deaths is going to be less than if you were making sure you were reaching those more vulnerable populations.”
Outreach to those populations is unlikely to resume until after the Omicron wave subsides, Schoch-Spana fears.
“We’re regressing in some respects to the early days,” Schoch-Spana said. “It’s déjà vu.”
Additional reporting by Caitlin Gilbert