Are Health Centers Facilitating Equitable Access to COVID-19 Vaccinations? An April 2021 Update.
|Community health centers are a national network of safety net primary care providers and are a primary source of care for many low-income populations and people of color. This analysis updates earlier work and examines the extent to which vaccination efforts through community health centers are reaching people of color using data from the federal government’s weekly Health Center COVID-19 Survey. The Biden administration is expanding a partnership with health centers to advance equitable access to COVID-19 vaccinations by directly supplying health centers with vaccines, which supplement doses supplied through state and local partnerships. We include data from the survey weeks of January 8 through April 2, 2021. Key findings include:
These data show that health centers appear to be reaching people of color at a higher rate than overall vaccination efforts. While vaccinations at health centers continue to represent a relatively small share of total vaccinations administered nationally, expanding health centers’ vaccination capacity has the potential to reach people of color and advance equity on a larger scale.
Current data suggest significant racial disparities in COVID-19 vaccinations, with higher vaccination rates among White people compared to Hispanic and Black people as of early April, based on available state-reported data. The Biden administration has identified equity as a key priority in its national COVID-19 response strategy. One action the administration is pursuing to advance equity in vaccinations is to increase distribution through community health centers. Health centers are a primary source of care for low-income populations and people of color and served nearly 30 million patients in 2019. Given health centers’ focus on underserved communities and their long-standing role in encouraging and providing immunizations, health centers are generally seen as trusted providers in their communities, especially among people of color.
The Health Center COVID-19 Vaccine Program began allocating vaccines directly to an initial group of 250 health centers in mid-February. The early participants in the program serve large volumes of specific high-need populations that may require more resource-intensive vaccination efforts, such as agricultural workers, people living in or near public housing, individuals with limited English proficiency, and people experiencing homelessness. By April 7, 2021, the program expanded to include all health centers nationwide (roughly 1,400 health center organizations), with participation phasing in over several weeks. While the 500 health centers participating as of April 7 had ordered more than 2.5 million doses, most vaccinations administered by health centers so far have been supplied by states and local jurisdictions, which are also working with health centers to speed up equitable distribution of the vaccine.
This analysis examines the extent to which vaccination efforts through community health centers are reaching people of color based on data from weekly surveys of health centers administered by the Health Resources and Services Administration (HRSA). We use cumulative weekly data starting January 8, 2021 (when health centers began reporting vaccinations in the survey) and ending April 2 (the most recent data available). This analysis updates data from a previous KFF analysis with more recent data and new information on second/final doses administered at health centers (in addition to first doses administered). Notably, the Johnson & Johnson vaccine is only reported as the second/final dose administered in the weekly survey, as it is completed in a single dose. This analysis also compares the community health center data to national vaccination data reported by the CDC, total population data, and total community health center patient population data. (See the methods section for more information about the data underlying this analysis.)
Among those with known race/ethnicity information, people of color made up the majority of people who received vaccinations at community health centers, including 59% of people receiving the first dose and 54% of people receiving the second/final dose of the vaccine. Hispanic people made up 31% of first doses and 26% of second/final doses administered by health centers, followed by Black people (13% and 12% of first and second/final doses, respectively), and Asian people (9% and 9%). People identifying with more than one race, as well as American Indian and Alaska Native (AIAN) and Native Hawaiian and Other Pacific Islander (NHOPI) people each made up 4% or less of those receiving first and second/final doses (Figure 1). Race/ethnicity was unknown or not reported for about 18% of first doses administered and 17% of second/final doses administered, resulting in gaps in the data. However, health center vaccination data are considerably more complete than national vaccinations reported by the CDC, which are missing race/ethnicity information for 45% of people receiving 1 or more vaccinations and 42% of people who are fully vaccinated.
The data suggest that people of color represent greater shares of vaccinations at health centers compared to their shares nationally based on data reported by the CDC (Figure 2). For example, Hispanic people accounted for 31% of those receiving their first dose through health centers, while they made up 11% of people who received 1 or more doses administered nationally. Similarly, 13% of people who received their first dose through health centers were Black, while Black people made up 8% of those who received 1 or more doses nationally. Findings were similar for second/final doses administered at health centers as well. Hispanic people made up 26% of second/final doses administered by health centers, compared to 9% of people who are fully vaccinated across the U.S., and Black people made up 12% of second/final doses administered at health centers compared to 8% of fully vaccinated individuals nationally. However, the ability to draw strong conclusions from these comparisons is limited by differences between the data as well as gaps in the CDC data, including the high share of vaccinations with unknown race/ethnicity and a high share of people reporting multiple or other race.
Health centers appear to be vaccinating people of color at similar or higher rates than their shares of the total population, but data suggest there remain opportunities for health centers to reach more of their patients of color (Figure 2). Health centers reached particularly large shares of Hispanic and Asian people relative to their share of the total population, while the shares of vaccinations among Black people were comparable to their share of the population. These vaccination patterns largely mirror health centers’ larger role serving patients of color, who made up 63% of patients in 2019. However, the shares of Hispanic and Black people vaccinated through health centers were slightly lower than their shares of the total community health center patient population (34% and 19% respectively), especially among people receiving the second/final dose of the vaccine. Only Asian peoples’ share of health center vaccinations was at least as high as their share of the health center patient population. These trends could, in part, reflect that health centers are providing vaccinations to some people who were not existing patients, consistent with state vaccination plans, as well as varying demographic profiles of patients who met the criteria for priority groups as states incrementally opened up vaccine eligibility.
The shares of vaccinations going to people of color through health centers have been increasing over time (Figure 3). For example, the share of first doses administered to people of color at health centers has grown from 34% to 64% as of April 2. Growth was especially rapid among Hispanic people receiving the first dose of the vaccine, which grew from 17% of vaccinations to 34% over the period. The share of second/final doses administered to people of color has grown as well, but at slower pace, increasing from 52% to 59% of second/final doses as of April 2. Asian people saw the largest growth among second/final doses administered in this time period, increasing from 4% to 9%. The reason for the slightly different growth rates between first doses and second/final doses administered may reflect the lag between the first and second doses for the Pfizer and Moderna vaccines (3 and 4 weeks, respectively), as well as people getting their first and second doses in different places. Additionally, people receiving the Johnson & Johnson vaccine are only reported as receiving the second/final dose (and not the first dose, as noted above). While the share of first and second/final doses administered to people of color has increased, so has the total number of vaccinations. The number of vaccinations administered per health center responding to the survey has grown from 60 total doses during the week of January 8 to 821 total doses during the week of April 2.
Similar to national patterns, Black and Hispanic peoples’ shares of first and second/final doses administered at health centers matched or exceeded their share of the population in the majority of states (Figure 4). However, Black and Hispanic peoples’ shares of first and second/final doses administered were lower than their shares of total health center patients in the majority of states. Conversely, Asian peoples’ shares of first and second/final doses administered at health centers were lower than their share of the state population in most states, but they exceeded their share of the health center patient population, primarily because health centers serve smaller shares of Asian patients compared to their share of the population in most states. Comparisons to overall vaccinations by race/ethnicity at the state level are limited due to gaps and limitations in overall state-level vaccination data. However, where overall state-level data are available, Black and Hispanic people generally account for smaller share of vaccinations compared to their share of the total population. As such, it is likely that vaccinations through health centers are reaching larger shares of Black and Hispanic people compared to overall vaccinations in many states.
As states open vaccine eligibility to the general population, expanding health centers’ role in vaccine distribution is a major part of ongoing efforts to address the racial disparities in COVID-19 vaccinations that have emerged. Reflecting their larger role serving and established trusted relationships with communities of color, evidence to date indicates that health centers are vaccinating people of color at a faster pace than overall vaccination efforts. Health centers are also administering the vaccine to larger shares of people of color than their shares of the population in most states. In addition, the share of people of color vaccinated at health centers has grown over time. While people of color make up the majority of health center vaccinations, data suggest that there are further opportunities for health centers to reach even more people of color, as the share of people of color vaccinated through health centers is still lower than the share of patients who are people of color in many states.
The growth in the share of people of color vaccinated in health centers likely reflects several factors, including improvements in community outreach, logistics, and efforts to address access barriers faced by many people of color, as well as the processes by which states incrementally expanded eligibility to certain priority groups for vaccinations. The Health Center COVID-19 Vaccine Program has increased the share of vaccinations distributed to people of color as well, even though the program is still being rolled out and program data are relatively limited. According to federal officials, approximately 70% of the allocated doses have been administered to people of color.
Although health centers appear to be advancing equitable access to vaccinations, the number of vaccinations administered by health centers remains relatively small. As of April 2, 2021, health centers have reported a cumulative 3.6 million first doses and 2.1 million second/final doses administered in weekly surveys. However, this is likely an undercount, as between 56% and 76% of health centers have responded to weekly surveys, and those that do not respond are not included in the total vaccination counts for the week. Still, health center vaccinations represent a small fraction of the 169 million doses administered nationally (as of April 2) and in comparison to the nearly 30 million health center patients in 2019. Further ramping up health centers’ involvement in vaccination efforts at the federal, state, and local levels will likely be a meaningful step in reaching people of color in greater numbers and advancing equity on a larger scale.
|This analysis primarily draws from the weekly Health Center COVID-19 Survey, administered by the Health Resources and Service Administration (HRSA). We rely on weekly data on the number of vaccinations per week by race/ethnicity starting with the January 8, 2021 survey through the April 2, 2021 survey. The National Association of Community Health Centers provided us with national totals of vaccinations by race/ethnicity for the week of January 22, which we were unable to access. Additionally, we were unable to retrieve state level data for surveys administered in January. We sum all weekly data over the period analyzed to represent cumulative totals. All state level data reflects cumulative data for weeks starting with the February 5, 2021 survey.
Health center vaccinations are reported separately for first dose and second/final doses in this analysis. To report first doses administered, health centers are asked, “By race and ethnicity, how many patients have initiated (1st of 2 doses received) their COVID-19 immunization series in the last week?” For second/final doses administered, health centers are asked, “By race and ethnicity, how many patients have completed (2nd, or only, dose received) their COVID-19 immunization series in the last week?” In separate guidance, HRSA specified that health centers should report patients receiving doses administered as a one-dose vaccine series (i.e., the Johnson & Johnson vaccine) to be reported as the second/final dose. In the same guidance, HRSA also specified that health centers should include vaccinations at the health center, as well as among established patients receiving the vaccination elsewhere, if the health center has records of the immunization. When comparing changes in first and second/final doses over a period of weeks (e.g., Figure 3), the baseline week for second/final doses began later than that for first doses (the week of February 5 vs. the week of January 8) due to low numbers of second/final doses administered in January.
All findings reported are based on known race/ethnicity. For our calculations, both the “Unreported/Refused to Report Race and Ethnicity” as well as “Non-Hispanic/Latino Ethnicity Patients (Unreported/Refused to Report Race)” were defined as unknown race/ethnicity. “Hispanic/Latino Ethnicity Patients (Unreported/Refused to Report Race)” were categorized as ‘Hispanic’ individuals for our analysis.
The Health Center COVID-19 Survey reports race/ethnicity differently from most other data sources. White and Black categories only include non-Hispanic individuals, while Asian, AIAN, NHOPI, and more than one race include Hispanic and non-Hispanic individuals. When comparing to population estimates from the 2019 American Community Survey and the Uniform Data System, we adjusted race categories to match the Health Center COVID-19 Survey’s race/ethnicity categories. We did not adjust national vaccination tabulations by race/ethnicity from the CDC’s COVID Data Tracker.
Vaccination data by race/ethnicity from the CDC are based on administrative data reported to the CDC. However, the health center data are based on vaccinations from weekly surveys beginning in January 2021 with varying response rates. In addition to different data collection methods, it is possible that the health center survey data may also exclude some vaccinations in December 2020. Additionally, the CDC reports data for 1 or more vaccinations administered, while the health center data report first and second/final doses separately. Moreover, the health center first dose data do not include the Johnson & Johnson vaccine, which is reported as second/final dose.