Blog & News
COVID-19 Vaccination Rates: State-level and Subpopulation Evidence from the Household Pulse Survey - Update 3
March 12, 2021:Update 3: Feb 17 to Mar 1
Newly available COVID-19 vaccines promise to help protect individual Americans against infection and eventually provide population-level herd immunity. The pace of COVID-19 vaccination rollout in the United States has been somewhat unsteady, with a sizeable share of ups and downs from week to week—reports of slow early going were followed by states’ responsive attempts to pick up the pace in following period, only to be hampered by storms across the southern region interfering with supply. However, signs of vaccination progress have resumed, with the recent approval and release of the one-dose Johnson & Johnson vaccine, manufacturers ramping up vaccine production, and achieving the benchmark of 100 million COVID vaccination shots administered to Americans far earlier than anticipated.
The initial groups prioritized for vaccination were health care workers on the front lines of the pandemic and nursing facility residents, many of whom are especially vulnerable to COVID-19 infection and severe outcomes. While these groups continue to hold priority in vaccination slots, many states have since expanded vaccine access to other (still high-priority) segments of the general population such as older adults, K-12 and child care workers, essential workers, and those with high-risk medical conditions, with further vaccine eligibility expansion guidelines potentially coming soon. However, there are concerns that these prioritization decisions and the existing mechanisms of the vaccine rollout—in addition to evidence that lower-income individuals, people of color, and individuals without strong connections to the health care system are less likely to get vaccinated—are inadequate to narrow the clear disparities in the vaccine rollout so far and could worsen existing pandemic-related health inequities.
The available data have not assuaged these concerns, and show patterns of lower vaccination rates among people with lower incomes and levels of education, and marginalized racial and ethnic groups. The U.S. Census Bureau recently released updated data on take-up of COVID-19 vaccines from the most recent wave of its Household Pulse Survey (HPS), collected February 17-March 1, 2021.1 The HPS is an ongoing, weekly tracking survey designed to measure impacts of the COVID-19 pandemic. These data provide an updated snapshot of COVID-19 vaccination rates and are the only data source to do so at the state level by subpopulation.
This blog post presents top-level findings from these new data, focusing on rates of vaccination (one or more doses) among U.S. adults (age 18 and older) living in households and comparing to results from the most recent wave of the HPS, collected February 3-15, 2021.2 As of publication, no HPS data collection past March 1 has been announced, so this may be the final post in this series. SHADAC will continue to monitor any further data collection announcements related to the HPS and will update our readers accordingly.
More than one in four adults received a vaccination, but this varied by state
According to the new HPS data, 25.5% of U.S. adults had received one or more COVID-19 vaccinations during this two-week period in the second half of February, though this varied by state from a low of 21.8% in Tennessee to a high of 39.7% in Alaska. More than three in ten adults had received a vaccine in five states: Alaska, Connecticut, Hawaii, New Mexico, and North Dakota.
Vaccination rates increased substantially across nearly all states; states with lower rates catching up
Nationally, adult vaccination rates were up from the previous wave of the HPS, increasing from 19.9% during February 3-15, 2021, to 25.5% during February 17-March 1, 2021. Most states also experienced increases in their vaccination rates, though again the size of these increases varied across the states, from an increase of 1.8 percentage points (PP) in Georgia to an increase of 10.6 PP in North Dakota.
Percent of Adults Who Had Received a COVID-19 Vaccine
Disparities in vaccination rates have not improved
COVID vaccination rates continued to vary to a great degree by demographic and socioeconomic factors, and disparities were largely unchanged from previous weeks. There has been little progress in getting more vaccines to certain groups such as low-income, Hispanic, and Black adults, for instance, and new vaccination strategies and greater emphasis on equity may be needed to close the gaps for the hardest-to-reach groups.
By race and ethnicity, non-Hispanic Asian and non-Hispanic White adults continued to have above-average vaccination rates at 29.2% and 28.0%, respectively. Rates among non-Hispanic adults identifying with “Multiple” races or “Some other” race (21.2%), non-Hispanic Black adults (20.2%), and Hispanic/Latino adults of any race (18.9%) remained below the national average.
Percent of Adults Who Had Received a COVID-19 Vaccine by Race/Ethnicity
Disparities in vaccination rates by income, which had narrowed somewhat in previous weeks, were relatively unchanged from earlier in February. Adults with household incomes below $50,000 continued to have vaccination rates below the national average, whereas adults with household incomes above $50,000 had vaccination rates higher than the national average. These gaps failed to appreciably improve. The gap between the lowest income adults (household incomes of less than $25,000) and the national average was especially large, with low-income adults being 9.6 PP less likely to have received a vaccine than all adults (15.9% vs. 25.5%).
Percent of Adults Who Had Received a COVID-19 Vaccine by Income
Disparities by level of education remained, with adults holding a bachelor’s degree or higher continuing to have the highest vaccination rate at 34.7%, and adults without a high school diploma having the lowest vaccination rates at 17.2%. However, disparities by education did narrow slightly, and vaccination rates among both adults with a high school diploma or equivalent and adults with less than a high school education increased somewhat faster than the overall adult rate.
Percent of Adults Who Had Received a COVID-19 Vaccine by Education
More than half of older adults received a COVID vaccine as the U.S., and many states, continued to make large progress in vaccinating older adults
Nationally, 54.6% of older adults (age 65 and older) had received at least one dose of the COVID-19 vaccine, which was 29.1 percentage points higher than the rate among all adults (25.5%). Vaccination rates for older adults ranged from 27.0% in Oregon to 73.3% in Louisiana. Older adult vaccination rates were below 40% in six states (Hawaii, New Jersey, Oregon, Pennsylvania, Vermont, and Virginia) and at or above 70% in four states (Alaska, California, Indiana, and Louisiana) as well as in the District of Columbia (D.C.)
Percent of Adults Age 65+ Who Had Received a COVID-19 Vaccine
As in the previous period, states continued to make good progress in rates of vaccination among older adults. Compared to the first half of February, 23 states increased their age 65+ vaccination rates by at least 0.5x, and two states (Rhode Island and Connecticut) more than doubled their 65+ vaccination rates. Only a handful of states failed to make substantial progress in increasing vaccination rates among older adults.
Notes about the Household Pulse Survey Data
The estimated rates presented in this post were calculated from the count estimates published by the Census Bureau. Though these counts are accompanied by standard errors, standard errors are not able to be accurately calculated for rate estimates. Therefore, we are not able to determine if the differences we found in our analysis are statistically significant or if the estimates themselves are statistically reliable. Estimates and differences for subpopulations at the state level should be assumed to have large confidence intervals around them and caution should be taken when drawing strong conclusions from this analysis. However, the fact that patterns of inequities in other vaccination rates are mirrored by these early indications of COVID-19 vaccination inequities demonstrates reason for concern.
Though produced by the U.S. Census Bureau, the HPS is considered an “experimental” survey and does not necessarily meet the Census’s high standards for data quality and statistical reliability. For example, the survey has relatively low response rates (7.3% for February 17 - March 1), and sampled individuals are contacted via email and text message, asking them to complete an internet-based survey. These issues in particular could be potential sources of bias, but come with the tradeoffs of increased speed and flexibility in data collection as well as lower costs. A future post will investigate differences between COVID vaccination rates estimated from survey data (such as the HPS) and administrative sources. The estimates presented this post are based on responses from 77,788 adults. More information about the data and methods for the Household Pulse Survey can be found in a previous SHADAC blog post.
Previous Blogs in the Series
COVID-19 Vaccination Rates: State-level and Subpopulation Evidence from the Household Pulse Survey (Update 2: Feb 3 to Feb 15)
COVID-19 Vaccination Rates: State-level and Subpopulation Evidence from the Household Pulse Survey (Update: Jan 20 to Feb 1)
COVID-19 Vaccination Rates: State-level and Subpopulation Evidence from the Household Pulse Survey (Jan 6 to Jan 18)
Related Reading
State-level Flu Vaccination Rates among Key Population Subgroups (50-state profiles) (SHADAC Infographics)
50-State Infographics: A State-level Look at Flu Vaccination Rates among Key Population Subgroups (SHADAC Blog)
Anticipating COVID-19 Vaccination Challenges through Flu Vaccination Patterns (SHADAC Brief)
New Brief Examines Flu Vaccine Patterns as a Proxy for COVID – Anticipating and Addressing Coronavirus Vaccination Campaign Challenges at the National and State Level (SHADAC Blog)
Ensuring Equity: State Strategies for Monitoring COVID-19 Vaccination Rates by Race and Other Priority Populations (Expert Perspective for State Health & Value Strategies)
SHADAC Webinar - Anticipating COVID-19 Vaccination Challenges through Flu Vaccination Patterns (February 4th) (SHADAC Webinar)
[1] The estimates presented here represent an average of this time period.
[2] It is important to mention that the HPS does not collect data for institutionalized adults, such as those living in nursing facilities, or in correctional facilities such as prisons or jails.
Blog & News
State-Specific Surveys Encompassing Residents’ COVID-19 Experiences
Original blog posted on June 12, 2020:Updated on February 26, 2021
Introduction and Purpose
One of the ways that states are responding to the novel coronavirus epidemic is to gather timely information from residents on their personal experiences and opinions regarding the pandemic. Such real-time information helps states effectively plan for current and impending impacts of this unprecedented public health crisis. The crisis has had significant impacts, including loss of employment and income, disruptions in employer-sponsored insurance coverage, and increased need for testing and treatment of COVID-19. State COVID-19 surveys can supplement and improve upon national data collection by providing needed information at the regional, state, and local levels. In addition, state polls and surveys can be tailored to address each state’s experience with the coronavirus and its priorities.
This blog from the State Health Access Data Assistance Center (SHADAC) provides a summary of state efforts to capture information on the coronavirus pandemic through state and local surveys fielded between March 2020 and January 2021. We include information on topics covered within the surveys as well as some results, in certain cases where they are available. Additionally, we have put together a clickable state-level map that provides links to the data collection instruments and results we identified in our search. Since our last update in October, we have identified 25 new surveys and 17 updated surveys. We encourage you to explore the survey information we collected by clicking on one of the blue highlighted states on the map below.
Note: The majority of the survey sources saved here include both survey questions and topline results. In some instances, we were not able to find information from the survey source, and instead included news articles referencing the results and methodology of the survey. Updates to previously identified surveys are noted.
Methods
SHADAC researchers conducted a targeted scan of state data collection efforts, namely surveys and polls, conducted by state agencies and other state and local stakeholders (e.g., universities, foundations, etc.). Sponsors and commissioners of these surveys include state universities, state and local health departments, health policy groups, and partnerships between universities and the media. We searched for surveys that included questions on the following:
- attitudes and beliefs about health-related issues of the pandemic;
- opinions about the state response to the pandemic;
- impact of COVID-19 on health and health care for individuals and families;
- impact of COVID-19 on loss of employment, loss of income, and disruptions in employer-sponsored health insurance; and
- knowledge and use of health and social safety net services.
The purpose of this scan was to provide an inventory of state-focused primary data collection efforts as well as to identify areas of commonality between these efforts. Search terms used in the most recent scan included the state name, “COVID-19” (and variations thereof), and “survey.” We focused primarily on surveys related to individuals’ access to needed health care, opinions on public health response, and disruptions in health insurance coverage. We excluded opinion polls conducted by market research firms and the media to gauge public opinion on administration of the crisis. Surveys of school districts and businesses were considered outside of the scope of our scan, as well.
Results
States represented: We conducted a scan across all 50 states and the District of Columbia (D.C.). As of January 2021, we found 41 states (an additional six states since our last update) with population-based surveys on health topics related to the coronavirus. Of those states, the number of surveys per state ranged from one to thirteen, though most states did not have more than four surveys. We identified four new surveys for a total of thirteen surveys in California that matched our criteria, each with slightly different focus areas. For example, we previously identified a survey sponsored by the California Health Care Foundation (CHCF) that was primarily interested in health care access and affordability. This update includes another CHCF survey focused on the experiences of low-income adult residents since the beginning of the pandemic, and asks specifically about racial discrimination. Another survey from the University of California—Berkley focused on issues related to specific vulnerable communities like farmworkers and people of color. We also included the larger California Health Interview Survey, which asks questions about COVID-19 treatment and impact as well as health insurance coverage.
Target population: Of the 113 total surveys identified across 41 states, most of these targeted specific populations such as working-age adults, parents of school-age children, or students. Nine surveys targeted larger localities (e.g., Los Angeles County, the Atlanta Metropolitan Area, the Detroit Metropolitan Area, etc.), and three other surveys targeted residents of multiple states with results stratified by state residence. These multi-state surveys represented specified segments of the country; for instance, the Great Lakes Poll from Baldwin Wallace University represented opinions primarily in the Midwest.
The majority of surveys focused on adults (age 18-64 and 65+), and nine surveys focused specifically on parents and caregivers or families; for example, one survey conducted by the New York Department of Education collected responses from both parents and children regarding comfort level in returning to school. All surveys included sections to collect demographic information on survey respondents (e.g., age, sex, and race/ethnicity), and most results were stratified by some of these characteristics.
Topics: Surveys included questions on the following subjects (among others): lifestyle changes resulting from the pandemic; contact with or knowledge of persons with confirmed cases; safety measures taken such as wearing a mask, physically distancing, and avoiding public places; perception of threat posed by the virus; ability to obtain medications, mental health care, and physical health care; ability to pay bills; mental health challenges such as increased stress and increased worry resulting from the pandemic; resources needed; returning to school; and opinion on an administration’s or entity’s handling of the crisis. Another common topic across the new surveys identified was public willingness to get the COVID-19 vaccine. Eighteen new surveys and 11 survey updates included questions and/or results about perspectives on COVID-19 vaccination hesitancy.
Timeframe: Some surveys or polls captured point-in-time information on public attitudes toward COVID-19. Other surveys are being conducted periodically, using multiple waves to establish baseline attitudes and points of comparison. For example, the City University of New York School of Public Health has conducted weekly, biweekly, and then monthly interval surveys since mid-March 2020 to closely capture respondents’ evolving opinions.
Survey results: While some surveys were still only in the field during our first iteration of survey information collection, many had already (and have since continued to) produced results. Reported results usually included overarching takeaways from the data, as well as topline information and crosstabs for survey questions. Many questions were broken down by demographic characteristics in order to take a closer look at nuance in public opinion.
States are continuing to gather interesting findings from their surveys; newly identified surveys tended to include information on subpopulations of interest and explored COVID-19 vaccine hesitancy. For example, a survey conducted by the Oregon Health Authority, in conjunction with Lara Media Services and DHM Research, oversampled people of color and employed innovative outreach methods to survey additional members of Oregon’s Latino community. Select survey results for Oregonians compared to those for Oregon’s Latino community included a higher likelihood among the Latino community to use and follow personal protective behaviors, but a lower likelihood to quarantine if they experience symptoms or have direct contact with someone with COVID-19. A top reason for lack of quarantine provided by the Latino community surveyed was the “need to work” since it’s their “only source of income.” In terms of the likelihood of getting the COVID-19 vaccine, state survey results revealed some similar insights. For instance, a statewide poll by the University of Texas and the Texas Tribune found that 42% of respondents would get the vaccine; when data were disaggregated by race and ethnicity, survey results showed that 44% of White, 30% of Black, and 47% of Hispanic respondents reported that they would get the vaccine. Another poll from the Hartford Courant and Sacred Heart University found that 44% of respondents would get the vaccine. When stratified by race, 48% of White, 28% of Black, and 41% of Hispanic respondents reported that they would get the vaccine. The Louisiana Public Health Institute’s Statewide COVID-19 survey presented data by coverage type and found that 60% of those who had health insurance reported that they would definitely/probably get the vaccine while only 43% of those who were uninsured reported that they would definitely/probably get the vaccine.
If you are aware of a survey that is missing from this resource, please refer them to our email at shadac@umn.edu.
Blog & News
COVID-19 Vaccination Rates: State-level and Subpopulation Evidence from the Household Pulse Survey (Update 2: Feb 3 to Feb 15)
February 25, 2021:Newly available COVID-19 vaccines promise to help protect individual Americans against infection and eventually provide population-level herd immunity. The pace of the COVID-19 vaccination rollout in the United States has been somewhat erratic—with reports of slow early going before picking up somewhat in following weeks, only to be hampered by recent storms across the southern region. However, signs of vaccination progress are appearing on the horizon once again, with manufacturers ramping up production, shipping getting back on track after the recent roadblocks, and early positive news from the FDA regarding Johnson & Johnson’s single-shot vaccine. The initial groups prioritized for vaccination were health care workers on the front lines of the pandemic and nursing facility residents, many of whom are especially vulnerable to COVID-19 infection and severe outcomes.
While these groups continue to hold priority in vaccination slots, many states have expanded vaccine access to other (still high-priority) segments of the general population such as older adults, K-12 and child care workers, essential workers, and those with high-risk medical conditions. However, there are concerns that these prioritization decisions and the existing mechanisms of the vaccine rollout—in addition to evidence that lower-income individuals, people of color, and individuals without strong connections to the health care system are less likely to get vaccinated—are inadequate to narrow the clear disparities in the vaccine rollout so far and could worsen existing pandemic-related health inequities.
The available data have not assuaged these concerns, and show patterns of lower vaccination rates among people with lower incomes and levels of education, and marginalized racial and ethnic groups. The U.S. Census Bureau recently released updated data on take-up of COVID-19 vaccines from the most recent wave of its Household Pulse Survey (HPS), collected February 3-15, 2021.1 The HPS is an ongoing, weekly tracking survey designed to measure impacts of the COVID-19 pandemic. These data provide an updated snapshot of COVID-19 vaccination rates and are the only data source to do so at the state level by subpopulation. This blog post presents top-level findings from these new data, focusing on rates of vaccination (one or more doses) among U.S. adults (age 18 and older) living in households and comparing to results from the most recent wave of the HPS, collected January 20-February 1, 2021.2
Nearly one in five adults had received a vaccination, but this varied by state
According to the new HPS data, 19.9% of U.S. adults had received one or more COVID-19 vaccinations during this two-week period in the first half of February, though this varied by state from a low of 16.3% in the District of Columbia (D.C.) to a high of 31.9% in Alaska. More than one in four adults had received a vaccine in three states: Alaska, Hawaii, and New Mexico.
Vaccination rates increased substantially across nearly all states; states with lower rates catching up
Nationally, adult vaccination rates were up from the previous wave of the HPS, increasing from 13.2% during January 20-February 1, 2021, to 19.9% during February 3-15, 2021. Most states also experienced increases in their vaccination rates, though again the size of these increases varied across the states, from an increase of 1.5 percentage points (PP) in Vermont to an increase of 10.9 PP in Wisconsin.
Percent of Adults Who Had Received a COVID-19 Vaccine
States that had previously had below-average vaccination rates caught up somewhat to the higher-performing states. The states that were below the national average in late January, such as California and Wisconsin, saw larger increases in their vaccination rates compared with the states that were above the national average in late January, so that by the middle of February, vaccination rates were somewhat more even across the states, with most states hovering just above or below 20% of their adult populations vaccinated.
Disparities in vaccination rates remain largely unchanged
COVID vaccination rates continued to vary to a great degree by demographic and socioeconomic factors, though disparities narrowed slightly from previous weeks. This narrowing could be due to the expansion of priority groups to include a broader share of the population over this period; however, progress has remained limited in getting vaccines to certain groups such as low-income, Hispanic, and Black adults, for instance, and new vaccination strategies may be needed to reach the hardest-to-reach groups such as these.
By race and ethnicity, non-Hispanic Asian and non-Hispanic White adults continued to have above-average vaccination rates at 25.3% and 21.5%, respectively. Vaccination rates among non-Hispanic adults identifying with “Multiple” races or “Some other” race, which had previously increased relative to the average, fell behind pace and rose to just 16.3%, below the national average of 19.9%. Rates among non-Hispanic Black adults (16.2%) and Hispanic/Latino adults of any race (15.0%) remained below the national average.
Percent of Adults Who Had Received a COVID-19 Vaccine by Race/Ethnicity
Disparities in vaccination rates by income continued to narrow, though rates among those with the lowest incomes remained far below the average. Adults with household incomes of less than $25,000 were nearly half as likely to have received a vaccine compared with all adults (10.7% vs. 19.9%). This gap was largely unchanged from previous weeks, even as the gap between other lower-income groups and the average steadily narrowed from early January.
Percent of Adults Who Had Received a COVID-19 Vaccine by Income
Disparities by level of education remained, with adults holding a bachelor’s degree or higher continued to have the highest vaccination rate at 28.2%, and adults without a high school diploma having the lowest vaccination rates at 12.2%. However, disparities by education did narrow somewhat, and vaccination rates among both adults with a high school diploma or equivalent and adults with less than a high school education increased faster than the overall adult rate.
Percent of Adults Who Had Received a COVID-19 Vaccine by Education
Nearly 2 in 5 older adults received a COVID vaccine as the U.S., and many states, continued to make large progress in vaccinating older adults
Nationally, 38.5% of older adults (age 65 and older) had received at least one dose of the COVID-19 vaccine, which was 18.6 percentage points higher than the rate among all adults (19.9%). Vaccination rates for older adults ranged from 17.6% in Rhode Island to 60.5% in Alaska. Older adult vaccination rates were below 25% in four states (New Hampshire, Oregon, Rhode Island, and Vermont) and at or above 50% in five states (Alaska, Georgia, Indiana, Mississippi, and Oklahoma) and in D.C.
Percent of Adults Age 65+ Who Had Received a COVID-19 Vaccine
As in the previous period, states continued to make large progress in rates of vaccination among older adults. Compared to the end of January, 19 states more than doubled their 65+ vaccination rates, and three states (Minnesota, Wisconsin, and Nebraska) more than tripled their 65+ vaccination rates, with Minnesota nearly quadrupling its rate (from 8.5% to 33.7%). Only a handful of states failed to make substantial progress in increasing vaccination rates among older adults.
Notes about the Household Pulse Survey Data
The estimated rates presented in this post were calculated from the count estimates published by the Census Bureau. Though these counts are accompanied by standard errors, standard errors are not able to be accurately calculated for rate estimates. Therefore, we are not able to determine if the differences we found in our analysis are statistically significant or if the estimates themselves are statistically reliable. Estimates and differences for subpopulations at the state level should be assumed to have large confidence intervals around them and caution should be taken when drawing strong conclusions from this analysis. However, the fact that patterns of inequities in other vaccination rates are mirrored by these early indications of COVID-19 vaccination inequities demonstrates reason for concern.
Though produced by the U.S. Census Bureau, the HPS is considered an “experimental” survey and does not necessarily meet the Census’s high standards for data quality and statistical reliability. For example, the survey has relatively low response rates (7.3% for February 3-15), and sampled individuals are contacted via email and text message, asking them to complete an internet-based survey. These issues in particular could be potential sources of bias, but come with the tradeoffs of increased speed and flexibility in data collection as well as lower costs. A future post will investigate differences between COVID vaccination rates estimated from survey data (such as the HPS) and administrative sources. The estimates presented this post are based on responses from 77,122 adults. More information about the data and methods for the Household Pulse Survey can be found in a previous SHADAC blog post.
Previous Blogs in the Series
COVID-19 Vaccination Rates: New State-level and Subpopulation Evidence from the Household Pulse Survey (Update: Jan 10 to Feb 1)
COVID-19 Vaccination Rates: New State-level and Subpopulation Evidence from the Household Pulse Survey (Jan 6 to Jan 18)
Related Reading
State-level Flu Vaccination Rates among Key Population Subgroups (50-state profiles) (SHADAC Infographics)
50-State Infographics: A State-level Look at Flu Vaccination Rates among Key Population Subgroups (SHADAC Blog)
Anticipating COVID-19 Vaccination Challenges through Flu Vaccination Patterns (SHADAC Brief)
New Brief Examines Flu Vaccine Patterns as a Proxy for COVID – Anticipating and Addressing Coronavirus Vaccination Campaign Challenges at the National and State Level (SHADAC Blog)
Ensuring Equity: State Strategies for Monitoring COVID-19 Vaccination Rates by Race and Other Priority Populations (Expert Perspective for State Health & Value Strategies)
SHADAC Webinar - Anticipating COVID-19 Vaccination Challenges through Flu Vaccination Patterns (February 4th) (SHADAC Webinar)
Blog & News
COVID-19 Vaccination Rates: New State-level and Subpopulation Evidence from the Household Pulse Survey (Jan 6 to Jan 18)
January 29, 2021:Newly available COVID-19 vaccines promise to help protect individual Americans against infection and eventually provide population-level herd immunity. However, the rollout of the COVID-19 vaccines thus far—largely delegated to the states—has been slow and inconsistent. The initial groups prioritized for vaccination were health care workers on the front lines of the pandemic and nursing facility residents, many of whom are especially vulnerable to COVID-19 infection and severe outcomes. However, there are concerns that these prioritization decisions—in addition to evidence that lower-income individuals, people of color, and individuals without strong connections to the health care system are less likely to get vaccinated—could worsen existing pandemic-related health inequities.
Preliminary data have unfortunately reinforced these concerns, showing patterns of lower vaccination rates among people with lower incomes and levels of education, and marginalized racial and ethnic groups. The U.S. Census Bureau recently released new data on take-up of COVID-19 vaccines from the most recent wave of its Household Pulse Survey (HPS), collected January 6-18, 2021. The HPS is an ongoing, weekly tracking survey designed to measure impacts of the COVID-19 pandemic. These data are the first to provide estimates of COVID-19 vaccination rates at the state level and by subpopulation. This blog post presents top-level findings from these new data, focusing on rates of vaccination (one or more doses) among U.S. adults (age 18 and older) living in a household unit.1
Roughly eight percent of adults had received a vaccination, but this varies by state
According to the new HPS data, 7.7% of U.S. adults had received one or more COVID-19 vaccinations during this two week period in January, though this varied by state from a low of 5.4% in California to a high of 13.7% in Hawaii. More than one in ten adults had received a vaccine in nine states: Alaska, Hawaii, Montana, New Mexico, North Dakota, Oklahoma, South Dakota, Texas, and Vermont.
Disparities in vaccination rates reflect concerns about harder-to-reach groups and groups prioritized for initial round of vaccinations
Vaccination rates also varied substantially by a number of demographic and socioeconomic factors. These could be partly a result of decisions to prioritize health care workers, who tend to be less racially and ethnically diverse than the overall population, and who often have higher incomes and levels of education.
By race and ethnicity, non-Hispanic Asian adults had the highest vaccination rates at 13.1%, followed by non-Hispanic White adults at 8.0%. Hispanic/Latino adults (any race), non-Hispanic Black adults, and non-Hispanic adults identifying with multiple races or some other race had lower vaccination rates (5.8%, 5.8%, and 6.2%, respectively). A similar pattern was seen across many states, with Asian and White adults often more likely to have received a vaccine than Black and Hispanic adults.
Large disparities in vaccination rates by income were also apparent, with the highest income groups reporting higher rates of vaccination compared to those with lower incomes, and rates increasing steadily in correlation with income. Of adults with household incomes of $100,000 or higher, 12.0% had received a COVID-19 vaccine, which was nearly 2.5x higher than the rate among those with incomes below $25,000.
Nearly half of all adults who had received a COVID-19 vaccine have incomes of at least $100,000, despite making up only three in ten adults in the overall population.
Similar patterns by income were seen across the states. For example, in 17 states, adults in the highest income category were at least 5x more likely to have been vaccinated than those in the lowest income category.
Patterns of vaccination by education were similar to those by income, with adults with less education being less likely to have received a vaccine compared to adults with more education. Nationally, 12.2% of adults with a bachelor’s degree or higher have received a vaccine compared with 3.7% of adults with less than a high school education.
More progress is needed in vaccinating the older adult population most vulnerable to severe COVID-19 morbidity and mortality
Nationally, older adults (age 65 older) were no more likely to have received a COVID-19 vaccine than the overall adult population. During the period of January 6 through January 18, 7.1% of older adults had received a vaccine compared with 7.7% of all adults. This may be of concern because older adults are more likely to develop severe COVID-19 cases or die from the disease compared to the general population. Consequently, many states have given precedence to vaccinations for older adults, but these early data don’t show that prioritization is resulting in higher vaccination rates.
Vaccination rates for older adults ranged from 1.7% in Nevada to 21.9% in Alaska. Vaccination rates were below five percent in 15 states and were above ten percent in seven states. Older adults were more likely to have received a vaccine than the overall population in just 11 states
Notes about the Household Pulse Survey Data
Many of the estimates published by the Census Bureau and presented here were not accompanied by standard errors. Therefore, we are not able to determine if the differences we found in our analysis are statistically significant or if the estimates themselves are statistically reliable. Estimates and differences should be assumed to have large confidence intervals around them—especially for subpopulations at the state level—and caution should be taken when drawing strong conclusions from this analysis. However, the fact that patterns of inequities in other vaccination rates are mirrored by these early indications of COVID-19 vaccination inequities demonstrates reason for concern.
Though produced by the U.S. Census Bureau, the HPS is considered an “experimental” survey and does not necessarily meet the Census’s high standards for data quality and statistical reliability. For example, the survey has relatively low response rates (6.5% for January 6–18) and sampled individuals are contacted via email and text message, asking them to complete an internet-based survey. These issues in particular could be potential sources of bias, but come with the tradeoffs of increased speed and flexibility in data collection as well as lower costs. The estimates presented this post are based on responses from 68,348 adults. More information about the data and methods for the Household Pulse Survey can be found in a previous SHADAC blog post.
Related Reading
Anticipating COVID-19 Vaccination Challenges through Flu Vaccination Patterns (SHADAC Brief)
New Brief Examines Flu Vaccine Patterns as a Proxy for COVID – Anticipating and Addressing Coronavirus Vaccination Campaign Challenges at the National and State Level (SHADAC Blog)
Ensuring Equity: State Strategies for Monitoring COVID-19 Vaccination Rates by Race and Other Priority Populations (Expert Perspective for State Health & Value Strategies)
Upcoming SHADAC Webinar - Anticipating COVID-19 Vaccination Challenges through Flu Vaccination Patterns (February 4th) (SHADAC Webinar)
1 It is important to mention that the HPS does not collect data for institutionalized adults, such as those living in nursing facilities. These individuals were commonly prioritized for the first rounds of COVID-19 vaccines, so the estimates of vaccination rates presented here are likely an undercount of population-wide vaccination rates. This undercount could be more pronounced among the total 65-and-older population, as they are disproportionately likely to reside in institutions. Further, these data do not represent adults in correctional facilities such as prisons or jails—another group of adults who are also at increased risk of contracting COVID-19.
Blog & News
SHADAC Webinar - Anticipating COVID-19 Vaccination Challenges through Flu Vaccination Patterns (February 4)
August 01, 2024:Date: Thursday, February 4, 2021
Time: 1:00 PM Central Time / 2:00 PM Eastern Time
Across the country, states have begun the first stages of their campaigns to vaccinate people against the novel coronavirus (COVID-19). However, early troubles have highlighted the challenges to such a massive endeavor, as pointed out in recent articles from the New York Times and the Washington Post.
Once the first tiers of recipients have been vaccinated, states will need to begin subsequent efforts to inoculate their broader resident populations—efforts that may be hampered by another, more-familiar set of hurdles, including vaccine skepticism and a U.S. health care system that typically leaves large segments of the population underserved.
Looking to the nation’s experiences with other vaccine campaigns such as influenza, can provide insights to the challenges faced by states in attaining their targets for coronavirus immunization.
In a recent SHADAC webinar, Senior Research Fellow Colin Planalp, MPA, presented data published in a recent brief, funded by the California Health Care Foundation (CHCF). The analysis uses flu vaccination rates for U.S. adults across the 50 states and the District of Columbia as a proxy to identify population subgroups that may be harder to reach with a COVID-19 vaccine. An analysis of several demographic categories, such as age, race/ethnicity, chronic health conditions, and health insurance coverage status was also included in the webinar discussion.
Mr. Planalp was joined by SHADAC Research Fellow Robert Hest, MPP, for a question and answer session following the webinar presentation.
Related Resources
State-level Flu Vaccination Rates Among Key Population Subgroups (SHADAC 50-state Infographics)
50-State Infographics: A State-level Look at Flu Vaccination Rates among Key Population Subgroups (SHADAC Blog)
COVID-19 Vaccine Challenges: Illustrating Hurdles to Population Immunity and Equity Using Flu Vaccination Data (SHADAC Webinar Slides)
Anticipating COVID-19 Vaccination Challenges through Flu Vaccination Patterns (SHADAC Brief)
Ensuring Equity: State Strategies for Monitoring COVID-19 Vaccination Rates by Race and Other Priority Populations (SHVS Expert Perspective)
State-Specific Surveys Encompassing Residents’ COVID-19 Experiences (SHADAC Survey Resource)