COVID-19 Vaccine Rollouts and the Reproduction of Urban Spatial Inequality: Disparities Within Large US Cities in March and April 2021 by Racial/Ethnic and Socioeconomic Composition

Abstract

Rollouts of COVID-19 vaccines in the USA were opportunities to redress disparities that surfaced during the pandemic. Initial eligibility criteria, however, neglected geographic, racial/ethnic, and socioeconomic considerations. Marginalized populations may have faced barriers to then-scarce vaccines, reinforcing disparities. Inequalities may have subsided as eligibility expanded. Using spatial modeling, we investigate how strongly local vaccination levels were associated with socioeconomic and racial/ethnic composition as authorities first extended vaccine eligibility to all adults. We harmonize administrative, demographic, and geospatial data across postal codes in eight large US cities over 3 weeks in Spring 2021. We find that, although vaccines were free regardless of health insurance coverage, local vaccination levels in March and April were negatively associated with poverty, enrollment in means-tested public health insurance (e.g., Medicaid), and the uninsured population. By April, vaccination levels in Black and Hispanic communities were only beginning to reach those of Asian and White communities in March. Increases in vaccination were smaller in socioeconomically disadvantaged Black and Hispanic communities than in more affluent, Asian, and White communities. Our findings suggest vaccine rollouts contributed to cumulative disadvantage. Populations that were left most vulnerable to COVID-19 benefited least from early expansions in vaccine availability in large US cities.

Racial concentration and dynamics of COVID-19 vaccination in the United States

“…While existing studies have shown that concentration of racial minorities is associated with lower levels of vaccine uptake especially during early rollout when the supply of COVID-19 vaccines was limited ( McFadden et al, 2021 ; Nguyen et al, 2022 ; DiRago 2022 ), this study helps advance current knowledge in several major ways. First, I have shown that concentrations of racial minorities are not always associated with lower COVID-19 vaccine uptake.…”

“…These disadvantaged communities are less resilient in their ability to respond to and recover from the waves of the pandemic because they are in short supply of vital resources to contend with the spread of the virus such as sanitizers, masks, as well as testing facilities and health care resources ( Godoy & Wood, 2020 ; Gaynor & Wilson, 2020 ). These communities also show lower COVID-19 vaccination rates ( DiRago, Li, et al, 2022 ; Hughes et al, 2021 ; Khubchandani & Macias, 2021 ; McFadden et al, 2021 ), and this exacerbates the unequal impacts of the pandemic. In Maryland, for example, Cardona et al (2021) show that counties with higher concentrations of Blacks and Latinos have higher infection, morbidity and mortality from COVID-19, but lower vaccination rates as compared to counties with predominantly Whites.…”

“…First, vaccination rates have been much lower among Blacks and Hispanics as compared to Asians and Whites ( Ndugga et al, 2021 ). This is especially concerning given that racial minorities, Blacks and Hispanics in particular, are at a higher risk of infections and becoming sicker and dying more often from COVID-19 ( Berkowitz et al, 2021 ; Millett et al, 2020 ; McFadden et al, 2021 ; Nguyen et al, 2022 ; DiRago 2022 ). Second, communities that are disproportionately populated by racial minorities, again Blacks and Hispanics in particular, report significantly lower vaccination rates ( Anderson & Ray-Warren, 2022 ; Brown et al, 2021 ; Hughes et al, 2021 ).…”

“…Hence, access to COVID-19 vaccines and therefore racial disparities in vaccination rates could be more related to socioeconomic advantages or disadvantages during early rollout due to the limited supply of COVID-19 vaccines than later as the availability of vaccines increases. In fact, existing research shows that vaccination rates during March and April 2021 were negatively associated with poverty and the uninsured population even though vaccines have been free to everyone regardless of health insurance coverage ( DiRago, Li, et al, 2022 ). For example, both vaccination rates and the increases in vaccination were found to be lower among socioeconomically disadvantaged Black and Hispanic communities than in more affluent, Asian, and White communities ( Anderson & Ray-Warren, 2022 ; DiRago, Li, et al, 2022 ).…”

“…In fact, existing research shows that vaccination rates during March and April 2021 were negatively associated with poverty and the uninsured population even though vaccines have been free to everyone regardless of health insurance coverage ( DiRago, Li, et al, 2022 ). For example, both vaccination rates and the increases in vaccination were found to be lower among socioeconomically disadvantaged Black and Hispanic communities than in more affluent, Asian, and White communities ( Anderson & Ray-Warren, 2022 ; DiRago, Li, et al, 2022 ). The increased variability of vaccines over time, however, could change the dynamics.…”