Racial disparities already apparent in Iowa's COVID-19 vaccination rates

When the Iowa Department of Public Health created a new advisory council in December to draft recommendations on allocating coronavirus vaccines, the body’s “guiding principles” were supposed “to ensure vaccine availability to specific populations, particularly in groups that are at highest risk for severe outcome from COVID-19 infection.” The council’s framework stated, “These priority recommendations and subsets must also recognize the importance of treating individuals fairly and promoting social equity, by addressing racial and ethnic disparities in COVID mortality […].”

Nevertheless, people of color in Iowa are being vaccinated for COVID-19 at substantially lower rates than white people, analysis by Sara Anne Willette has found. As of February 7, white Iowans had received more than double the doses of vaccine per 1,000 population as Black Iowans, Native Americans, or people of Asian descent, and Iowans not of Latino ethnicity had received more than triple the doses per capita as had Latinos in Iowa, Willete calculated.

WHITE IOWANS VACCINATED AT HIGHER RATE THAN PEOPLE OF COLOR

Willette maintains the Iowa COVID-19 Tracker website, where she updates a wide range of downloadable data daily and scrapes testing data (which can’t be downloaded) from the state website.

These numbers come from the “vaccination snapshot” tab on the spreadsheet labeled COVID-19 Vaccination Data, updated on February 7. Using data from the vaccine dashboard page on the state’s official website coronavirus.iowa.gov, Willette set up columns showing the percentage and number of Iowans falling into various demographic groups, as well as how many vaccine doses individuals in each group received. The latest data shows 324,929 doses had been administered. Of that total:

White Iowans received 245,289 doses, which works out to about 86 doses per 1,000 white people (roughly 90 percent of the state’s population).

Black Iowans received 3,574 doses, which works out to about 31 doses per 1,000 African Americans (about 3.7 percent of the state’s population).

Asian Americans received 3,119 doses, which works out to about 41 doses per 1,000 people of Asian descent (2.4 percent of Iowans).

Native Americans or Alaska natives received 487 doses, which works out to about 41 doses per 1,000 American Indians (0.38 percent of Iowans).

Native Hawaiian or Pacific Islanders received 195 doses, which works out to about 52 doses per 1,000 Iowans in those groups (0.12 percent of population).

Latinos received 4,776 doses, which works out to about 24 doses per 1,000 Latinos in Iowa (6.3 percent of population).

Iowans who have no Latino ethnicity received 235,986 doses, which works out to about 80 doses per 1,000 Iowans not in that demographic group.

The state website presents the same data in a different way. As of the evening of February 7, white Iowans had received 75.6 percent of vaccine doses administered, 21 percent of doses had gone to Iowans of unknown race, Black Iowans had received 1.07 percent of doses, Asians 0.94 percent, American Indians 0.15 percent, and Native Hawaiians or Pacific Islanders 0.05 percent.

Just 1.47 percent of COVID-19 vaccine doses have gone to Iowa Latinos, 72.5 percent to Iowans who are not Latino, and 26.1 percent to Iowans of unknown ethnicity, the state’s dashboard shows.

These disparities are particularly worrying, since people of color are disproportionately represented in certain “essential” jobs (such as in the meatpacking or service industries) that put them at higher risk of exposure to coronavirus. Although a slightly higher percentage of Black and Latino Iowans are children, and therefore ineligible to receive the COVID-19 vaccine, that does not fully account for the imbalance.

UPDATE: Some readers have suggested that since Iowa nursing home residents are overwhelmingly white and were prioritized for early vaccinations, that may have contributed to the disparities. If so, the disparities should decrease in the coming weeks and months as more people in other population groups are vaccinated. I’ll be keeping an eye on this data.

OTHER INEQUITIES BAKED INTO VACCINE DISTRIBUTION

Health care workers and nursing home residents or employees were the state’s top priority populations for COVID-19 vaccines in December. As Iowa moved into vaccinating people in the next tier, including those aged 65 or older, a troubling trend emerged. Some of the state’s largest health care providers, such as MercyCare, UnityPoint, and The Iowa Clinic, put out the word that they would be contacting “eligible” patients in their system to schedule appointments.

Jorge Salinas, a hospital epidemiologist at the University of Iowa Hospitals and Clinics, commented on January 25, “And it begins: if you are an established patient of the healthcare system they’ll call you. Don’t call because lines will be busy. If you don’t have primary care, usually the poor, you are to call the health department.”

A UnityPoint spokesperson told Bleeding Heartland on January 29,

UnityPoint Health is laser-focused on vaccinating as many people as possible, as quickly as possible. […] Initiatives of this scale all have to start somewhere, and our current process involves reaching out to individuals over the age of 65 who are in our electronic medical record system.

We’re currently experiencing high call volume at all of our clinics regarding the COVID-19 vaccine from patients and non-patients. Our team is working hard to get back to all individuals and schedule appointments for those who meet the eligibility requirements outlined by public health. Due to high call volume, we are asking our patients not to call and request a vaccination appointment but rather wait until they receive notification from us that they are eligible.

In other words, Iowans who don’t regularly see a health care provider will not be considered “eligible,” even if they fall into a priority population, as defined by the state.

Sarah Ekstrand, spokesperson for the Iowa Department of Public Health, told reporters last week, “Iowa has 1,700 enrolled vaccine providers. Approximately half of Iowa’s enrolled vaccine providers will offer vaccine to anyone who qualifies, such as a pharmacy or a local public health agency.”

Clark Kauffman delved into this issue in a February 4 article for Iowa Capital Dispatch. A spokesperson for Genesis Health System in eastern Iowa told him prioritizing existing patients would make “recordkeeping” easier. And communications staff for the Polk County Health Department said they are working “with several different partners so that there is wide distribution among the pharmacies, health department, Drake University and clinics.” She advised people without a “clinic home” or “pharmacy home” to “schedule an appointment with the health department or Drake University.”

How many Iowans who don’t regularly see a health care provider (a group that likely includes more people of color) would know they are supposed to contact the county health department or Drake University?

Did Iowa’s Infectious Disease Advisory Council approve the concept of letting health care providers favor their established customers, or even discuss it? We have no idea, since the group met behind closed doors.

IOWA AMONG WORST STATES FOR SHARE OF VACCINES ADMINISTERED

According to the latest information on the New York Times website, Iowa ranked dead last among the 50 states for percentage of residents who have received at least one COVID-19 vaccine shot. Our 7.5 percent is well below the national average of 9.5 percent. Governor Kim Reynolds asserted at her February 4 news conference that Iowa ranks 47th for vaccine supply per capita, which she said explains our low vaccination rate. But only seven states and Washington, DC have administered a smaller share of their vaccine allocations than Iowa has, the New York Times data indicates.

The Des Moines Register’s editorial board observed,

As of data reported by midday Sunday [February 7], Iowa had administered 64% of the doses delivered to us. Minnesota had administered 77% of its doses; South Dakota, 82%. Illinois and Wisconsin also had all administered a higher percentage than Iowa.

This state has received about 510,000 doses but administered about 328,000. That means there are about 182,000 doses of vaccine, a number that has grown day after day, sitting in freezers or refrigerators (and hopefully being properly stored).

Now that Reynolds has lifted all restrictions on business activity as well as her limited mask mandate for indoor activities, and a more transmissible COVID-19 strain has been identified in Iowa, it’s imperative to get more vaccines into Iowans’ arms. But as state officials look for ways to pick up the pace, they should also focus on reducing disparities in how these life-saving shots are administered.

P.S.–Iowa women have received more than twice as many doses of COVID-19 vaccine as men: 139 doses per 1,000 females to 63 doses per 1,000 males, according to Willette’s data (or 69 percent of doses to 31 percent, as presented on the state’s website). Both health care workers and nursing home residents are more likely to be female, which likely accounts for much of that disparity.

Top illustration by msvisuals available via Shutterstock.

  • Speed matters

    Given that this whole campaign has not been done before and many offices are not able to operate phone banks, I think the Unity Point plan is sensible. I would err more dramatically on the side of speed by taking my clinics to big office buildings or factories and shooting up the whole workforce regardless of age or ethnicity. Such an approach could work in favor of Latinos since many can be found in the same places of employment.

    Every injected person helps end the spread. Excessive worry about following a certain order is probably part of the reason my county has done so poorly getting its vaccines into bodies.

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