Are Health Centers Facilitating Equitable Access to COVID-19 Vaccinations?
|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 examines the extent to which early vaccination efforts through community health centers are reaching people of color using data from the federal government’s weekly Health Center COVID-19 Survey. Additionally, this analysis may shed light on the Biden administration’s recent partnership with health centers to advance equitable access to COVID-19 vaccinations by directly supplying health centers with vaccines. We include data from the survey weeks of January 8 through February 26, 2021, largely before the start of the partnership with the Biden administration.
Key findings include:
These early 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 represent a relatively small share of total vaccinations administered nationally to date, 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 and advancing equity on a larger scale.
Early 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 March, 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 Biden administration’s initial plans will provide 1 million doses directly to 250 health centers and anticipates eventually opening up direct access to vaccine supply for all health centers nationwide (more than 1,350 health center organizations) as supply increases. Many states and local jurisdictions are also working with health centers to advance equitable access to the vaccine and speed up distribution.
This analysis examines the extent to which early 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 8th, 2021 (when health centers began reporting vaccinations in the survey) and ending February 26th (the most recent data available). Most vaccinations reported here were prior to the Biden administration providing vaccines directly to health centers, which began with a limited number of health centers (approximately 25) as of February 15, 2021. 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 people receiving their first dose of the COVID-19 vaccine at health centers and for whom race/ethnicity was known, just over half (54%) were people of color, including 26% who were Hispanic and 12% who were Black (Figure 1). Additionally, 10% were Asian, 4% identified with more than one race, and AIAN and NHOPI people made up 2% and 1% of vaccinations, respectively. Race/ethnicity was unknown or not reported for about 20% of health center vaccinations, providing considerably more complete data on race/ethnicity than the national vaccination data reported by the CDC, which is missing race/ethnicity information for 47% of people receiving 1 or more vaccination, but still resulting in gaps in the data.
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 26% of those receiving their first dose through health centers, while they made up 9% of people who received 1 or more doses administered nationally. Similarly, 12% of people who received their first dose through health centers were Black, while Black people made up 7% of those who received 1 or more doses 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. Health centers reached particularly large shares of Hispanic people relative to their share of the total population. One in four people vaccinated through health centers were Hispanic (26%), while Hispanic people make up 17% of the U.S. population. Both Black and Asian people made up similar shares of vaccinations compared to their share of the population. Black people made up 12% of health center vaccinations and 12% of the U.S. population, and Asian people made up 10% of vaccinations and 6% 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 Black and Hispanic people vaccinated through health centers were slightly lower than their shares of the total community health center patient population. This 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 fall into current priority groups eligible for the vaccine.
The shares of vaccinations going to people of color through health centers have been increasing in recent weeks (Figure 3). Health centers responding to the weekly surveys in January 2021 reported that, among people receiving the 1st dose of vaccinations and for whom race was known, 47% were people of color. In February, the share of 1st doses administered to people of color grew to 56%. Hispanic people experienced the largest growth from January to February (22% vs. 27%), followed by Asian people (7% vs. 11% growth) and Black people (10% vs. 13% growth).
Patterns of vaccinations in health centers by race/ethnicity varied widely by state (Figure 4). For example, Black people’s share of health center vaccinations exceeded their share of the population in 27 states (out of 51 with DC) but was lower than their share of the population in 18 states (6 states had equal shares). Similarly, Hispanic peoples’ share of health center vaccinations exceeded their share of the state population in 30 states but was lower than their share of the population in 19 states (2 states had equal shares). In most states, the share of vaccinations among Asian people at health centers was lower than their share of the total population. Consistent with the national health center data, the share of health center vaccinations among Black and Hispanic people was smaller than their share of the total health center patients in most states. Conversely, Asian people accounted for a higher share of vaccinations than their share of the patient 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.
Reflecting their larger role serving and building trusted relationships with communities of color, health centers have been an important place for people, particularly Hispanic people, to receive immunizations in the past. As such, providing COVID-19 vaccines through community health centers may be particularly helpful for vaccinating people of color going forward and could help address some of the racial disparities in COVID-19 vaccination that are emerging. These early data show that health centers appear to be vaccinating people of color at a faster pace than overall vaccination efforts and reaching larger shares of people of color than their share of the state population in the majority of states. In addition, recent growth in the shares of people of color vaccinated in health centers likely reflects more targeted community outreach and efforts to address logistical challenges people of color may face as well as the changing priority groups eligible for the vaccine in accordance with state vaccination plans. However, even among people receiving vaccines at community health centers, there are some disparities in vaccinations, suggesting that there are opportunities for health centers to reach even more 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 February 26, 2021, health centers have reported a cumulative 1.4 million 1st doses and 560,000 2nd doses administered in weekly surveys. However, this is likely an undercount, as between 56% and 72% 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. The Biden administration’s initial plan to directly supply 250 health centers with 1 million doses of vaccine in the initial phase of the partnership will significantly increase the number of vaccines health centers can administer, but still represents a small fraction of the 90 million doses administered nationally to date 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 8th, 2021 survey through the February 26th, 2021 survey. We were unable to access data for one week (the week ending January 22nd), which was not included in our analysis. The January 22nd survey accounted for approximately 133,000 vaccinations at health centers nationally, or 9% of vaccinations reported in the survey overall and 30% of vaccinations in January, based on cumulative totals reported by the National Association of Community Health Centers. 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 5th, 2021 survey.
Health center vaccinations are based on 1st dose vaccinations for this analysis. Each week, 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?” In separate guidance, HRSA 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.
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 shown here are based on a 1st dose administered in each week and does not include counts for a 2nd dose.