This monthly report is from the Office of Health Equity in the Virginia Department of Health under the supervision of the Governor’s Chief Diversity, Equity, and Inclusion Officer and the Equity Leadership Task Force. It provides an overview of vaccination equity in the Commonwealth of Virginia, including key equity accomplishments for the month of March 2021.

In addition to reporting equity distribution of the COVID-19 vaccine, this report also compares Virginia to other states in Region 3 of the Federal Emergency Management Agency (FEMA), namely Delaware, the District of Columbia, Maryland, Pennsylvania, and West Virginia. It presents an overview of recent legislative and executive activities at both the federal and state levels. In addition, it explores vaccine hesitancy, changes over time, and considers equity considerations for future vaccine distribution.

Summary key equity findings include:

Targeted Community Efforts

• Virginia has opened five Community Vaccination Centers (CVCs) in locations across the Commonwealth intended to reach vulnerable populations. The five initial CVC sites (Danville, Petersburg, Prince William County, Portsmouth, and Hampton Roads/Norfolk) were selected after the Virginia Department of Emergency Management (VDEM) conducted an equity analysis to determine the communities with the largest number of vulnerable populations and communities with the largest percentage of vulnerable population and greatest COVID-19 impact (Source). However, early evidence suggests that community vaccination sites located in and targeted at vulnerable communities are being inundated with out-of-town residents who are not from the targeted communities (Source).

• Virginia has enhanced equitable vaccine distributions by adopting ratios for risk of infection and rate of vaccination. Nationally, and in the Commonwealth of Virginia, although African-Americans and Latinos were disproportionately impacted by COVID-19 cases, hospitalizations, and deaths, whites have been vaccinated at higher rates. Virginia is using evidence-based criteria to prioritize equitable vaccine allocation in health districts that align with risk of infection (Source; Source).

Vaccinations have Increased but Racial Disparities Persist

• About 1 in 4 Virginians (25.5%) have received at least one dose of the COVID-19 vaccine (Source). Between February and March, vaccination rates in Virginia increased from 14.8% to 29.5% – a 99% increase over the past month. This mirrors the national one dose vaccination rate of 29.4% (Source). Over 3.7 million vaccine doses have been administered in Virginia. Over 1.34 million Virginians have been fully vaccinated (15.7% of the population). Virginia is administering approximately 65,000 vaccinations per day on average (Source; Source). Vaccine availability is increasing. In addition to the new one-shot Johnson and Johnson COVID-19 vaccine, overall vaccine production and distribution of COVID-19 vaccines have increased (Source). Within FEMA Region 3, Virginia currently ranks first out of six in the percentage of distributed vaccines that have been administered. Delaware, the District of Columbia, Maryland, Pennsylvania, and West Virginia lower than Virginia (Source).

• Blacks and Hispanics have been disproportionately infected with COVID; however whites have been disproportionately vaccinated (Source). For example, Hispanics have received 7% of all vaccinations, but constitute 17% of COVID-19 cases. Comparatively, whites have received 68% of all vaccinations, but constitute 52% of the COVID-19 cases.

• Rural counties have lower vaccination rates: Those living in rural counties experience a higher risk due to COVID-19 (Source), yet rural counties have lower vaccination rates per 100,000 population (Source). Some of the challenges facing rural areas include vaccine hesitancy, limited vaccine supply based on population per capita, limited broadband access for a high technology-driven enrollment process, and limited regional health care centers and vaccinators.

Vaccine Hesitancy Declining

• Vaccine hesitancy in the Commonwealth is declining. In Virginia, 69% of whites and 73% of minorities said that they would be willing to get a vaccine in January 2021 (Source). Nationally, the most vaccine hesitant of all groups is rural conservatives (Source). The greatest increase in vaccine enthusiasm has occurred among racial minorities (Source; Source). Importantly, relationships matter in regard to vaccination willingness. Living with or knowing someone who has been vaccinated decreases vaccine hesitancy (Source).

Core Recommendation

• To address inequities in vaccinations in Virginia, vaccine allocations, vaccination strategies, and vaccine communications should be targeted at vulnerable populations. This includes continuing to prioritize equity in all decision-making regarding communications, vaccination allocations, pre-registration, mass vaccination plans, diversifying community vaccination plans, and, most importantly, monitoring and accountability of vaccination equity outcomes.