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 April 2021.

This report also compares Virginia’s equitable vaccination progress with other states in Region 3 of the Federal Emergency Management Agency (FEMA), namely Delaware, the District of Columbia, Maryland, Pennsylvania, and West Virginia. An overview of recent legislative and executive activities at both the federal and state levels is included. In addition, the report explores vaccine hesitancy, changes over time, and equity considerations for future vaccine distribution. Key findings include:

Targeted Community Efforts

• Virginia continues to operate Community Vaccination Centers (CVC) in locations across the Commonwealth to reach vulnerable populations and has opened a new location. The original CVC sites (Danville, Petersburg, Prince William County, Portsmouth, and Hampton Roads/Norfolk) continue to be operational. Further, VDH and VDEM in partnership with the National Guard opened a CVC at the Virginia National Guard (VNG) Armory in Blackstone. A continuing issue is that such sites are being inundated with out-of-town residents who are not from the targeted communities.

• Virginia has enhanced equitable vaccine distributions by continuing to use ratios for risk of infection and rate of vaccination. Nationally and in Virginia, although Blacks and Latinos continue to have higher COVID-19 cases, hospitalizations, and deaths, whites continue to be vaccinated at higher rates. Virginia is using evidence-based criteria which align with risk of infection to prioritize equitable vaccine allocation in health districts.

• VDH and VDEM are continuing to engage in promising practices to reduce inequities. These promising practices include: Making the registration process as simple and accessible as possible; collaborating with trusted community leaders; creating targeted outreach efforts to at-risk communities; providing information in multiple languages; and removing requirements to show ID or other forms of documentation at registration or check-in during vaccination events.

Vaccinations have Increased but Racial Disparities Persist

• More Virginians are getting vaccinated. Approximately 45% of all Virginians have received at least one dose and 1 in 3 (32%) are fully vaccinated. Now in Phase 2 (as of April 18), all Virginians age 16 and older can schedule vaccine appointments. Nearly 80 percent of teachers, school staff, and childcare workers have received at least one shot of the COVID-19 vaccine. Between March and April 2021, vaccination rates in Virginia increased from 25.9% to 45%, slightly above the national one-dose vaccination rate of 44.33%.

• Blacks and Hispanics continue to be disproportionately infected with COVID-19; however, whites continue to be disproportionately vaccinated. For example, Blacks have received 14% of vaccinations but constitute 21% of the COVID-19 cases. Hispanics have received 11% of vaccinations but constitute 20% of COVID-19 cases. Comparatively, whites have received 63% of vaccinations but constitute 50% of the COVID-19 cases. Over 1.4 million of the doses administered in Virginia have no race or ethnicity data reported.

• While rural counties’ overall risk levels have declined, risks remain elevated, and these areas continue to have lower vaccination rates. Between March and April 2021, the elevated risk for rural areas has increased and rural vaccinations have decreased. While Virginia has continued to show improvements in the urban-rural divide in terms of COVID-19 vaccinations, overwhelmingly, some rural areas continue to experience equity issues in terms of access to vaccines.

Vaccine Hesitancy

• In Virginia, vaccine hesitancy among Black and Brown communities is decreasing at a more rapid rate than white communities. White Republicans have one of the highest rates of vaccine hesitancy when compared to members of other political parties. Other groups, such as long-term care facility staff, also observe high rates of vaccine hesitancy. Emerging data has revealed that Black and Brown communities experience difficulties accessing the COVID-19 vaccine. As such, access difficulties are contributing factors to lower vaccination rates for people of color.

Vaccine Access

• There are a number of factors that can contribute to lack of vaccination access across the Commonwealth. These include: language barriers, transportation needs, people with disabilities, and individuals experiencing homelessness. The CDC has said health equity means every person has an opportunity to achieve optimal health regardless of their skin color, education level, gender identity, sexual orientation, occupation, their neighborhood, and disability status.