At This Early Stage of the COVID-19 Vaccine Roll-Out, Most Older Adults Have Not Yet Been Vaccinated As Supply Remains Limited

Note: An updated analysis with more recent data is available here.

Since the beginning of the coronavirus pandemic, older adults have been at greater risk of serious illness, hospitalization, and death due to COVID-19. In mid-January, the Trump Administration advised states to expand vaccine eligibility to people ages 65 and older, in addition to health care workers, and residents and staff in long-term care facilities – a recommendation that was reinforced by the incoming Biden Administration. As of February 1, 2021, more than half of all states (29 states and the District of Columbia) have expanded eligibility for COVID-19 vaccines to include people 65 and older.

To date, nearly 32 million people, or about 10% of the US population, have received at least one dose of a COVID-19 vaccine. According to the CDC, adults ages 65 and older, including residents of long-term care facilities who are primarily in this age group, account for 29% of all people who were administered a COVID-19 vaccine dose in the first month of vaccination, disproportionate to their share of the overall population (15%). Nationwide, more than 54 million people are age 65 or older, in addition to those who are living in long-term care facilities.

This analysis looks at COVID-19 vaccination rates among older adults at the state level, and the share of all vaccines administered that have been given to older adults, among the 28 states and DC that are currently reporting vaccination data by age as of February 4, 2021. This analysis covers the early stages of vaccination efforts when many – but not all – states had recently expanded eligibility to include the 65-and-older population but still coping with high demand and very limited supplies of COVID-19 vaccines.

Findings

Older adults have been disproportionately affected by COVID-19, with the highest cumulative rates of hospitalizations and deaths (Figure 1). Hospitalization and death rates due to COVID-19 increase with age. For example, the hospitalization rate for adults 65 to 74 is more than 2.5 times higher than for adults ages 40-49 years old. The differences in death rates are even more dramatic: the death rate for adults 65 to 74 is more than 9.5 times higher than among adults ages 40-49. And even among people ages 65 and older, rates of hospitalizations and deaths continue to increase as age increases. The rate of hospitalizations is more than 2.5 times higher and deaths 7.4 times higher among those 85 and older compared to those 65-74.

Adults 65 and older have comprised the majority – at least 75% – of all COVID-19 deaths in every month since the significant escalation of the pandemic in Spring 2020 (Figure 2). The share of people who died of COVID-19 who were 65 and older reached a high of 82% in May 2020 before dipping somewhat in the summer months, but has remained higher than 80% since October 2020. More than half of COVID-19 deaths overall have been among people 75 and older.

As of February 4, 2021, 28 states and the District of Columbia are reporting some COVID-19 vaccination data by age – but not all of these states have expanded to begin vaccinating people 65 and older specifically (Figure 3; Appendix Table 1). Of states reporting vaccination data by age, 15 are reporting data for adults 65 and older, all of which have expanded vaccinations to this age group; 13 are reporting data for adults 60 and older, 4 of which have expanded vaccinations to people 65 and older; and 1 is reporting data for adults 70 and older (in addition to data for people 50 to 69 years old). Some of the most populous states in the country, including New York and California, are not currently reporting vaccination data by age.

In each of the states that report COVID-19 vaccinations by age cohort, the majority of older adults have not yet received at least one dose of the vaccine (Figure 4). The share of adults 65 and older who have received at least one dose of the vaccine ranges from 34% in West Virginia to 10% in Pennsylvania. The relatively low rate in Pennsylvania may be partly explained by data not included from Philadelphia county. Nine states – West Virginia, North Carolina, Florida, Mississippi, Delaware, Texas, Michigan, New Jersey, and Wisconsin, plus the District of Columbia – report vaccinating at least 20% of their 65 and older population. Each of the states reporting vaccination rates among the 65 and older population have expanded eligibility to this age group.

Among the three states – Florida, Georgia, and Texas – that placed people ages 65 and older in the initial prioritization group (that is, before the federal government advised including them), two (Florida and Texas) are reporting vaccination rates by age, and Florida has the highest vaccination rate among older adults (29%) as of February 4th.

Similarly, among the 13 states that report COVID-19 vaccinations for adults 60 and older, the majority of older adults have not yet received at least one dose of the vaccine – but only four of these states (Alaska, Maryland, Tennessee, and Virginia) have expanded eligibility to people 65 and older. The share of adults 60 and older who have received at least one dose ranges from 37% in Alaska to 9% in Rhode Island. In Massachusetts, which reports vaccinations for adults 70 and older, only 6% of adults in this age group have received at least one dose of the vaccine.

Among states reporting COVID-19 vaccination data by age, older adults account for a majority of people vaccinated in less than half of states (Figure 5). Among the 15 states reporting vaccination rates among people 65 and older, this group accounts for more than half of all people vaccinated in only three states – Florida, North Carolina, and Mississippi. The higher rate in Florida likely reflects the decision to prioritize the 65 and older population before the revised federal guidance was announced; North Carolina and Mississippi expanded to people 65 and older shortly after the federal government revised its guidance. The share of state residents who have received at least one COVID-19 vaccine dose who are age 65 and older ranges from 23% in Pennsylvania to 72% in Florida.

In the 13 states reporting vaccinations by age for adults 60 and older, this age cohort accounts for half or more of all people who have received one or more doses in 6 states, with the share of those vaccinated who are 60 and older ranging from 31% in Rhode Island to 68% in Louisiana.

Very few states report vaccination rates among older adults by race/ethnicity or gender. Among the 28 states and DC that do report vaccinations by age, none report both age and race/ethnicity, which would be useful in providing more targeted outreach to populations most affected by the virus or who are currently experiencing vaccine access issues. Only one state (Texas) reports vaccination rates among the 65 and older population by gender.

Discussion

In response to recent recommendations to prioritize people 65 and older for COVID-19 vaccines, many, but not all, states have changed their vaccination plans and redefined their priority populations to include older adults. On an ongoing basis, states are making tough decisions about how best to allocate a limited and insufficient supply of vaccines, balancing the needs and concerns of different populations, including older adults, but also essential workers, such as teachers, postal workers, delivery drivers, and others who have frequent contact with the public.

Vaccination rates among older adults, as among other populations, are influenced by many factors, but perhaps the most significant determinant is that demand for the vaccine continues to exceed supply, and states often do not know how much supply they are going to have in a given week. Further, it has been less than a month since recommendations were issued for states to expand eligibility to adults 65 and older, and some states may still not have fully vaccinated their first priority populations. In addition, states, and counties within states, have different prioritization criteria and sign-up procedures, among other differences that contribute to variations across states. These differences may also lead to confusion among people who are eligible for vaccines. This is reflected in recent KFF polling showing that the majority of adults, including older adults, say they do not have enough information about when and where they will be able to get vaccinated.

Furthermore, older adults have reportedly faced a host of problems getting vaccinated, including not knowing how to schedule appointments or where to get vaccinated, waiting in long lines, or arriving for an appointment to find vaccines no longer available. People 65 and older also may be disadvantaged by first-come first-served appointment signups that occur online rather than by telephone, since almost one in five people in this age group do not have internet access at home and they may be less fluent with technology. Further, underlying inequities in resources, such as access to technology and transportation, may further increase barriers to vaccination for seniors of color. The fact that the demand for vaccine far exceeds the supply needed to fully vaccinate older adults, coupled with these on-the-ground realities, are likely to influence our results, although the degree to which is not quantifiable.

The lack of uniformity across states in how they report vaccination and what data are reported makes it difficult to provide a clear picture of the rollout of vaccines to older adults overall, or how vaccination rates vary among certain high-risk segments of the older population, such as older adults in communities of color. While states have made some progress vaccinating older adults in the relatively short time since recommendations expanded to include older adults, there is still a long way to go before this population is fully vaccinated.

Methods
This analysis uses publicly available data from state websites pertaining to vaccine administration retrieved on February 4, 2021. Population estimates by age for each state come the from 2019 US Census Bureau.

There are some data limitations. Notably, 22 states do not report vaccination rates by age, which means it is not possible to calculate the overall share of older adults in the US who have received a COVID-19 vaccine based on state-level data. States also vary in the age increments they report, with some reporting data for those 65 and older with others reporting 60 and older or 70 and older. Tennessee reports data for adults 61 and older. One state, North Dakota, reports vaccination rates by age, but not vaccine distribution by age, and are therefore defined as not reporting vaccinations by age. Another state, Connecticut, reports age data for adults 75 and older by county, but not at the state level, and are therefore defined as not reporting vaccinations by age.

States also report vaccinations differently. States vary in whether they report the number of people who have received at least one vaccine dose, people who have received one dose and people who have received two doses, or total vaccinations administered. Where possible, we report data for the total number of people who have received at least one vaccine dose. However, some states only report total vaccinations, meaning people who have received two doses are included in the data twice. As of 2/4/21, Pennsylvania’s vaccine dashboard data does not include data from Philadelphia county due to differences in reporting criteria.

States also vary in whether their age data include long-term care facility residents. Currently, only three states (Maine, Massachusetts and Virginia) explicitly state that their age data include data from the Pharmacy Partnership for Long-Term Care and other long-term care facilities. One state, North Carolina specifies that data on doses administered as part of the Partnership are not reflected in their age data. The remainder of the states either do not specify whether their age data include data from long-term care facilities, or in others, it was unclear based on the description. According to CDC data, about 1.5 million residents of long-term care facilities received at least one dose of the vaccine nationwide, most of whom are presumably older than age 65. If states do not take into account long-term care residents who have been vaccinated, the shares reported here may somewhat understate the total share of older adults that have received at least one dose in those states. Finally, it is possible that the estimates of vaccination rates based on state websites may be low if there is a lag in reporting by states.

Appendix

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