Albert Einstein once famously said if he were given an hour to solve a problem, he’d spend 55 minutes understanding it, and then take just five minutes developing solutions.
That formula makes total sense, and perhaps especially when considering a complex and tangled problem like inequity and healthcare. Translated narrowly for the U.S. vaccination effort, it means that it is crucial that we collect the data needed to identify who is having trouble getting vaccinated and why.
Only then can we figure out how to correct injustices.
What gets measured gets managed. With improved data and analysis, we can pinpoint disparities, scrutinize root causes, and adapt strategies accordingly. It has been true in our national health equity work across pilot projects and statewide rollouts, boiling down to three major operating principles:
- Use the latest data when making decisions.
- Work with independent analysts.
- Standardize demographic data reporting.
Looking at Local and National Trends
Take Colorado. Like much of the country, this state of 5,760,000 people has sought to confront the impact of racial inequity in the face of Covid-19. But Black, Latinx and Hawaiian/Pacific Islander residents suffered disproportionately in terms of Covid-19 hospitalizations and deaths, and Black and Brown residents have received only 14 percent of vaccinations despite making up 26 percent of the population.
Balanced vaccine distribution was the goal, but data tells us that Colorado has not achieved that.
This is discouraging. Nationwide, the broader trends have been equally unfavorable. An analysis of archived Centers for Disease Control and Prevention (CDC) vaccination data that we conducted revealed that the share of final vaccine doses that have gone to communities of color fell from 39 percent in January, to 32 percent in February, to 30 percent in March, highlighting a widening chasm between equity and reality.
Even more worrying: A recent CDC report noted that as of May 25, race and ethnicity were known for only 56 percent of those who had received at least one vaccine dose. In the absence of a national database, many states are not recording this information. So we are estimating our own national numbers to increase our understanding of the fairness gap.
Thanks to the great work of many community-based organizations and leadership from local and federal governments, these trends have since reversed. Our internal analysis suggests that in May, over 50 percent of the approximately 28 million new fully vaccinated Americans came from communities of color. However, the progress has been uneven.
What Next?
What steps do we need to take to better tackle inequities?
It is critical that currently available data on demographics be easily accessible to decisionmakers. Data should be open access, disaggregated, and include additional details, including income and age to understand key associations. For example, if CDC data can be stratified by not only demographics but also other characteristics like age, income, distance to a health center, decision makers can better understand and address the underlying drivers of unequal vaccination rates.
In our own commissioned research fielded by HIT Strategies in communities of color in five U.S. cities, we found that the majority of Black and Latino Americans want to get vaccinated – 72 percent in this survey. However, many faced access barriers:
- 63 percent indicated that they did not have enough information about where to get the vaccine.
- 20 percent said they had trouble finding health care when needed.
- more than 20 percent said they had regularly been treated with disrespect when getting health care in the past.
The good news? Despite these systemic barriers, only three percent of those surveyed were completely against getting the Covid-19 vaccine. Others were waiting for access to the vaccine and to better information about the vaccine. This data helped The Rockefeller Foundation and our partners align on a vaccination strategy that addressed both access and confidence issues through our Equity-First Vaccination Initiative.
Data has helped our partners clearly and confidently address questions their communities of color have about the vaccine.
Independent analysts and data scientists can be vital partners for this work, translating complicated vaccination data into practical tools.They can help policymakers identify racial, geographic and socioeconomic gaps in vaccine coverage in real time.
A city- or state-level dashboard that shows vaccine sites, travel time to sites from various communities, as well as strength of demand, could help policymakers understand how their current vaccine distribution plans contribute to economic, social or racial inequities. Finding weaknesses in distribution, access, or even data-gathering is the first step to resolving them.
A great example is the work at University of Wisconsin at Madison through the Covid-19 Modeling Accelerator, where researchers are investigating whether vaccine delivery and allocations are equitable. Their work acknowledges long standing disparities in health care, education, income, and wealth attainment.
The team will build a catalog of fairness interventions and assess them to see if they yield positive outcomes (i.e., increasing immunization rates). This work will allow decision-makers to evaluate which interventions are worth allocating resources toward moving forward. The team expects that this model will be helpful for the state of Wisconsin and other states and geographies looking to increase equity.
Looking down the road, we need better race and ethnicity reporting standards that do not erase certain groups or group categories together. Applying these standards to all locations should be the goal, and incentivizing states to collect this information may be needed. While some jurisdictions, like the city of Chicago, successfully collect and report granular, disaggregated data, others, like the state of Texas, can only legally report aggregate data. As a result, we are unaware of where the most severe racial disparities exist and cannot target our efforts to increase access and uptake accordingly.
Reducing constraints to collecting and reporting racially-disaggregated data—while protecting individual patient data — would improve the quality and quantity of vaccination data which, in turn, would increase vaccine equity.
Health inequities, along with economic disparities, are emotional issues. We cannot forget what this pandemic revealed—that Black and Brown communities suffered disproportionately in a variety of ways.
But to fix the problems, we need to pinpoint them with accuracy, and for that we need data. Our ultimate goal is to support the reduction of disparities today and help prepare our public health systems to truly respond more equitably to the next crisis we face.