Disparities in vaccination for COVID-19 among underserved minority patient populations
Brooke S. Carter, PharmD
PGY1 Pharmacy Resident, DCH Regional Medical Center, Tuscaloosa, AL
Health disparities in the United States exist within age, sex, race, and/or ethnicity groups. Many of the inequities are further compacted by social determinants of health, such as physical environment, occupation, economic stability, and education.1 The impact of these disparities can be measured by poor health outcomes; thus, many efforts have been made to address and eliminate them.1 A specific public health concern is to reduce the disparities of immunization rates in underserved minority populations.2 The ongoing Coronavirus Disease 2019 (COVID-19) pandemic emphasizes the importance of vaccination, particularly in non-Hispanic Black, Hispanic or Latino, and non-Hispanic Asian people who have historically lower vaccination coverage.1-3
Vaccinations are the most effective strategy for the reduction of vaccine-preventable diseases and their associated complications.2 Historically, vaccination rates have shown to be persistently lower in underserved minority populations.1-3 A study utilized a survey to assess adult vaccinations by race/ethnicity for five routinely recommended vaccines: influenza, tetanus, pneumococcal, human papilloma virus, and zoster vaccine.2 The results indicated that non-Hispanic Black, Hispanic or Latino, and non-Hispanic Asian people had lower vaccination rates in all five vaccines compared to non-Hispanic white people.2 Similarly, a study utilized a survey to assess vaccination rates and attitudes associated with the influenza vaccine.3 The results included 2208 responses from diverse racial/ethnic participants and revealed that non-Hispanic Black and Hispanic or Latino people were significantly less likely to be vaccinated for influenza than non-Hispanic white people.3
The knowledge that has been established on vaccination disparities among racial and ethnic minority patients should infer that barriers exist and must be addressed regarding the COVID-19 vaccine. The Centers for Disease Control and Prevention (CDC) has published weekly demographic characteristics of patients that have received the COVID-19 vaccine in the United States.4,5 There have been 52.9 million vaccines administered in the United States thus far, and 55% of those patients have reported race/ethnicity.5 The CDC report of people vaccinated for whom demographics were known revealed: 0.3% non-Hispanic Pacific Islander, 1.7% non-Hispanic American Indian, 5.3% non-Hispanic Asian, 6.1% non-Hispanic Black, and 8.9% Hispanic or Latino people received at least one dose of the COVID-19 vaccine compared to 63.2% of non-Hispanic White people.5 The rates reported for the COVID-19 vaccine for each racial/ethnic group is indicative of disparities with minority populations. It is imperative that healthcare providers seek to identify and eliminate the barriers to the COVID-19 vaccine in these populations.
The historic beliefs and barriers that have contributed to the disparities in vaccination rates in minority populations vary among ethnic and racial groups. The results of studies have shown that barriers such as cultural and language differences between patients and providers can create distrust and lack of understanding on the advantages of vaccinations.1-3 Additionally, health insurance status, household income, and access to services have been identified as barriers to vaccination in underserved minority patients.1-3 Finally, difference in attitudes towards vaccination and preventive care, propensity to seek and accept vaccines, variations in the likelihood that providers recommend vaccination, and difference in concerns about vaccinations, including safety have been shown to be barriers that contribute to vaccination disparities in underserved minority groups.1-3 It is essential for healthcare providers to be conscious of the barriers that have previously existed for vaccinations in minority groups in order to effectively address them in regard to the COVID-19 vaccine.
As a postgraduate year 1 (PGY-1) pharmacy resident I have had the unique opportunity to complete a primary care rotation at a faith-based clinic that seeks to provide care to uninsured and underinsured patients. The clinic received a limited supply of the COVID-19 vaccine to provide to patients identified as high risk based on comorbid conditions. The patients that were identified as high risk were contacted by telephone about the opportunity to receive the vaccine. The phone call was dedicated to providing information about the vaccine, the patient’s risk associated with contracting Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), and to addressing any questions or concerns. The amount of underserved minority patients that expressed interest and scheduled an appointment to receive the COVID-19 vaccine was notably higher than the demographics reported by the CDC. The openness and trust conveyed by this patient population could be due to a variety of strategies implemented by the clinic to reduce health disparities. First, the interactions between the healthcare professionals and patients at the clinic allow for trustworthy relationships to be developed. Trust has shown to be major factor for individuals in the decision-making process of vaccination.2 Additionally, as a faith-based clinic the patients can be confident that there will be absence of discrimination, which improves the trust in recommendations made and care provided. Finally, cultural competency has been adopted by the providers in order to foster effective interactions and address disparities in a cross-cultural clinic.
Although disparities exist in underserved minority populations, there are great opportunities for pharmacists and other healthcare providers to identify and address racial/ethnic barriers and adopt cultural competency training to improve relationships, gain trust, and have positive impact on health outcomes.1 In the unprecedented time of the COVID-19 pandemic, there is opportunity to address vaccine hesitancy and improve vaccination rates in underserved minority populations.
- Pattin AJ. Disparities in the use of immunization services among underserved minority patient populations and the role of pharmacy technicians: a review. Journal of Pharmacy Technology. 2017;35(5):171-176.
- Lu P, OHalloran A, Williams WW, et al. Racial and ethnic disparities in vaccination coverage among adult populations in the U.S. Am J Prev Med. 2015;49(6S4):S412-S425.
- Chen JY, Fox SA, Cantrell CH, et al. Health disparities and prevention: racial/ethnic barriers to flu vaccinations. Journal of Community Health. 2007;32(1):5-20.
- Centers for Disease Control and Prevention. COVID-19 racial and ethnic health disparities. http://www.cdc.gov/coronavirus/2019-ncov/community/health-equity/racial-ethnic-disparities/disparities-impact.html. Accessed February 14, 2021.
- Centers for Disease Control and Prevention. COVID-19 data tracker: demographic characteristics of people receiving COVID-19 vaccinations in the United States. https://covid.cdc.gov/covid-data-tracker/#vaccination-demographic. Accessed February 16, 2021.