By Millicent Gorham
September 11, 2023
The United States faces a significant vaccine equity gap. Across the board, white Americans are more likely to be up to date on CDC recommendations than their Black and Brown counterparts. For example, in 2019, white adults were almost twice as likely as Black and Hispanic adults to receive shingles vaccinations. And it’s not just older groups, CDC data shows that Black and Hispanic women are far less likely than white women to have received the Tdap vaccine during pregnancy. Unfortunately, we have seen similar geographic disparities with vaccine uptake in rural communities and lagging rates in urban and suburban areas.
The pandemic has taught us that vaccine equity is possible. The National COVID-19 Preparedness Plan, issued by the White House in March 2022, showed parity in COVID-19 vaccination rates across Hispanic, Black, Asian and white adults. This was a major achievement and the result of a comprehensive effort. Indeed, the original COVID-19 vaccination series that rolled out in early 2021 was the first adult vaccine to reach some degree of parity. This hard-won victory resulted from strong CDC recommendations, on-the-ground legwork of public health and community leaders, and significant investment by the public and private sectors.
As we head into our fourth fall with COVID-19, it is essential that government leaders take specific steps to ensure that gains in vaccine equity are not lost. It would be a tragedy to erase so much progress.
I encourage the CDC to keep three things in mind as they consider recommendations for the updated COVID-19 vaccine:
– Issue strong and clear guidance with a universal recommendation. CDC should issue a broad recommendation that encourages anyone who could benefit from the vaccine to get immunized. One of the biggest barriers to vaccination is confusion and misinformation. As we emerge from a pandemic, it is important that we not do anything that could in turn discourage vaccinations.
– Keep it Simple. While there are good reasons that people with chronic health conditions often benefit more from being vaccinated, making recommendations on the basis of risk can also create challenges and confusion. Many Americans may not even know they are at risk. For example, millions of Americans are living with undiagnosed diabetes so they would not realize a recommendation targeted to the diabetic population would apply to them.
– Be Wary of Creating Hurdles that Compound Inequities. The CDC sometimes makes recommendations using what they call “Shared Clinical Decision Making” – which is their way of saying that individuals can consult with their health care provider and make the choice. Unfortunately, studies have shown that patients who are male, Latino, Black or live in the South are much less likely than other Americans to have access to primary care. While it’s important that patients have conversations about their health with their provider, complicating the recommendation and creating another step prior to vaccination would only make it harder for people impacted by health inequities to get the vaccine.
It is important to note that a CDC recommendation for COVID-19 does not mean a vaccine is required. We know that regardless of the recommendation, many people will choose not to be vaccinated. However, a clear, broad-based routine recommendation sets up the most frictionless process for people who want to be immunized. This designation also triggers important but less visible health system features that support vaccination, like populating an electronic medical record, or EMR, with information that reminds providers to recommend vaccines.
While the pandemic exposed a long-standing equity gap in vaccines, our response helped to close it with the COVID-19 vaccine. It is critical that we stay the course – the health of our nation’s most vulnerable people depends on it.