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The COVID-19 pandemic continues to be a major public health concern. With over 1.4 million cases and over 26 thousand deaths in LA as of Oct. 4, 2021 (LA Public Health)
http://www.publichealth.lacounty.gov/media/Coronavirus/locations.htm#case-summary

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COVID Rates are Higher Among Unvaccinated People

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COVID Rates are Higher Among Unvaccinated People

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In LA, unvaccinated people were 4.9 times more likely to get infected and 29.2 times more likely to be hospitalized than the fully vaccinated (CDC, 2021).
https://www.cdc.gov/mmwr/volumes/70/wr/mm7034e5.htm

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Centers for Disease Control and Prevention

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On August 24, 2021, this report was posted online as an MMWR Early Release.

Jennifer B. Griffin, PhD ¹; Meredith Haddix, MPH ¹; Phoebe Danza, MPH ¹; Rebecca Fisher, MPH ¹; Tae Hee Koo, MPH ¹; Elizabeth Traub, MPH ¹; Prabhu Gounder, MD ¹; Claire Jarashow, PhD ²; Sharon Balter, MD ¹ ( View author affiliations)

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Summary
What is already known about this topic?
Although COVID-19 vaccines are highly effective, some fully vaccinated persons will be infected with SARS-CoV-2.
What is added by this report?
During May 1-July 25, 2021, among 43,127 SARS-CoV-2 infections in residents of Los Angeles County, California, 10,895 (25.3%) were in fully vaccinated persons, 1,431 (3.3%) were in partially vaccinated persons, and 30,801 (71.4%) were in unvaccinated persons. On July 25, infection and hospitalization rates among unvaccinated persons were 4.9 and 29.2 times, respectively, those in fully vaccinated persons. In July, when the Delta variant was predominant, cycle threshold values were similar for unvaccinated, partially vaccinated, and vaccinated persons.
What are the implications for public health practice?
Efforts to enhance COVID-19 vaccination coverage, in coordination with other prevention strategies, are critical to preventing COVID-19-related hospitalizations and deaths.

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COVID-19 vaccines fully approved or currently authorized for use through Emergency Use Authorization from the Food and Drug Administration are critical tools for controlling the COVID-19 pandemic; however, even with highly effective vaccines, a proportion of fully vaccinated persons will become infected with SARS-CoV-2, the virus that causes COVID-19 ( 1). To characterize postvaccination infections, the Los Angeles County Department of Public Health (LACDPH) used COVID-19 surveillance and California Immunization Registry 2 (CAIR2) data to describe age-adjusted infection and hospitalization rates during May 1-July 25, 2021, by vaccination status. Whole genome sequencing (WGS)-based SARS-CoV-2 lineages and cycle threshold (Ct) values from qualitative reverse transcription-polymerase chain reaction (RT-PCR) for two SARS-CoV-2 gene targets, including the nucleocapsid (N) protein gene region and the open reading frame 1 ab (ORF1ab) polyprotein gene region,* were reported for a convenience sample of specimens. Among 43,127 reported SARS-CoV-2 infections in Los Angeles County residents aged ≥16 years, 10,895 (25.3%) were in fully vaccinated persons, 1,431 (3.3%) were in partially vaccinated persons, and 30,801 (71.4%) were in unvaccinated persons. Much lower percentages of fully vaccinated persons infected with SARS-CoV-2 were hospitalized (3.2%), were admitted to an intensive care unit (0.5%), and required mechanical ventilation (0.2%) compared with partially vaccinated persons (6.2%, 1.0%, and 0.3%, respectively) and unvaccinated persons (7.6%, 1.5%, and 0.5%, respectively) (p<0.001 for all comparisons). On July 25, the SARS-CoV-2 infection rate among unvaccinated persons was 4.9 times and the hospitalization rate was 29.2 times the rates among fully vaccinated persons. During May 1-July 25, the percentages of B.1.617.2 (Delta) variant infections estimated from 6,752 samples with lineage data increased among fully vaccinated persons (from 8.6% to 91.2%), partially vaccinated persons (from 0% to 88.1%), and unvaccinated persons (from 8.2% to 87.1%). In May, there were differences in median Ct values by vaccination status; however, by July, no differences were detected among specimens from fully vaccinated, partially vaccinated, and unvaccinated persons by gene targets. These infection and hospitalization rate data indicate that authorized vaccines were protective against SARS-CoV-2 infection and severe COVID-19 during a period when transmission of the Delta variant was increasing. Efforts to increase COVID-19 vaccination, in coordination with other prevention strategies, are critical to preventing COVID-19-related hospitalizations and deaths.

LACDPH analyzed data for laboratory-confirmed cases of SARS-CoV-2 reported from testing laboratories to LACDPH during May 1-July 25, 2021, which included a total of 9,651,332 Los Angeles County residents (excluding Pasadena and Long Beach residents). † A laboratory-confirmed SARS-CoV-2 infection was defined as a first detection § of SARS-CoV-2 RNA or antigen in a respiratory specimen. Vaccination status was ascertained by matching SARS-CoV-2 case surveillance and CAIR2 data on person-level identifiers using an algorithm with both deterministic and probabilistic passes. Persons were considered fully vaccinated ≥14 days after receipt of the second dose in a 2-dose series (Pfizer-BioNTech or Moderna COVID-19 vaccines) or after 1 dose of the single-dose Janssen (Johnson & Johnson) COVID-19 vaccine ¶; partially vaccinated ≥14 days after receipt of the first dose and <14 days after the second dose in a 2-dose series; and unvaccinated <14 days after receipt of the first dose of a 2-dose series or 1 dose of the single-dose vaccine or if no CAIR2 vaccination data were available. COVID-19-associated hospitalizations were defined as hospital admissions occurring ≤14 days after a first SARS-CoV-2 infection. COVID-19-associated deaths were defined as deaths occurring ≤60 days after the date of a first laboratory-confirmed SARS-CoV-2 infection or deaths with COVID-19 listed as a cause of or contributing condition to death.

Differences in the percentages of infections by vaccination status were calculated using chi-square tests for categorical variables and Kruskal-Wallis tests for medians; p-values <0.05 were considered statistically significant. Age-adjusted rolling 7-day SARS-CoV-2 infection and hospitalization rates were estimated by vaccination status.** Using convenience samples, WGS lineage data from all available sequencing results (6,752) †† and Ct values from diagnostic qualitative RT-PCR assays targeting two genes (SARS-CoV-2 nucleocapsid [SC2N; 5,179], ORF1ab [1,041], and N [1,062]) from two laboratories were reported over time by vaccination status. Analyses were conducted using SAS (version 9.4; SAS Institute). This activity was determined by LACDPH's Institutional Review Board (IRB) to be a surveillance activity necessary for public health work and therefore did not require IRB review.

The percentage of fully vaccinated Los Angeles County residents increased from 27% on May 1, 2021, to 51% on July 25, 2021. During the same period, 43,127 cases of SARS-CoV-2 infection among residents aged ≥16 years were reported to LACDPH, including 10,895 (25.3%) in fully vaccinated persons, 1,431 (3.3%) in partially vaccinated persons, and 30,801 (71.4%) in unvaccinated persons ( Table). The largest percentages of cases across all groups were among adults aged 30-49 years and 18-29 years, females, and Hispanic persons. Among fully vaccinated persons on July 25, 55.2% had received the Pfizer-BioNTech vaccine, 28.0% had received the Moderna vaccine, and 16.8% had received the Janssen vaccine. Lower percentages of fully vaccinated persons were hospitalized (3.2%), were admitted to an intensive care unit (0.5%), and required mechanical ventilation (0.2%) compared with partially vaccinated persons (6.2%, 1.0%, and 0.3%, respectively) and unvaccinated persons (7.6%, 1.5%, and 0.5%, respectively) (p<0.001). Among hospitalized persons and persons admitted to an intensive care unit, the median age was higher among vaccinated persons (median = 64 years, interquartile range [IQR] = 53.0-76.0 years; median = 64 years, IQR = 54.0-76.0 years, respectively) and partially vaccinated persons (median = 59, IQR = 46.0-72.0; median = 65, IQR = 57.0-80.0, respectively) than among unvaccinated persons (median = 49, IQR = 35.0-62.0; median = 56, IQR = 41.0-66.0, respectively) (p<0.001). A lower percentage of fully vaccinated (1.2%) and partially vaccinated (2.0%) persons were admitted to a hospital after their SARS-CoV-2 positive test result date compared with unvaccinated persons (4.2%). A lower percentage of deaths (0.2%, 24) occurred among fully vaccinated persons than among partially vaccinated (0.5%, seven) and unvaccinated (0.6%, 176) persons (p<0.001). Death investigations determined that six of the 24 fully vaccinated persons who died had immunocompromising conditions, including HIV infection, cancer (i.e., prostate, pancreatic, lung, or leukemia), and liver transplantation, and that the median age was higher among vaccinated (median = 78 years, IQR = 63.5-87.5 years) and partially vaccinated (median = 74, IQR = 58.0-80.0) persons than among unvaccinated persons (median = 63, IQR = 51.5-79.5) (p = 0.01).

Among all Los Angeles County residents, the age-adjusted 7-day incidence and hospitalization rates increased exponentially among unvaccinated, fully vaccinated, and partially vaccinated persons, with the highest rates among unvaccinated persons in late June ( Figure 1). On May 1, in unvaccinated persons, the age-adjusted incidence (35.2 per 100,000 population) was 8.4 times and the age-adjusted hospitalization rate (4.6 per 100,000 population) was 10.0 times the rates in fully vaccinated persons (4.2 and 0.46, respectively). Partially vaccinated persons had a similar incidence (4.1) and hospitalization rate (0.27) as fully vaccinated persons. On July 25, the age-adjusted incidence in unvaccinated persons (315.1) was 4.9 times that in fully vaccinated persons (63.8); the rate among partially vaccinated persons was 46.8. The age-adjusted hospitalization rate in unvaccinated persons (29.4) was 29.2 times the rate in fully vaccinated persons (1.0); the hospitalization rate was similar in partially vaccinated persons (0.90) (Supplementary Table; https://stacks.cdc.gov/view/cdc/109087).

During May 1-July 25, the percentages of residents aged ≥16 years with SARS-CoV-2 Delta variant infections increased from 8.6% to 91.2% in fully vaccinated persons (1,667), from 0% to 88.1% in partially vaccinated persons (198), and from 8.2% to 87.1% in unvaccinated persons (4,887) ( Figure 2). In May, median Ct values were lower in specimens from unvaccinated persons than in those from partially vaccinated and fully vaccinated persons for the ORF1ab gene target (22.8, 36.6, and 27.7, respectively) and N gene target (24.0, 36.0, and 30.6, respectively); however, in July, no differences were found by vaccination status among the gene targets (SC2N = 19.3, 20.2, and 19.4; ORF1ab = 18.8, 17.8, and 19.0; N = 19.3, 18.6, and 19.5, respectively) (Figure 2).

Discussion

The results of this population-based analysis using linked SARS-CoV-2 infection surveillance and vaccination registry data indicate that fully vaccinated persons aged ≥16 years with SARS-CoV-2 infection were less likely than unvaccinated persons to be hospitalized, to be admitted to an intensive care unit, to require mechanical ventilation, or to die from SARS-CoV-2 infection during a period when the Delta variant became predominant. Although age-adjusted hospitalization rates in partially vaccinated persons were similar to those in fully vaccinated persons, age-adjusted incidences were slightly lower in partially vaccinated persons than in fully vaccinated persons. These data indicate that authorized vaccines protect against SARS-CoV-2 infection and severe COVID-19, even with increased community transmission of the newly predominant Delta variant ( 2).

The SARS-CoV-2 Delta variant is highly transmissible ( 3) and became the predominant variant in Los Angeles County during May-July 2021. During this period, SARS-CoV-2 cases and hospitalizations increased substantially, most notably among unvaccinated persons. In May, specimens from fully vaccinated and partially vaccinated persons had higher Ct values for two gene targets compared with unvaccinated persons; however, by July, median Ct values had decreased and were similar in all gene regions in specimens from fully vaccinated, partially vaccinated, and unvaccinated persons. These findings are similar to those from a recent study showing no difference in Ct values in specimens from vaccinated and unvaccinated persons during a large outbreak ( 4). Ct values are correlated with the amount of viral nucleic acid present; however, Ct values are an imperfect proxy for viral nucleic acid load, are not standardized across testing platforms, vary by specimen type and time from specimen collection, and should be limited to assessing differences at the population level, not the person level. §§

The findings in this report are subject to at least six limitations. First, vaccination data for persons who lived in Los Angeles County at the time of their laboratory-confirmed infection but who were vaccinated outside of California were unavailable, leading to misclassification of their vaccination status; if vaccinated persons without accessible records were considered to be unvaccinated, the incidence in unvaccinated persons could be underestimated. Second, case ascertainment is based on passive surveillance, with known underreporting that might differ by vaccination status. Similarly, screening and testing behaviors might differ among groups. Third, COVID-19-associated hospitalizations were determined based on hospital admission and SARS-CoV-2 test dates alone, leading to the inclusion of incidental hospitalizations that were not associated with COVID-19. Fourth, COVID-19-associated deaths included deaths occurring ≤60 days after a first SARS-CoV-2 positive test date; therefore, some COVID-19-associated deaths might have been from other causes (excluding trauma). In addition, certain COVID-19-associated deaths might have been a result of long-term sequelae after 60 days and were not included. Fifth, lineage and Ct values were available only for a convenience sample of SARS-CoV-2 cases. Finally, all the assays used to generate Ct values for comparison were qualitative, and none is approved for use in quantitating the amount of viral nucleic acid present.

The findings in this report are similar to those from recent studies indicating that COVID-19 vaccination protects against severe COVID-19 in areas with increasing prevalence of the SARS-CoV-2 Delta variant ( 5, 6). Efforts to increase COVID-19 vaccination coverage, in coordination with other prevention strategies, are critical to preventing COVID-19-related hospitalizations and deaths. Ongoing surveillance to characterize postvaccination infections, hospitalizations, and deaths will be important to monitor vaccine effectiveness, particularly as new variants emerge.

Acknowledgments

Kelsey Oyong; Heidi Sato; Rebecca Lee; Mireille Ibrahim; Kathleen Poortinga; Mirna Ponce-Jewell; Dulmini Wilson; Emmanuel Mendoza.

¹Acute Communicable Disease Control Program, Los Angeles County Department of Public Health, California; ² Vaccine Preventable Disease Control Program, Los Angeles County Department of Public Health, California.

Characteristic

Vaccination status, no. (%)

p-value

Total

Fully vaccinated

Partially vaccinated

Unvaccinated

Total no. of cases 43,127 10,895 1,431 30,801
-

Vaccine manufacturer

Age group, yrs

Sex

Race/Ethnicity

Died 207 (0.5)24 (0.2)7 (0.5)176 (0.6)<0.001

FIGURE 1. Age-adjusted rolling 7-day SARS-CoV-2 infection and hospitalization rates,* by vaccination status† - Los Angeles County, California, May 1-July 25, 2021

* Rolling 7-day incidence was calculated by summing the total number of persons or hospitalizations during a 7-day period and dividing by the total population at the end of the 7-day period.

† Persons were considered fully vaccinated ≥14 days after receipt of the second dose in a 2-dose series (Pfizer-BioNTech or Moderna COVID-19 vaccines) or after 1 dose of the single-dose Janssen (Johnson & Johnson) COVID-19 vaccine; partially vaccinated ≥14 days after receipt of the first dose and <14 days after the second dose in a 2-dose series; and unvaccinated <14 days receipt of the first dose of a 2-dose series or 1 dose of the single-dose vaccine or if no vaccination registry data were available.

FIGURE 2. SARS-CoV-2 whole genome sequencing lineage results* and reverse transcription-polymerase chain reaction cycle threshold values† for two gene targets,§ by vaccination status¶ and month - Los Angeles County, California, May 1-July 25, 2021

Abbreviations: Ct = cycle threshold; N = nucleocapsid; ORF1ab = open reading frame 1 ab; RT-PCR = reverse transcription-polymerase chain reaction; SC2N = SARS-CoV-2 nucleocapsid.

* SARS-CoV-2 infections among Los Angeles County residents aged ≥16 years with whole genome sequencing lineage results (n = 6,752) for fully vaccinated (n = 1,667), partially vaccinated (n = 198), and unvaccinated (n = 4,887) persons.

† Whiskers represent minimum and maximum observations; top of box represents the third quartile, bottom represents the first quartile, and box height represents the interquartile range. The midline is the median.

§ Ct values are correlated with the amount of viral nucleic acid present. Gene targets for RT-PCR testing included the N protein gene region and the ORF1ab polyprotein gene region. The N gene targets were analyzed separately for two laboratories because Ct values are not directly comparable across different testing laboratories; these N gene targets were designated SC2N and N to differentiate between the two participating laboratory partners. Gene targets were selected based on testing platforms used by Los Angeles County Department of Public Health laboratory partners. Analysis of SC2N Ct values is restricted to a Fulgent test result with a Ct value on the same day as person's first positive RT-PCR test result; SC2N gene target values (n = 5,179) are stratified for fully vaccinated (n = 1,248), partially vaccinated (n = 151), and unvaccinated (n = 3,780) persons. Analysis of ORF1ab and N Ct values is restricted to a Valencia Branch Laboratory test result with a Ct value on the same day as person's first positive RT-PCR test result. ORF1ab (n = 1,041) and N (n = 1,062) gene target values are stratified for fully vaccinated (n = 289 and n = 297, respectively), partially vaccinated (n = 36 and n = 41, respectively), and unvaccinated (n = 716 and n = 724, respectively) persons.

¶ Persons were considered fully vaccinated ≥14 days after receipt of the second dose in a 2-dose series (Pfizer-BioNTech or Moderna COVID-19 vaccines) or after 1 dose of the single-dose Janssen (Johnson & Johnson) COVID-19 vaccine; partially vaccinated ≥14 days after receipt of the first dose and <14 days after the second dose in a 2-dose series; and unvaccinated <14 days receipt of the first dose of a 2-dose series or 1 dose of the single-dose vaccine or if no vaccination registry data were available.

Suggested citation for this article: Griffin JB, Haddix M, Danza P, et al. SARS-CoV-2 Infections and Hospitalizations Among Persons Aged ≥16 Years, by Vaccination Status - Los Angeles County, California, May 1-July 25, 2021. MMWR Morb Mortal Wkly Rep 2021;70:1170-1176. DOI: http://dx.doi.org/10.15585/mmwr.mm7034e5external icon .

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covid-19 vaccine effectiveness and reinfection in vaccinated and unvaccinated people

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covid-19 vaccine effectiveness and reinfection during delta variant

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covid-19 vaccine effectiveness in california

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SARS-CoV-2 Infections and Hospitalizations Among Persons...

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On August 24, 2021, this report was posted online as an MMWR Early Release. Jennifer B. Griffin, PhD 1; Meredith Haddix, MPH 1; Phoebe Danza, MPH 1; Rebecca Fisher, MPH 1; Tae Hee Koo, MPH 1; Elizabeth Traub, MPH 1; Prabhu Gounder, MD 1; Claire Jarashow, PhD 2; Sharon Balter, MD 1 ( View author affiliations) View suggested citation What is already known about this topic?

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In LA, Latinx Population are Dying From COVID at Disproportionate Rates

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In LA, Latinx Population are Dying From COVID at Disproportionate Rates

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- The Latinx population has the highest number of cases (over 700 thousand) and highest number of deaths (over 13 thousand) due to COVID compared to other race/ethnicities
- 62.3% of the Latinx population 12+ year of age received at least 1 dose of vaccine (LA Public Health, 2021)
http://www.publichealth.lacounty.gov/media/Coronavirus/locations.htm#case-summary

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Settings include interim housing, shelters, encampments, and single room units, and service providers supporting People Experiencing Homelessness (PEH)

Obs

Setting Name

Setting Type

Number of Confirmed Staff

Number of Confirmed Non-Staff

Total Deaths

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Settings include interim housing, shelters, encampments, and single room units, and service providers supporting People Experiencing Homelessness (PEH) Obs Setting Name Setting Type Number of Confirmed Staff Number of Confirmed Non-Staff Total Deaths

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1. Decrease the # of COVID cases among Latinx adults 18+  in LA within 2 years.

2. Decrease the # deaths due to COVID among Latinx adults 18+ in LA within 2 years.

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1. Increase # of Latinx adults 18+ in LA who will receive the vaccine by 1 year (Behavior)

2. Increase the access to the vaccine For Latinx adults 18+ (Circumstance)

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1. Decrease # of Latinx adults 18+ in LA who feel hesitant about getting the vaccine within 6 months. (Attitude)

2. Decrease the fear of immigration-related issues some Latinx adults 18+ may have regarding the vaccine within 6 months. (Knowledge)

3. Decrease the # of Latinx adults 18+ in LA who are worried about the cost of the vaccine within 6 months. (Knowledge)

4. Increase the belief among Latinx adults 18+ that receiving the vaccine will benefit themselves and their communities within 6 months. (Attitude)

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Latinx Adults are Less Likely Than White Adults to Get The Vaccine 

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Latinx Adults are Less Likely Than White Adults to Get The Vaccine 

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In our country overall, White people are 1.1 times more likely to get a vaccination than the Latinx community. This can be due to a number of different causes which increases the likelihood that these people will die of COVID.

"Black and Hispanic people remain less likely than their White counterparts to have received a vaccine, leaving them at increased risk, particularly as the variant spreads. However, the data show that these disparities are narrowing over time, particularly for Hispanic people."

https://www.kff.org/coronavirus-covid-19/issue-brief/latest-data-on-covid-19-vaccinations-race-ethnicity/

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As of this week, 77% of the adult population in the United States have received at least one dose of a COVID-19 vaccine. While this progress represents a marked achievement in vaccinations that has led to steep declines in COVID-19 cases and deaths, vaccination coverage-and the protections provided by it-remains uneven across the country. With the continued spread of the more transmissible Delta variant, cases, hospitalizations, and deaths are rising, largely among unvaccinated people. While as of September 21, 2021, White adults accounted for the largest share (60%) of unvaccinated adults, Black and Hispanic people remain less likely than their White counterparts to have received a vaccine, leaving them at increased risk, particularly as the variant spreads. However, the data show that these disparities are narrowing over time, particularly for Hispanic people.

Reaching high vaccination rates across individuals and communities will be key for achieving broad protection through a vaccine, mitigating the disproportionate impacts of the virus for people of color, and preventing widening racial health disparities going forward. The Centers for Disease Control and Prevention (CDC) has indicated that vaccine equity is an important goal and defined equity as preferential access and administration to those who have been most affected by COVID-19.

The CDC reports demographic characteristics, including race/ethnicity, of people receiving COVID-19 vaccinations at the national level. As of September 21, 2021, CDC reported that race/ethnicity was known for 59% of people who had received at least one dose of the vaccine. Among this group, nearly two thirds were White (60%), 10% were Black, 17% were Hispanic, 6% were Asian, 1% were American Indian or Alaska Native, and <1% were Native Hawaiian or Other Pacific Islander, while 5% reported multiple or other race. However, CDC data also show that recent vaccinations are reaching larger shares of Hispanic, and Black populations compared to overall vaccinations. Among vaccines administered in the past 14 days, 23% have gone to Hispanic people and 14% to Black people (Figure 1). These recent patterns suggest a narrowing of racial gaps in vaccinations at the national level, particularly for Hispanic and Black people, who account for a larger share of recent vaccinations compared to their share of the total population (23% vs. 17% and 14% vs. 12%, respectively). While these data provide helpful insights at a national level, to date, CDC is not publicly reporting state-level data on the racial/ethnic composition of people vaccinated.

To provide greater insight into who is receiving the vaccine and racial/ethnic disparities in vaccination, KFF is collecting and analyzing state-reported data on COVID-19 vaccinations by race/ethnicity. As of September 20, 2021, 47 states and Washington D.C. were reporting vaccination data by race/ethnicity. This analysis examines how the vaccinations have been distributed by race/ethnicity and the share of the total population vaccinated by race/ethnicity. It also assesses trends in these data since March 1.

Distribution of Vaccinations by Race/Ethnicity

Figure 2 shows the shares of COVID-19 vaccinations, cases, and deaths among Black, Hispanic, Asian, and White people. The data also show the distribution of the total population by these groups as of 2019. Data are not presented for other groups due to data limitations. Together these data show:

Black people have received smaller shares of vaccinations compared to their shares of cases, deaths, and the total population in more than half of states reporting data. In the remaining reporting states, the share of vaccinations they have received is similar to their shares of cases, deaths, and the total population. For example, in Florida, Black people have received 9% of vaccinations, while they make up 15% of cases, 17% of deaths, and 15% of the total population.

Reflecting disproportionate levels of infection, Hispanic people have received smaller shares of vaccinations compared to their shares of cases in most reporting states. Their share of vaccinations is similar or higher than their shares of deaths in most reporting states. However, in some states it remains lower. For example, in California, 31% of vaccinations have gone to Hispanic people, while they account for 61% of cases, 47% of deaths, and 40% of the total population in the state.

These current patterns reflect growing shares of vaccinations going to Hispanic and Black people over time. Between March 1 and September 20, the share of vaccinations going to Hispanic people increased in all states reporting data for both periods and increased for Black people in most reporting states. In a few cases, these increases were large. For example, the share of vaccinations going to Black people increased from 26% to 45% in DC and from 25% to 38% in Mississippi. Similarly, the share of vaccinations going to Hispanic people increased by at least 10 percentage points in six states, including Florida (17% to 32%), Nevada (13% to 27%), California (19% to 31%), Texas (23% to 35%), New Jersey (6% to 18%), and New York (9% to 21%). The share of vaccinations going to Asian people also increased in most states reporting data for both periods, while it fell for White people in most reporting states. The share going to White people declined by 10 percentage points or more in 15 states (Florida, Arizona, Nevada, Alabama, Maine, Georgia, New Jersey, Tennessee, Texas, Virginia, Mississippi, New York, Illinois, Colorado, and Indiana).

In nearly all reporting states, the share of vaccinations among Asian people was similar to or higher than their shares of cases, deaths, and total population. For example, in Hawaii, 53% of vaccinations have been received by Asian people, which is higher than their share of the total population (40%) and their shares of cases and deaths (both at 44%).

White people received a higher share of vaccinations compared to their share of cases in most states reporting data. In fewer than half of reporting states they received a higher share of vaccinations compared to their shares of deaths and total population, while in other states it was similar or lower. For example, in Colorado, 76% of vaccinations were received by White people, while they make up 68% of the population. In Tennessee, 64% of vaccinations have been received by White people, which is lower than their share of cases (71%), deaths (78%), and their share of the population (77%).

Percent of the Total Population Vaccinated by Race/Ethnicity

We also calculate the percent of the total population that has received a COVID-19 vaccine for 45 states that report racial/ethnic data based on people who have received at least one dose of the vaccine. These data will differ from other estimates of vaccination rates among adults or the eligible population ages 12 and older.

Figure 3 shows the percent of the total population who have been vaccinated by race/ethnicity in each of these states and the total across 43 of these states. (North Dakota and New Mexico are excluded from the total due to differences in how they report their data.) It also shows the ratio of vaccination rates for White people compared to those of Black, Hispanic, and Asian people, as well as the percentage point difference between vaccination rates for White people and the rates for the other groups.

Overall, across these 43 states, the percent of White people who have received at least one COVID-19 vaccine dose (53%) was 1.2 times higher than the rate for Black people (45%) and 1.1 times higher than the rate for Hispanic people (49%) as of September 20, 2021. White people had a higher vaccination rate compared to Hispanic people in most reporting states, except Missouri, Vermont, Tennessee, DC, Louisiana, Virginia, Nevada, New York and South Carolina. White people also had a higher rate than Black people in every reporting state, except Oregon, Alaska, Idaho, Mississippi, Washington, and Louisiana. The size of these differences varied widely across states, and they have been narrowing over time. The overall vaccination rate across states for Asian people was higher compared to White people (69% vs. 53%), which is consistent with the pattern in most reporting states. However, Asian people had lower vaccinations rates than White people in five states (Colorado, North Dakota, Utah, Pennsylvania, and South Dakota).

Between September 7 and September 20, Black and Hispanic people experienced a slightly larger increase in vaccination rates compared to White and Asian people, narrowing the disparities in vaccination rates (Figure 4). Vaccination rates increased by 1.3 percentage points for both Hispanic people and Black people, from 48.2% to 49.4%, and from 43.2% to 44.5%, respectively. Vaccination rates increased by 0.6 percentage points for Asian people and by 0.9 percentage points for White people over the period (from 68.1% to 68.8%, and from to 52.3% to 53.3%, respectively). The larger increases in rates for Black and Hispanic people continue to narrow the gap in vaccination rates between these groups and White people.

The completeness of race/ethnicity data has improved in most states since March 1. Most states have had declines in their shares of vaccinations with unknown or missing race, with some states, like Arizona, experiencing particularly large declines, falling from (36% of vaccinations with unknown race to 11%).

Discussion

As the Delta variant continues to spread across the country, risks are increasing, particularly for people who remain unvaccinated. White people account for the largest share of people who remain unvaccinated, but Black and Hispanic people are less likely than their White counterparts to have received a vaccine, leaving them at increased risk, which may lead to widening disparities going forward and limit the nation's recovery.

At the same time, the data show that these disparities are narrowing over time, particularly for Hispanic people. This may reflect a combination of efforts focused on increasing vaccination rates among people of color through outreach and education and reduction of access and logistical barriers to vaccination, increased interest in getting the vaccine as the Delta variant continues to spread, and the increases in vaccinations among younger adults and adolescents who include higher shares of people of color compared to other adults. Despite this progress, the ongoing disparities in rates highlight the importance of continued efforts to increase vaccination rates and to address gaps in vaccination both geographically and across racial/ethnic groups.

While the data provide useful insights, they also remain subject to gaps, limitations, and inconsistencies that limit the ability to get a complete picture of who is and who is not getting vaccinated. For example, data gaps and separate reporting of data for vaccinations administered through the Indian Health Service limit the ability to analyze vaccinations among American Indian and Alaska Native and Native Hawaiian and Other Pacific Islander people. Moreover, some states have high shares of vaccinations that are missing race/ethnicity, limiting the ability to interpret the data. For example, in Washington D.C., 22% of vaccinations were among people classified as "unknown." Three states were not reporting vaccination data by race/ethnicity. Comprehensive standardized data across states are vital to monitor and ensure equitable access to and take up of the vaccine.

All reported data on vaccinations by race/ethnicity are available through our COVID-19 State Data and Policy Actions tracker and downloadable through our State Health Facts Online tables. KFF will continue to update these data on a regular basis going forward as vaccination distribution continues.

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Latest Data on COVID-19 Vaccinations by Race/Ethnicity

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As of this week, 77% of the adult population in the United States have received at least one dose of a COVID-19 vaccine. While this progress represents a marked achievement in vaccinations that has led to steep declines in COVID-19 cases and deaths, vaccination coverage-and the protections provided by it-remains uneven across the country.

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Although most Latinx people are willing to take the vaccine there is still a good portion of young Latinx that are still hesitant about the vaccine and its effectiveness. Community efforts are being made in order to reach and to take into account these individuals. Latinx people are less likely to get the vaccine compared to their white counterparts.  71%  of Latinx people are likely to get the vaccine where 36% will “definitely get the vaccine”, 35% of Latinx people will “probably get the vaccine”, 8% probably not getting it”, and 18% “definitely not getting the vaccine”. Whereas 73% of White people are likely to get the vaccine, 46% definitely getting it.
https://www.kff.org/coronavirus-covid-19/poll-finding/vaccine-hesitancy-among-hispanic-adults/

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The KFF COVID-19 Vaccine Monitor is an ongoing research project tracking the public's attitudes and experiences with COVID-19 vaccinations. Using a combination of surveys and focus groups, this project will track the dynamic nature of public opinion as vaccine development unfolds, including vaccine confidence and hesitancy, trusted messengers and messages, as well as the public's experiences with vaccination as distribution begins.
Vaccine Hesitancy Among Hispanic Adults

The COVID-19 pandemic has had a disproportionate impact on people of color. A previous KFF analysis found that along with Black and American Indian and Alaska Native (AIAN) people, Hispanic people were overrepresented in coronavirus cases and more likely to suffer worse outcomes than their White counterparts. Moreover, Hispanic adults have been harder hit by the economic impact of the pandemic as the December 2020 KFF COVID-19 Vaccine Monitor poll finds half (52%) of Hispanic adults say their household has lost a job or income since the coronavirus began spreading in the U.S. in February 2020 -compared to fewer White adults (42%) who say the same. With the risk of coronavirus ever present, four in ten Hispanic adults (43%) say they are essential workers required to work outside their home during the coronavirus outbreak (78% of all employed Hispanic adults compared to six in ten employed White and Black adults). With Hispanic adults being among the groups most impacted by the pandemic, the KFF COVID-19 Vaccine Monitor finds that while most Hispanics are open to getting vaccinated, there remains a sizeable share, particularly among younger Hispanics, who express at least some vaccine hesitancy. Communication efforts focused on reaching Hispanics will need to take this and other heterogeneity into account. This analysis seeks to shed light on what we know so far about vaccine hesitancy among Hispanic adults and the messages and trusted messengers that might succeed at ensuring a robust vaccination effort for this key group.

Most Hispanic adults indicate they are likely to get the COVID-19 vaccine with seven in ten (71%) saying they will "definitely get" the vaccine (36%) or "probably get it" (35%). While a similar share of White adults (73%) say they will probably or definitely get the vaccine, Hispanic adults are less likely than their White counterparts to say they "definitely" will get it (36% vs. 46%). About one in four Hispanic adults say they will "probably not get it" (8%) or "definitely not get it" (18%).

One in four Hispanic adults (26%) report being the most enthusiastic to get the vaccine saying they will get the COVID-19 vaccine "as soon as possible," an additional four in ten (43%) say they will "wait and see" how it is working for others before getting the vaccine. One in ten (11%) say they will only get the vaccine if they are required to do so for work or other activities and 18% of Hispanic adults say they "will definitely not" get the vaccine, similar to the share of White and Black adults who say they definitely will not get the vaccine (15% each). While a majority of Hispanic adults indicate they are open to getting the vaccine, a smaller share of Hispanic adults compared to White adults express enthusiasm of wanting to get the vaccine as soon as possible (26% vs. 40%).

Among Hispanic adults, differences across age groups are more pronounced than those across gender, education, and income levels. Mirroring age differences among White adults, there is a generational divide among Hispanic adults when it comes to vaccine hesitancy. While eight in ten Hispanic adults ages 50 or older say they will either "definitely" (44%) or "probably" (36%) get the COVID-19 vaccine, two-thirds of Hispanics under 50 say the same. Moreover, when asked more specifically about when they would like to get vaccinated, four in ten (38%) Hispanic adults over 50 say they would want to get vaccinated "as soon as they can," compared to one in five younger adults who say the same. Indeed, the largest share of younger Hispanic adults would prefer to "wait and see" (45%) before getting the COVID-19 vaccine. As about three in four Hispanic adults in the U.S. are under the age of 55, these younger Hispanics will be a key group for vaccination outreach efforts.

Notably, though most Hispanic essential workers - a group that is largely made up of adults under age 50 - say they will definitely or probably get the vaccine (69%), just one in four (23%) say they want to get the vaccine "as soon as they can" while one in five (18%) say they will "only get the vaccine if it is required" and a similar share of essential workers say they "definitely won't" get the vaccine (18%). As efforts to distribute the COVID-19 vaccine continue, vaccine acceptance among these Hispanic essential workers will be particularly important given they are more likely to have interactions with many other people.

Hispanic Age Gap In Confidence In The Vaccine

The December KFF COVID-19 Vaccine Monitor finds a generational confidence gap may be contributing to why older Hispanic adults are more likely to report wanting a COVID-19 vaccine "as soon as they can," while younger Hispanic adults may be more hesitant. Overall, six in ten Hispanic adults say that they are at least somewhat confident that when a COVID-19 vaccine is available, it will have been tested for safety and effectiveness (61%), it will be distributed in a way that is fair (61%), and that the development of the COVID-19 vaccine is taking into account the needs of Hispanic or Latino people (60%). However, Hispanic adults over the age of 50 are more likely than those under 50 to say they are confident in each of these items, with larger shares of older adults saying they are confident that a vaccine will have been tested for safety and effectiveness (73% vs. 56%), that it will be distributed in a way that is fair (70% vs. 57%), and that the development of the COVID-19 vaccine is taking into account the needs of Hispanic or Latino people (68% vs. 56%).

Moreover, while two-thirds of older Hispanic adults (67%) see getting vaccinated for COVID-19 as "part of everyone's responsibility to protect the health of others," younger Hispanic adults under 50 are divided on whether they see getting the vaccine as a collective responsibility (48%) or as a personal choice (50%). Half of Hispanic essential workers (52%) say that getting vaccinated is more a "personal choice."

Hispanic Trust In Public Health Messengers May Help Address concerns Among Those Most Hesitant

Despite a sizeable share of younger Hispanic adults and Hispanic essential workers expressing some hesitancy towards the COVID-19 vaccine, majorities of Hispanic adults overall say they trust their own doctor or health care provider to provide reliable information about a COVID-19 vaccine (75%) and majorities say they trust the CDC (71%), the FDA (66%), their local public health department (65%), Dr. Fauci (62%), or President-elect Joe Biden (58%). Even among Hispanic adults who say they want to "wait and see" before they get the vaccine, at least six in ten say they trust these public health officials and organizations.

Yet notably, younger Hispanic adults are less trusting than their older counterparts of government officials, including President-elect Joe Biden and state government officials. However, about two-thirds of Hispanic adults, regardless of age, say they trust their local public health department to provide reliable information about the COVID-19 vaccine and about seven in ten or more trust their own doctors and the CDC.

Notably, many people, including many Hispanic adults, also face additional barriers to getting vaccinated, such as lack of health insurance or a usual source of care, lack of information about the vaccine being cost-free, and logistical barriers such as limited transportation. However, as the new Biden Administration is set to take over the country's vaccine distribution efforts and address vaccine hesitancy, Hispanic adults overall and as well as those who express some hesitancy to get vaccinated, appear to be open to information from public health organizations and individuals.

Younger Hispanic adults, in particular, may need to be reassured about the safety and effectiveness of the vaccine. Moreover, these younger Hispanic adults who express hesitancy about the vaccine may not be swayed by messages stressing the importance of vaccination for the health of the broader community, but may instead be more receptive to information that highlights how getting vaccinated may be the right choice for them to make in order to protect themselves, their families and get their lives back to normal.

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The KFF COVID-19 Vaccine Monitor is an ongoing research project tracking the public's attitudes and experiences with COVID-19 vaccinations. Using a combination of surveys and focus groups, this project will track the dynamic nature of public opinion as vaccine development unfolds, including vaccine confidence and hesitancy, trusted messengers and messages, as well as the public's experiences with vaccination as distribution begins.

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Why are Latinx Adults Less Likely to Get the Vaccine?

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Why are Latinx Adults Less Likely to Get the Vaccine?

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Among the Latinx population in LA 30% of Latinx adults want to get the vaccine as soon as possible, however statistics show that Latinx are less likely to get the vaccine. Monitors controlling the intake of vaccines, discusses the many different barriers that Latinx adults have to face such as racial gaps that include concerns about a possible cost of the vaccine, lost wages, and immigration-related issues.

https://www.kff.org/other/press-release/vaccine-monitor-unvaccinated-hispanic-adults-are-twice-as-likely-as-white-adults-to-want-a-covid-19-vaccine-asap-highlighting-a-key-outreach-opportunity-for-vaccination-efforts

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Fears About Costs and Documentation Requirements Pose Potential Barriers for Some Hispanic Adults

Nearly Two-Thirds of Unvaccinated Hispanic Adults Worry about Missing Work due to Vaccine Side Effects

A third (33%) of unvaccinated Hispanic adults say they want to get a COVID-19 vaccine as soon as possible - twice the share as among unvaccinated White (16%) or Black (17%) adults, presenting an opportunity for targeted outreach to boost overall vaccination rates, according to a new KFF COVID-19 Vaccine Monitor report focused on the vaccine views and experiences of Hispanic adults.

The higher share of Hispanic adults who want to get vaccinated quickly but have not yet reflects some significant access barriers and information gaps identified by the Monitor, including concerns about potential costs, lost wages, and immigration-related issues.

"With so many unvaccinated Hispanic adults eager to get a shot, there's an opportunity to further close the gap in vaccination rates by addressing worries about costs and practical concerns such as time off work," said Liz Hamel, a KFF vice president and director of KFF's public opinion and survey research.

Overall, nearly half (47%) of all Hispanic adults say they've already gotten at least one dose of a COVID-19 vaccine, lagging behind the rate for White adults (60%) but similar to the rate for Black adults (51%).

Among all unvaccinated Hispanic adults, nearly two thirds (64%) are concerned about missing work due to side effects, and half (52%) worry they may have to pay out-of-pocket for the vaccine - even though all adults nationally cannot be charged to get the vaccine.

Though the federal government has made clear that vaccines should be available to people regardless of their immigration status, 4 in 10 unvaccinated Hispanic adults (39%) say they are concerned that they might be required to provide a Social Security number or government-issued identification to get vaccinated, and about a third (35%) are concerned that getting a vaccine might negatively affect their own or a family member's immigration status.

Those fears reflect how vaccines are being administrated in some locations. Even though the vaccine is available to all adults in the U.S, regardless of their immigration or insurance status, more than half (56%) of Hispanic adults who have been vaccinated say they were required to show a government-issued identification when they received the vaccine, and 15% say they were asked to provide a Social Security number. Nearly a quarter (23%) say they were asked for health insurance information.

Unvaccinated Hispanic adults who are uninsured or potentially undocumented in general are more concerned than other Hispanic adults about both immigration- and cost-related issues.

Information gaps also may be contributing to these concerns. Less than half of Hispanic adults know that the vaccines are free for all U.S. residents (46%) and that all adults are eligible regardless of immigration status (42%).

With all adults now eligible to get vaccinated nationwide, a much larger share of unvaccinated Hispanic adults (42%) than unvaccinated White adults (26%) are unsure if they are eligible to receive the vaccine in their state. Among Hispanic adults who are potentially undocumented, more than half (57%) are unsure about their eligibility.

Opportunities for Expanding Vaccination Rates Among Less Eager Hispanic Adults

The Monitor also examines several potential strategies that could affect the willingness of Hispanic adults to get vaccinated among those who have not already done so and aren't hoping to do so as soon as possible.

Nearly half (46%) of this less-eager group say they would be more likely to get vaccinated if it were offered to them where they normally go for health care. That is twice the share as among White adults (23%).

Among those in this group who are employed, more than half (54%) say they would be more likely to get it if their employer gave them paid time off to recover from side effects, nearly three times the share among White workers (19%). In addition, 38% of less-eager Hispanic workers say they would be more likely to get vaccinated if their employer arranged for a medical provider to administer the vaccine at their workplace, compared to 14% of similar White workers.

Employer financial incentives to get vaccinated also could encourage vaccination among less-eager Hispanic workers. Nearly 4 in 10 (38%) of this group say they would be more likely to get a vaccine if their employer offered them a $200 incentive to do so.

International travel requirements also could motivate significant shares of less-eager Hispanic adults to get vaccinated: 41% say they would be more likely to get vaccinated if it were required to travel abroad, including nearly two-thirds (63%) of those born outside the United States.

Other key results include:

Among those who have been vaccinated, Hispanic adults are twice as likely (22%) as White (11%) or Black (10%) adults to say they got their vaccine at a community health center. The share is even higher (30%) among those who primarily speak Spanish.

About half of Hispanic adults who have been vaccinated or tried to make an appointment did so online (48%), fewer than among White adults (58%). A quarter (25%) of Hispanic adults say they signed up or tried to sign up by phone, and another 16% say they did so in person.

Most Hispanic adults who predominantly speak Spanish (68%) say it is easy to find COVID-19 vaccine information in Spanish, but 27% say it is difficult.

Hispanic Adults Are More Likely than White Adults to Say the Pandemic Negatively Affected Their Family's Health and Finances

The report also examines some of the disproportionate impacts that the pandemic has had on Hispanic families:

Hispanic adults are more likely than White adults to say someone in their family has tested positive for COVID-19 (28% vs.18%) or that a family member or close friend has died from it (38% vs.18%).

Similarly, two-thirds (67%) of Hispanic adults say they are worried that they or someone in their family will get sick from coronavirus, including 41% who say they are very worried. The share who says they are very worried is four times higher among Hispanic adults than among White adults (10%).

Hispanic adults are also more likely than White adults to say that the pandemic has negatively affected their personal financial situation (48% v. 36%). The shares are higher among Hispanic adults who predominantly speak Spanish (55%) and with household incomes less than $40,000 annually (56%).

"While the vaccines are available to all adults regardless of their insurance or immigration status, many Hispanic adults who have been vaccinated say they were asked for their health insurance information or a government-issued ID," said Samantha Artiga, a KFF vice president and director of the racial equity and health policy program. "That can pose barriers for many, particularly those who are uninsured or are potentially undocumented immigrants."

Designed and analyzed by public opinion researchers at KFF, the KFF Vaccine Monitor survey was conducted from April 15-29 among a nationally representative random digit dial telephone sample of 2,097 adults, including oversamples of adults who are Black (507) or Hispanic (778). Interviews were conducted in English and Spanish by landline (298) and cell phone (1,799). The margin of sampling error is plus or minus 4 percentage points for results based on Hispanic adults. For results based on subgroups, the margin of sampling error may be higher.

The KFF COVID-19 Vaccine Monitor is an ongoing research project tracking the public's attitudes and experiences with COVID-19 vaccinations. Using a combination of surveys and qualitative research, this project tracks the dynamic nature of public opinion as vaccine development and distribution unfold, including vaccine confidence and acceptance, information needs, trusted messengers and messages, as well as the public's experiences with vaccination.

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Vaccine Monitor: Unvaccinated Hispanic Adults are Twice as Likely as White Adults to Want a COVID-19 Vaccine ASAP, Highlighting a Key Outreach Opportunity for Vaccination Efforts

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A third (33%) of unvaccinated Hispanic adults say they want to get a COVID-19 vaccine as soon as possible - twice the share as among unvaccinated White (16%) or Black (17%) adults, presenting an opportunity for targeted outreach to boost overall vaccination rates, according to a new KFF COVID-19 Vaccine Monitor report focused on the vaccine views and experiences of Hispanic adults.

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In a pool of nationwide studies, investigators found that COVID-19 vaccine hesitancy rates were among the highest in Latinx individuals. Sociodemographic factors such as income, level of education, gender, etc. were said to be the cause for these findings. Mistrust with the healthcare system, and racism are also a prominent basis as to why some may not get vaccinated. There are also more instances where the Latinx population and other communities of color maybe exposed to inadequate information and myths regarding the vaccine.

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Highlights

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It is not well known if COVID-19 vaccination hesitancy in racial and ethnic minorities is associated with unique sociodemographic and cognitive correlates.

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In this review, a pool of 13 studies (n ​= ​107,841 participants) was included and we found that the overall COVID-19 vaccination hesitancy for adult Americans was 26.3%, but much higher for African-Americans (41.6%) and Hispanics (30.2%).

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The major predictors of vaccine hesitancy in African-Americans and Hispanics were: sociodemographic characteristics and cognitive correlates.

Abstract

COVID-19 vaccines were approved for use in the general American public by late 2020 and early 2021. Media reports started highlighting COVID-19 vaccination hesitancy in racial and ethnic minorities. However, little is known about the extent of COVID-19 vaccination hesitancy in racial and ethnic minorities and whether there are unique sociodemographic and cognitive correlates associated with vaccine hesitancy. Thus, the purpose of this study was to review all nationwide studies on COVID-19 vaccine hesitancy among African-Americans and Hispanics (the largest minority groups in the U.S.). A comprehensive review of the published literature was conducted to search for national studies and a final pool of 13 studies (n ​= ​107,841 participants) was included in this review. The overall pooled prevalence rate of COVID-19 vaccination hesitancy for adult Americans across all studies was 26.3% (95%Ci ​= ​17.3-36.4). In contrast, the overall pooled prevalence rate of COVID-19 vaccination hesitancy for African-Americans was 41.6% (95%Ci ​= ​34.4-48.9) and for Hispanics, it was 30.2% (95%Ci ​= ​23.2-37.7). The major predictors of vaccine hesitancy in African-Americans and Hispanics were: sociodemographic characteristics (e.g., age, gender, income, education, and household size); medical mistrust and history of racial discrimination; exposure to myths and misinformation, perceived risk of getting infected with COVID-19; beliefs about vaccines and past vaccine compliance, and concerns about the safety, efficacy, and side effects from the COVID-19 vaccines. Given the high COVID-19 vaccine hesitancy rates in racial/ethnic minorities and the unique factors associated with vaccine hesitancy in African-Americans and Hispanics, several clinic-based and community-oriented practice recommendations have been included in this article.

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COVID-19 vaccination hesitancy in Hispanics and African-Americans: A review and recommendations for practice

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It is not well known if COVID-19 vaccination hesitancy in racial and ethnic minorities is associated with unique sociodemographic and cognitive correlates. * In this review, a pool of 13 studies (n ​= ​107,841 participants) was included and we found that the overall COVID-19 vaccination hesitancy for adult Americans was 26.3%, but much higher for African-Americans (41.6%) and Hispanics (30.2%).

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According to The New York Times, some reasons why Latinxs are hesitant or choose not to receive the vaccine are related to employment issues such as if side affects will prevent them from working, leading to job lost or if their employer does or does not give payed time off (May 2021).
https://www.nytimes.com/2021/05/13/health/covid-vaccine-latino-hispanic.html

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Issues of access and fears of employment and immigration consequences have kept their Covid vaccination rates low, the findings suggest.

Anna Aguilar, a member of the Guatemalan Maya community in Lake Worth, Fla., received a Covid vaccine last month. Credit... Saul Martinez for The New York Times

Latino adults in the United States have the lowest rates of Covid-19 vaccination, but among the unvaccinated they are the demographic group most willing to receive the Covid shots as soon as possible, a new survey shows.

The findings suggest that their depressed vaccination rate reflects in large measure misinformation about cost and access, as well as concerns about employment and immigration issues, according to the latest edition of the Kaiser Family Foundation Covid-19 Vaccine Monitor.

Earlier polls had suggested that skepticism about the vaccine was widespread among Latinos, but the latest survey showed that hesitation is declining.

"With so many unvaccinated Hispanic adults eager to get a shot, there's an opportunity to further close the gap in vaccination rates by addressing worries about costs and practical concerns such as time off work," said Liz Hamel, a vice president of the foundation and director of public opinion and survey research.

Indeed, 33 percent of unvaccinated Latino adults responding to the survey said they wanted the shots as soon as possible, compared with 16 percent of the unvaccinated white adults and 17 percent of the unvaccinated Black adults.

Over all, nearly half of the Latino respondents, 47 percent, said they had gotten at least one dose of a Covid vaccine, compared with 60 percent of white adults and 51 percent of Black adults.

"The report shows that many Latinos have a high motivation to get vaccinated," said Kurt Organista, a professor of social welfare at the University of California, Berkeley. "They live in multigenerational households and cramped quarters. They want to protect their families."

But, he added, "they work a lot - their work participation rates are higher than average Americans - so they don't want to jeopardize their jobs by taking time off to get vaccinated."

The survey showed that misunderstandings about cost and eligibility had also stymied them.

Even though the Covid vaccines are free in the United States, half of the unvaccinated Latino respondents worried that they would have to pay for the shot. Two-thirds said they feared they would have to miss work because of side effects.

About 18 percent of the Latino respondents said they did not yet have permanent residential status in the United States. Though the Biden administration and local public health officials have reiterated that the shots are available to anyone regardless of immigration status, more than half of this group reported being unsure about whether they were eligible to get the shots.

Nearly 40 percent of all the unvaccinated Latinos responding to the survey said they feared they would need to produce government-issued identification to qualify. And about a third said they were afraid that getting the shot would jeopardize either their immigration status or that of a family member.

Many health departments have been undertaking increasingly inventive measures to sign up Spanish speakers and to reassure them that their immigration status will not be endangered, said Erin Mann, the program manager for the National Resource Center for Refugees, Immigrants and Migrants, based at the University of Minnesota, which advises communities about best practices to reach underserved people. These include having language-specific drive-up lanes for testing and vaccination, holding events in the evenings and having health care workers phone individuals to sign them up.

The results of the poll were drawn from a nationally representative telephone survey, conducted from April 15 to April 29, of 2,097 adults, including 778 English- and Spanish-speaking Latinos.

The State of Vaccine Mandates in the U.S.

Vaccine rules.On Aug. 23, the F.D.A. granted full approval to Pfizer-BioNTech's coronavirus vaccine for people 16 and up, paving the way for mandates in both the public and private sectors. Such mandates are legally allowed and have been upheld in court challenges.

College and universities. More than 400 colleges and universities are requiring students to be vaccinated against Covid-19. Almost all are in states that voted for President Biden.

Schools. California became the first state to issue a vaccine mandate for all educators and to announce plans to add the Covid-19 vaccine as a requirement to attend school, which could start as early as next fall. Los Angeles already has a vaccine mandate for public school students 12 and older that begins Nov. 21. New York City's mandate for teachers and staff, which went into effect Oct. 4 after delays due to legal challenges, appears to have prompted thousands of last-minute shots.

Hospitals and medical centers. Many hospitals and major health systems are requiring employees to get vaccinated. Mandates for health care workers in California and New York State appear to have compelled thousands of holdouts to receive shots.

New York City. Proof of vaccination is required of workers and customers for indoor dining, gyms, performances and other indoor situations. City education staff and hospital workers must also get a vaccine.

At the federal level. On Sept. 9,President Biden announced a vaccine mandate for the vast majority of federal workers. This mandate will apply to employees of the executive branch, including the White House and all federal agencies and members of the armed services.

In t he private sector. Mr. Biden has mandated that all companies with more than 100 workers require vaccination or weekly testing, helping propel new corporate vaccination policies. Some companies, like United Airlines and Tyson Foods, had mandates in place before Mr. Biden's announcement.

The report on the findings also explored the disproportionately harsh impact of the pandemic on Latino families, which helped explain their willingness to be vaccinated. About 38 percent of Latino adults said that a relative or close friend had died from Covid-19, compared with 18 percent of white adults who reported having had similar experiences. Two-thirds of Latino adults said they feared that either they or a relative might get sick from the coronavirus. Financial fears related to the pandemic rippled through Latino families, too. Nearly half said they had been adversely affected economically, compared with about one-third of white respondents who said so.

While about a third of unvaccinated Latino adults were eager to get a shot as soon as possible, two-thirds were more reluctant, describing themselves as waiting and seeing (35 percent), only if required by work (13 percent) or definitely not (17 percent). But this group did seem amenable to incentive strategies, the report suggested. For them, improved access would be helpful.

More than half in this group who are overall reluctant and also employed said they would get the shots if their employers gave them paid time off to recover from side effects, a rate nearly three times that of white workers. (The Biden administration has urged companies to adopt the measure.) And 38 percent of this group would be inclined to be vaccinated if their employer arranged for the shots to be distributed at the work site. Nearly four in 10 said they would be more likely to get the shot if their employer provided a $200 incentive to do so.

Their responses also pointed to the importance of community-based access. Nearly half said they would be more likely to be vaccinated if the shots were available at sites where they normally go for health care. Dr. Organista said this finding showed the growing use of such clinics, which rely heavily on "promotores de salud" - community-based health workers, often volunteers, who provide assistance especially to Spanish-speaking residents.

"These clinics treat people irrespective of their ability to pay and immigration status," he said. "People in the community know this. That's a big opportunity and a solution for vaccination."

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Many Unvaccinated Latinos in the U.S. Want the Shot, New Survey Finds

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Issues of access and fears of employment and immigration consequences have kept their Covid vaccination rates low, the findings suggest. Latino adults in the United States have the lowest rates of Covid-19 vaccination, but among the unvaccinated they are the demographic group most willing to receive the Covid shots as soon as possible, a new survey shows.

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Covid 19 vaccination accessibility has also been a clear indicator pertaining to low vaccination status in communities of color. Many States and counties made efforts to recognize COVID-19 disparities and accessibility by placing vaccination sites in pharmacies within heavily impacted communities. However, their efforts came up short due to the fact that a lot of Latinx communities are also pharmacy deserts. These communities may also have independently owned pharmacies which do not have the capacity or availability to administer an adequate amount of vaccines within these communities.

There are also instances in which vaccination sites are placed within these communities but wealthy whites from different areas occupy most of the available appointments.

Internet access may also be an indicator for low vaccine rates seeing as though scheduling appointments are mostly online.

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Citation: Reverby SM (2021) Racism, disease, and vaccine refusal: People of color are dying for access to COVID-19 vaccines. PLoS Biol 19(3): e3001167. https://doi.org/10.1371/journal.pbio.3001167

Published: March 8, 2021

Copyright: © 2021 Susan M. Reverby. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Funding: The author received no specific funding for this work.

Competing interests: The author has declared no competing interests exist.

In the early 1900s as knowledge of germ theory spread, the Atlanta Constitution newspaper in Georgia editorialized that "Germs Know No Color Line," an early reminder that bacteria do not stay segregated by race [ 1]. In 2021, unless at least 70% of us get vaccinated or have long-term immunity from having had COVID, we will have proven that "Viruses Know No Color or Ethnicity Lines [ 2]." Yet widespread beliefs that the virus is no worse than the flu, that masks and social distancing are not necessary, and that the vaccination is more dangerous than the disease will hamper our ability to get to herd immunity. Such beliefs, when they become actions, will prolong the pandemic.

Now that the vaccines are becoming available, albeit too slowly as we try to stop the spread of the virus, we need to consider the paradox of why so many people still seem to be resisting the injections even as they are difficult to get. To explain "vaccine hesitancy" we need a more nuanced read of history and contemporary realities. We must consider why so much focus is on vaccine refusal, rather than on the lack of access to the vaccine and healthcare in general.

The concern with vaccine hesitancy has been laid primarily at the feet of African American and Latinx communities in the United States. Study after study appears to show that more Black and Brown people, out of proportion to their numbers in the population, are getting sick and dying from COVID-19 compared with whites, yet resisting the vaccinations because of mistrust [ 3]. Rather than a nuanced analysis for this mistrust of conventional medical care, however, we routinely hear a litany of historical explanations. In Black communities, a holy trinity of medical horror stories are trotted out: Dr. J. Marion Sims' use of slave women for gynecological experimentation, the 40-year study in Tuskegee of "untreated syphilis in the Male Negro," or the taking of Henrietta Lacks' cervical cancer cells to begin the first reproducible cell lines. In the Latinx communities, the explanations focus more on requirements to present government-issued identification, mistrust of government sponsorships given the histories of forced sterilizations and experimentation on Black and Brown bodies, and reliance on herbal remedies [ 4, 5].

Against this backdrop, many of the news stories on the refusal to wear masks or socially distance tie such actions to political conservatives, libertarians, or some form of toxic masculinity. Yet it is not just white people who get their news from rightwing media outlets, social media, and word of mouth that spread fears of vaccine consequences, or a sense that the government is using the vaccine to harm people, or will implant things to track individuals. Such disinformation and fears have spread through Latinx communities as well [ 6]. All of these historical and conspiratorial factors matter of course, but in ways not frequently acknowledged. When people of color refer to such historical claims it is often as a way to say that structural racism is real, or I, my family, or community have been subjected to this kind of racist treatment, but when it comes to health care I will explain this experience in historical terms because it sounds less crazy [ 7]. When mass incarceration, unlawful police actions, and unwarranted immigration raids shape a community's experience, why should they trust the government? In turn, conspiracy theories have always been fundamental to American politics, infiltrate medical beliefs, and affect health behaviors [ 8]. The news media's focus on mistrust or seemingly ridiculous conspiracies, however, ignores the racist structures that shape economic, political, and social realities that lead to health disparities.

The alarming statistics on who is getting the vaccines, and who is not, should shift our attention away from mere mistrust in communities of color and toward the structures of racism that cause that mistrust. Chicago provides a good example. Aware that equity ought to drive the vaccine roll-out, that city's health department sought to provide local pharmacies with the vaccines. But that well-intentioned effort did not account for the fact that many of the city's minority communities are "pharmacy deserts" or are populated not by the big chains but by independent stores that do not have the capacity to vaccinate right now. Similarly, when vaccination signups must be done online, lack of access to decent internet connections or even smartphones make it nearly impossible to do [ 9].

While only a long-term perspective and commitment to public health, primary care, and affordable health insurance can change some of the underlying structural problems that shape the pandemic, there is much we can do now: acknowledge that the mistrust is realistic, keep an equity lens in full view as the vaccines are rolled out, consider deploying vaccinators to local churches and independent pharmacies, keep explaining why the vaccine is safe and effective and be transparent if there are problems, make sure that immigration police are kept out of vaccination centers, press for vaccination in the prisons, or better yet decarceration. We may be in a biological battle with the virus, but winning will require more than medical research prowess alone. We must harness social and political tools to dismantle the structural barriers that perpetuate deadly health disparities.

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Racism, disease, and vaccine refusal: People of color are dying for access to COVID-19 vaccines

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As the vaccines against COVID are slowly becoming available, we need to consider the paradox of why so many people of color are dying from the disease yet cannot get the vaccinations. Focus of concern ought to shift from vaccine refusal to lack of access.

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VFTP: Vaccination for the Pueblo

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Latino Adults who live in the city of Los Angeles (18+)

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Program Activities Phase 1: Program Development (mos. 1-3)

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Program Activities Phase 1: Program Development (mos. 1-3)

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Hire 4 Peer Educators among community leaders from the city of Los Angeles that can serve as a bridge for us to deliver our curriculum

Obtain 1,000 doses of Johnson & Johnson vaccination and hire a nurse to administer vaccines

Purchase a truck to create a mobile unit to move around the city of LA and material that will be used during the program

Develop a curriculum to train the informative ambassadors

Develop (vaccination/informative) campaign for the Hispanic community in the area of the city of LA; bilingual social media outreach

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Program Activities Phase 2: Program Implementation (mos. 3-21) 

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Program Activities Phase 2: Program Implementation (mos. 3-21) 

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Information for the Public - ambassador training curriculum

4 peer educators meet 2 hours a day, once a week for 5 weeks for training to be able to carry out the program and spread factual information regarding vaccines to the community

Over the course of 16 months the team is expected to administer 1,000 Johnson and Johnson vaccines to the adult 18+ Latinx community in LA

Peer educators will attend LA organized community events two times a week from 10 a.m. - 3.p.m.

Peer Educator Vaccination Information “tour”
Once training is complete, peer educators will station medical van at organized LA community events and provide information regarding COVID-19, vaccinations, and administering vaccinations to the Adult 18+ Latinx Community.

Peer Educators will share startling statistics on the disproportionate effect of COVID among Latinx adults 18 + in LA

Death rates among Latinx adults 18 + in LA will be highlighted

Benefits about the vaccine, herd immunity, and other advantages of getting vaccinated will be shared

Myth Busters & Fact Checks

Due to high exposure to myths within the media regarding COVID -19 and the vaccine, peer educators will address misinformation that may be common to see online.

Making vaccine appointments

Peer educators will assist people visiting the van with making vaccination appointments with their iPads for individuals who do not want to get immediately vaccinated

Vaccinations

There will also be a nurse present to administer  the Johnson and Johnson vaccine for individuals who do want immediate vaccination

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Program Activities Phase 3: Closing (mos. 21-24)

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Program Activities Phase 3: Closing (mos. 21-24)

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Hold a parade closing party to highlight the increase in the intake of vaccines in the area of the city of LA

Conduct graduation for ambassadors

Conduct evaluation activities

Final report about the program

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4 peer educators

1 Information for the Public Training Curriculum

2000 Myth busters & Fact Check flyers

100 social media posts

1000 Johnson & Johnson vaccines administered