Quantifying Racial and Ethnic Disparities in U.S. COVID-19 Vaccine Acceptance and Uptake

Abstract

BackgroundRacial and ethnic minority groups in the United States face a greater risk of COVID-19 infection and mortality relative to non-Hispanic White individuals. Despite this elevated risk, early evidence from the first months of COVID-19 vaccine distribution suggests that racial and ethnic minority groups were underrepresented in the vaccinated population. However, previous analyses by race-ethnicity have not considered variation in patterns of inequality by geography, have focused only on the largest race-ethnicity groups, and have not distinguished between vaccine access and vaccine acceptance as drivers of vaccination rates. Comprehensive, current estimates of vaccine uptake and vaccine acceptance by race-ethnicity and geography are needed to inform interventions that increase vaccination rates equitably across all communities. MethodsUsing data from a large online survey of United States adults collected in May 2021 (n = 731,640), we produced estimates of vaccine uptake and vaccine acceptance by state for six race-ethnicity categories. We projected vaccine acceptance under counterfactual scenarios in which an intervention eliminates hesitancy due to common concerns for each state-race-ethnicity group. FindingsRelative to non-Hispanic White populations, vaccine uptake was lower among non-Hispanic Black or African American, Hispanic or Latino, and non-Hispanic Native American or Alaska Native populations in the majority of states. In contrast, rates of vaccine acceptance were higher for non-Hispanic Black or African American and Hispanic or Latino populations relative to non-Hispanic White populations in a majority of states. Of the 50 state-race-ethnicity groups with the largest gap between acceptance and uptake, 30 were Hispanic or Latino populations, while 17 were non-Hispanic Black or African American populations. Removing hesitancy attributable to concern regarding side effects would result in the highest level of vaccine acceptance across nearly all state-race-ethnicity groups. InterpretationSix months since the initial Emergency Use Authorization of the COVID-19 vaccine, Non-Hispanic Black or African American, Hispanic or Latino, and non-Hispanic Native American or Alaska Native populations continue to receive the COVID-19 vaccine at a lower rate than non-Hispanic White individuals. The large gap between uptake and acceptance rates among Non-Hispanic Black or African American and Hispanic or Latino groups suggests that interventions that address barriers to vaccine access—rather than those that target vaccine hesitancy—may currently be most important in ensuring equitable rates of vaccination by race-ethnicity.