Racial Inequities in the Vaccine Rollout

Communities of color have been failed by limited access and poor communication

Photo: Allen J. Schaben/Getty Images

Another day, another headline about Covid-19 racial health disparities. This time, it’s the all too predictable inequities in the rollout of the vaccines.

In virtually every state with reported vaccination rates broken down by race, Black Americans have received significantly fewer doses than White Americans. According to Kaiser Health News, Pennsylvania is the worst off, with a fourfold difference in vaccination rates between the two races (0.6% of Black residents versus 2.6% of White residents). Most other states hover around a two- to threefold difference in vaccination rates by race. Mississippi has the largest gap between the percentage of the state’s Black population (38%) and the percentage of vaccinated residents who are Black (15%).

There are several explanations for these disparities, none of them excusable. Health care workers were the first group to receive the vaccine, and while there are a higher number of White health care workers at the top of the ladder (because Black Americans have historically been held back from reaching the highest rungs), the overall racial breakdown of health care workers maps almost exactly to that of the U.S. population: 60% White and 40% people of color.

According to the Kaiser Family Foundation:

In 2019, there were over 18.6 million people working in the health care industry across a range of occupations and settings. Overall, 60% of health care workers were White and 40% were people of color, including 16% who were Black, 13% who were Hispanic, and 7% who were Asian. However, the racial/ethnic composition of health care workers varied across occupations and settings. Black and Hispanic health care workers made up relatively larger shares of aides and personal care workers and direct contact support workers. Black and Hispanic workers also accounted for larger shares of health care workers in home health care, and Black workers made up a relatively larger share of workers in skilled nursing facility or other residential care settings.

In many states, hospitals received the lion’s share of vaccine doses while home health workers were left with little guidance on how, when, and where they could receive their shots. As outlined above, that has disproportionately affected Black and Latinx professionals. There are also whisper networks at hospitals and university medical centers that help board members and co-workers who wouldn’t otherwise be eligible jump the queue. Even when there’s a valid reason to vaccinate people outside of the current phase, like when a freezer breaks, there’s a question of access: Who gets the text message from the lab technician? Who sees the notice on Twitter? Who’s able to immediately take time out of their day and potentially off work to rush to a pharmacy to get a shot?

In many cities, the majority of vaccination sites have been in predominantly White zip codes.

As the vaccine rollout expanded to include adults aged 65 and up, access has become an even bigger issue. In many cities, the majority of vaccination sites have been in predominantly White zip codes. When cities try to rectify this inequity and prioritize vaccinations in more diverse neighborhoods — which also have higher Covid-19 case and death rates — some states, like Texas, have blocked these efforts. Even when vaccination centers are deliberately set up in Black and Latinx neighborhoods, White people from outside the community come in and snatch up all the appointments, as happened in New York City. Unsurprisingly, Gothamist reported on Sunday that in New York, “three white residents receive a COVID-19 vaccine for every Black or Latino person in the city.”

Among many seniors of color, confusing state health department websites, lack of access to technology or high-speed internet, and limited English language skills can serve as barriers to reserving vaccine appointments. One suggestion to get around these issues is to reserve a certain number of spots at each vaccination center for walk-in appointments for local residents.

New reporting from the Washington Post also found that bumping seniors up to the front of the line to get the vaccine ended up pushing back essential workers in the food, farming, and transportation industries, who are disproportionately people of color. Even if those essential workers are currently eligible to receive the vaccine, many don’t know how to get an appointment. For example, The 19th reports that “Black women and Latinas are less likely to be insured or have regular access to a physician who could guide them through the vaccination process.”

There are also higher rates of vaccine hesitancy among Black and Latinx adults. Public health campaigns have been initiated by Black doctors and medical associations, celebrities, churches, and community leaders to try to address people’s concerns. However, a Kaiser Family Foundation survey found that one of the most important factors influencing whether people are willing to get the vaccine is if they know someone personally who’s received it. If no one in your community has been vaccinated because no one has access, it’s difficult to break down that wall.

The good news is vaccine hesitancy rates are dropping across the board as more people get the shots, which have been shown to be overwhelmingly safe and effective in large-scale clinical trials. President Biden has also committed to expanding access to vaccines and improving racial health equity, including the establishment of the Covid-19 Health Equity Task Force, headed by Marcella Nunez-Smith, MD. Plans include establishing more vaccination centers in Black and Latinx neighborhoods and improving communication to those communities. The question remains when those initiatives will start to make a dent in the numbers.

Health and science writer • PhD in 🧠 • Words in Scientific American, STAT, The Atlantic, The Guardian • Award-winning Covid-19 coverage for Elemental

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