Virginia has not recorded the race or ethnicity of more than half of the people who have received the coronavirus vaccine, undercutting a critical pillar in marshaling resources to hard-hit populations.
There’s little evidence to show that will change, even as the state pledges an equitable distribution of a limited supply that researchers say is nearly impossible to execute without accounting for these demographics.
The already questionable success of asking its most skeptical and underserved communities for trust lies in incomplete state figures that show that when race has been recorded, 71% of those vaccinated have been white. Whites account for less than half of COVID-19 hospitalizations, but make up 59% of health care workers prioritized in the first phase of distribution.
Black and Latino workers make up nearly a third of the state’s health care workforce, but available statewide vaccine reporting shows less than 10% of those receiving shots are Black and barely 7% are Latino — a group for which as of Saturday, the state had no outreach plan available. In localities like Richmond and Hampton, Black residents are three to four times more likely to be hospitalized than white patients.
Experts in public health and medical ethics warn that while state health officials focus on other vaccination setbacks, among them another data gap, the outcome of overlooking the nearly 230,000 unreported vaccinations by race and ethnicity could prove Virginia’s most preventable and deadliest pandemic failure yet.
“We always say, ‘That’s not who we are.’ What happens is, that is who you are,” said Dr. Robert Winn, director of the VCU Massey Cancer Center. “We’re uncomfortable with race; therefore, we don’t get race collection of data. We’re uncomfortable with class; therefore, we don’t get class data. ... And we just pretend like that data would be great, but it doesn’t matter.”
Winn added that recording race and ethnicity is the bare minimum, and more extensive understanding of communities requires information like income, access to food and housing, and the neighborhoods in which patients live.
Otherwise, Winn said, “We will never really actually know how we were making impacts.”
Despite the gap, Virginia Department of Health spokesperson Erin Beard said the agency will not require vaccinators to report “some” demographics like race and ethnicity because it could prevent a provider from reporting a shot given, and that the more information needed to document a vaccine in the state’s tracking system, the more likely the vaccine cannot be reported.
Beard did not provide examples of that happening, but challenges in collecting this data partially exist because health care systems have not prioritized it. The VDH website notes that while not mandated, providers are asked to enter this data.
Beard’s advice conflicts with guidance from the Centers for Disease Control and Prevention, which lists reporting race and ethnicity as a requirement, but does not apply any downward pressure on states for not doing so.
“VDH’s goal is to vaccinate as many people as possible, and we do not want to turn away any person because they did not provide supplementary data,” Beard said.
The Virginia Hospital and Healthcare Association, whose 110 hospitals have doled out more than 230,000 vaccines, did not answer whether doctors at hospitals are asking patients about race or ethnicity and referred questions to the VDH instead.
Only 17 states in the U.S. are currently reporting vaccinations by race and ethnicity. Of those, Virginia is the second-worst at tracking this data. It trails only New York, which has 2.2 times the population and has administered half a million more doses.
North Carolina, which has administered nearly 150,000 more doses than Virginia, has reported all of its vaccinations by race and ethnicity as of Friday.
When the VDH released a wider range of race and ethnicity data on June 16, a media release said, “It is important for the public to understand these health disparities so they can respond appropriately” and that statisticians with the Office of Health Equity would be using this data to “inform tracking and reporting guidelines” to be better prepared for similar crises in the future.
The VDH could not provide those findings and how it adapted those recommendations to reporting race and ethnicity seven months later.
Nakeina Douglas-Glenn, a VCU Wilder School professor who has specialized in race and social equity for more than 15 years, said the lack of data collection shows why the mistrust in health care systems and government agencies is so ingrained: Communities know they view race and ethnicity as an afterthought. So the conversation on trust is misguided, Douglas-Glenn said.
“Because it puts the conversation back on the community to say ‘Once we sort of collectively decide that we trust the government, then we’re going to be able to open our doors to vaccines,’ ” Douglas-Glenn continued. “But what we’re all collectively seeing is that the vaccine is not on the other side of the door if we were to open it.”
Almost half of Black adults nationwide said they were not confident that vaccine distribution was taking the needs of Black people into account, according to a December poll from the Kaiser Family Foundation. More than a third of Hispanic adults said the same of Hispanics.
Further undermining the progress of combating hesitancy surrounding the vaccine, which is highest among Black and Latino communities, is how the VDH chose who to prioritize within each group, Douglas-Glenn said.
Driving the priority lists is risk of exposure and the essential workers who Gov. Ralph Northam has said in recent media briefings “keep our society functioning.” Douglas-Glenn said the sentiment sounds more like an economic discussion than a prioritization of who’s most vulnerable.
“We’re sort of targeting professions that can help us to do that,” Douglas-Glenn said. “But where do we place value? What does that mean for those who don’t necessarily move into these sort of dominant professions?”
In phase two, first in line are police officers, firefighters and hazmat workers, and the Census Bureau estimates these professions are more than 65% white. Cleaning staff, however, are not specifically outlined outside of those who work in hospitals. Further clarification is offered in federal guidance, but there’s no guarantee that cleaning staff are receiving vaccines at the same rate. At least 43% of this industry is Latino or an immigrant.
Farmworkers, who do not have paid sick leave, are mostly Latino and have wrestled with some of the largest COVID-19 outbreaks in the U.S. They are listed as fourth in line in the second phase. About 40% of public transit workers are Black or Latino and over the age of 50. They’re ranked seventh.
Meanwhile, the limited vaccine supply has meant some teachers, who are third in line and headed into in-person learning, have not received their first dose. The process could take months.
Dr. Danny Avula, the state’s vaccine distribution coordinator, said that while there are outlined priorities for phase two, the order is not super restrictive. He added that correctional facilities and homeless shelters, second in line for vaccines in phase two, skew toward nonwhite populations in low-income areas.
“The logic and ethical framework that was used to build the tiering absolutely considered that,” Avula said. “But what it doesn’t fix is that there’s still going to be a lot of inherent resistance. ... It’s not just a question of offering the vaccine, it’s simultaneously having to do all of that other education work and marketing and finding ambassadors who are going to get vaccinated.”
Vaccination demographics on the local level are not available to gauge if that work has been successful — “we should make that happen,” said Avula — and neither is a breakdown of who is receiving doses within each phase. Anecdotally, state officials say the vaccine uptake is highest among physicians, who average a yearly income of more than $200,000 in Virginia, according to the Bureau of Labor Statistics, and are predominantly white.
Among the most at-risk are nurses, according to an October report from the CDC. But while that industry is nearly 80% white in the U.S., more than 60% of nurses hospitalized with the virus were Black or Latino.
For lower-wage positions such as home health workers — who make less than $9 per hour, do not have paid sick leave or overtime pay, and are mostly Black women — the vaccination rates fall to 20% to 30%.
“It may be unintentional, but the result in some areas — especially Hampton Roads — are that cities with more resources and more affluent neighborhoods are a little bit further along and more organized and leaving behind communities,” said Del. Cia Price, D-Newport News, in a Tuesday health committee meeting.
Virginia Health Secretary Dan Carey told Price he expects a “dramatic improvement” over the next two weeks and assured that Virginia is “walking the walk” in getting vaccines to historically discriminated-against groups.
The VDH has touted efforts to place equity at the forefront — more so than nearly all other states with as high of Black populations.
But the last town halls were in the middle of December and are no longer posted on the VDH’s vaccine landing page as of Friday, along with any mention of race or mistrust. The majority of ongoing efforts that include Winn’s Friday conversations with Black faith leaders and prominent health officials do not explicitly include Latino and immigrant populations.
Both navigate language barriers highlighted recently when a translation error on VDH’s website told Spanish readers for nearly a month that the vaccine wasn’t necessary. The error — in English the site said the vaccine wasn’t mandatory — was a result of the health agency’s reliance on Google Translate, which experts criticized and federal guidance advises not to use for vital information.
In a Saturday media release, available in Spanish, the VDH announced an update to its ASK-VDH-3 hotline that widens accessibility for non-English speakers seeking COVID-19 and other public health resources.
The Richmond and Henrico County health districts will be starting Spanish town halls in the coming weeks and have translated vaccine interest forms and websites.
VCU Medical Center, the largest hospital in the region, has translated its “What to Know about the COVID vaccine” videos, vaccine articles and media releases to Spanish, the second-most spoken language in Virginia.
Earlier last week, Avula could not articulate specific statewide measures geared toward Spanish-speaking communities in the future, other than a Latino-owned consulting company that has a staff member who is helping with outreach work and a reliance on Spanish radio, community health clinics and advocacy organizations that have long worked to close the holes the government couldn’t.
In a Virginia Latino Advisory Board meeting on Friday, board Chair Paul Berry said the state’s COVID-19 outreach plan for Latino communities would not roll out for a few more weeks. In two months, it will be a year since Virginia had its first coronavirus case.
This article has been updated reflect The Virginia Hospital and Healthcare Association's response to questions about whether doctors are asking patients about race or ethnicity data.