Privilege and Politics Influence Vaccine’s Racial Disparity – “Structural Inequities Pose a Serious Threat To Progress”

Researchers break down social factors behind various black-and-white COVID-19 vaccination rates.

Income, education level and political ideology all play into racial disparities in vaccination rates that have made African Americans more vulnerable to COVID-19, finds new research from the Center for Health Information and Decision Systems at the University of Maryland’s Robert H. Smith School of business.

In “Socioeconomic Privilege and Political Ideology are Associated With Racial Disparity in COVID-19 Vaccination,” newly published in the Proceedings of the National Academy of Sciences, the authors write that “structural inequalities pose a serious threat to progress” in the pursuit of national vaccination.

The paper breaks down 15 social determinants of health — from car ownership and home internet access to accessibility to health care facilities — to reveal how they correlate with racial disparities in COVID-19 vaccination among white and black populations.

Combining data from state, federal and other sources, the researchers analyzed vaccination data from April 19 — when the injections were made available to all U.S. adults and by which time nearly half had already reported receiving at least one dose — in 756. US counties where relevant racial data is held, or half of the US adult population.

The researchers, Maryland Smith professors Ritu Agarwal, Guodong (Gordon) Gao and Jui Ramaprasad, Smith senior researcher Michelle Dugas, along with Maryland Smith doctoral students Gujie Li and Junjie Luo, also compared the same factors with differences in flu vaccination, and found that socioeconomic and political factors play a greater role than flu in the context of COVID-19.

Meanwhile, an important non-finding, Agarwal said, is some evidence that vaccine hesitancy is a major contributor to racial disparities in vaccination rates.

“You see in the popular media a dominant narrative of medical mistrust, and discussion of outreach strategy and community engagement, perhaps using churches to reach out to black people,” she said. “Our results provide some insight into how resources might be allocated, because it’s not just hesitation that lowers rates — it might be the ability to take a day off to get vaccinated, or the ability to access information to learn more about vaccines.”

Socioeconomics was a major driver of inequality, and counties with higher overall median incomes showed lower differences in vaccination coverage between black and white residents. A county in the 75th percentile (with a median household income of about $64,000) compared to a county in the 50th percentile (with a household income of about $54,000) showed 1.3 percentage points less racial disparity in vaccination – significant differences, given an overall vaccine percentage difference between the provinces of 16%. It’s a finding, the researchers wrote, that could suggest the counterintuitive step of protecting everyone more effectively by making additional vaccines available in wealthier areas, where they’re more likely to be used, during times of scarcity.

District-level differences in high school success rates were another leading cause of unequal COVID-19 vaccination rates between races, the researchers found. Those in the 75th percentile of educational inequality have a 10.7 percentage point difference in high school graduation between white and black residents, along with a coronavirus vaccination difference of 2.7 percentage points higher than a county with equal graduation rates.

Politics is also key, but in a way that may be surprising. The stronger the Republican turnout in a county, the researchers found, the greater the parity that existed between black and white COVID vaccination rates. Each 2.5 percentage point increase in Republican vote share correlated with a 1 percentage point decrease in vaccine inequality across racial lines, with their analysis showing that the apparent reduced inequality is due to lower white vaccination rates, rather than higher black vaccination rates.

What’s clear from the results, the researchers said, is that socioeconomic and political environments create public health barriers for vulnerable populations and society at large — which the United States must find a way to overcome.

“If these structural barriers are not addressed, there is a double risk of additional loss of life and a significant delay towards ending the COVID-19 pandemic or fighting similar future outbreaks,” they wrote.

Reference: “Socioeconomic privilege and political ideology are associated with racial inequality in COVID-19 vaccination” by Ritu Agarwal, Michelle Dugas, Jui Ramaprasad, Junjie Luo, Gujie Li and Guodong (Gordon) Gao, July 29, 2021, Proceedings of the National Academy of Sciences.
DOI: 10.1073/pnas.2107873118