The affluent town of Woodbridge, Conn., has less than half the population of neighboring Ansonia, and yet it’s home to more people who have received a Covid-19 vaccine. The inequity is stark: In Woodbridge, where residents have a median household income of $138,320 a year, 19.3% of the population had been vaccinated as of Feb. 4, according to Connecticut health department data. In Ansonia, where the median income is $45,563 a year, just 7.1% have received their first shot.
Connecticut has the most glaring disparity in vaccination rates between its richest and poorest communities — a difference of 65% — according to a STAT analysis of local-level vaccine data in 10 states with the biggest wealth gaps. Four other states — California, Florida, New Jersey, and Mississippi — also have vaccinated a significantly higher proportion of people in the wealthiest 10% of counties.
The discrepancies vary: In California, 156 shots have been given to residents in the richest areas for every 100 vaccines in the poorest counties, while in Mississippi, 111 vaccines have been given to residents of the richest counties for every 100 doses in the poorest places.
In Washington, D.C., the vaccination rate in the wealthiest two wards is more than double that in the two least wealthy.
The findings back up, with hard data, anecdotal reports from around the country that wealthy people have been able to gain access to vaccines ahead of low-income people. “We’re seeing individuals who have privilege and access who are edging out the people who don’t,” said Tekisha Dwan Everette, executive director of Health Equity Solutions in Connecticut and a member of the governor’s Covid-19 advisory task force in that state.
But the analysis also reveals that some states appear to be distributing vaccines more equitably than others. Among states with the greatest wealth gaps, Texas, Tennessee, New Mexico, Pennsylvania, and Illinois did not show a significant county-level income divide in vaccination rates. The analysis excluded states, including Georgia, Louisiana, and Massachusetts, that do not publicly share county-level data on vaccine recipients.
Because counties can contain diverse populations, the analysis is not a definitive indicator of equity, however. Several experts said they expected more precise data would reveal wealth inequalities even in those states with equitable county-level data. And in a number of these states, racial disparities were still evident.
Any gap in vaccinating rich versus poor inevitably exacerbates racial divides. Black and Latino people are far more likely to live in poverty than white people, and despite having died at higher rates throughout the pandemic, they are receiving fewer vaccines than white people.
The data suggest that, in some states, the first wave of vaccines has favored the rich. “There really are two Conneticuts. We, as a state, need to put more focus on that,” said Tiffany Donelson, chief executive of the Connecticut Health Foundation.
Inequity has been a feature of the pandemic since the start, said Everette, citing Covid-19 testing sites that have been more accessible to wealthier populations. “Instead of learning from that lesson, we’re recreating the privilege,” she said.
Simply locating vaccination sites in diverse and lower-income areas isn’t enough: “People are traveling outside their own geographic region to get a vaccine in another place,” she said.
Similar issues have been seen in California. “We’ve heard those stories of people in LA driving to Compton or to another part where there are other sites,” said Anthony Wright, executive director of Health Access California.
State policies can help address inequalities. Texas vaccination hubs are required to set aside a portion of vaccines for vulnerable communities, work with local leadership, and distribute the vaccine in racially diverse areas, said Imelda Garcia, chair of the Texas Expert Vaccine Allocation Panel. By contrast, in California, counties are expected to focus on equity, but aren’t given specific requirements on how to do so, said California Covid-19 vaccine task force spokesperson Darrel Ng.
But the vaccine rollout in Texas, though it hasn’t reflected income inequality, has disproportionately benefited white residents, the state’s data show. Racial data hasn’t been recorded for all vaccinations, said Garcia, and more complete data collection could show more equitable distribution: “The data doesn’t reflect what’s occurring. I can tell the data is missing.”
Similar concerns about missing data apply to the county-level analysis, as several states with the greatest divides have not released this information. Tracking and sharing this data is one way to improve equality, said Julie Swann, head of the department of industrial and systems engineering at North Carolina State University. “If we start measuring who they’re reaching in terms of race, ethnicity, or income, then they’ll do the extra things necessary to reach everyone.”
The rush to vaccinate people as quickly as possible likely limited equity in the first phase of the rollout. “[States] were worried they’d lose their allocation if they did not move quickly,” said Swann. “Everyone freaked out.”
Vaccine distribution so far has predominantly focused on health care workers and those over 75. “Equity is our north star for vaccine distribution and as the state rolls out its new vaccine distribution network, we will be able to more precisely target our efforts to vaccinate disproportionately impacted communities,” said California’s Ng.
But the lack of equality in the first phase for health care workers is also indicative of disadvantages faced by poorer communities. Fewer people will be vaccinated in areas with a scarcity of hospitals, which are often poorer, rural areas. California’s Central Valley, for example, has a far less robust health care system than Silicon Valley.
“Those areas more heavily resourced with health care infrastructure and workers, by definition got more of the vaccine,” said Wright, of Health Access California.
Connecticut is taking several steps to address the vaccine inequality, said state health department spokesperson Maura Fitzgerald, including setting aside vaccines for those in vulnerable communities, and creating a vaccine phone line for residents without the internet.
In New Jersey — where STAT found the vaccination rate is 28% higher in the richest counties — the health department is working with partners including places of worship and senior centers to provide education and access to vaccines through mobile clinics and potentially door-to-door vaccinations in areas badly affected by Covid-19, said state health department spokesperson Donna Leusner. Washington, D.C., has partnered with hospitals, community health centers, and other organizations to help achieve equity, wrote a health department spokesperson and around 20% to 30% of vaccine supply is targeted to diverse populations including homeless shelters and faith-based initiatives.
Meanwhile, Mississippi health department spokesperson Liz Sharlot said the state is working with Black pastors, historically Black colleges and universities, and prominent African American doctors to address the disparity. And Florida — where the vaccination rate is 23.6% higher in the richest counties — is working with places of worship and other sites in underserved communities where the vaccine can be administered, said a health agency spokesperson. Florida vaccine allocations per county are based on the size of the population over 65 years old.
While older people are more vulnerable to Covid-19, distributing the vaccines based on age can contribute to inequities. In Connecticut, the northeast section of Hartford has a life expectancy of 68.9 years, compared to 84.6 years in West Hartford Center, so a smaller share of its residents have been eligible for vaccination so far. The state opened vaccinations to those aged 65 to 75 only this week. “In Hartford, you’re missing a substantial piece of the population,” said Donelson, of the Connecticut Health Foundation.
Online reservation systems have also contributed to the disparities. A vaccine distribution system that gives appointments to those who can book them fastest inevitably rewards those with the time and connections. People often have to call around five different health care centers to try get onto a vaccination list, said Georges Benjamin, executive director of the American Public Health Association. “It tells you a lot about the lack of planning,” he said.
Online booking systems require a computer, Wi-Fi, and the ability to navigate a complicated system, said Wright. Richer people are more able to take time off work and have easier access to the transportation needed to be vaccinated.
“People who are wealthier will be more dialed into the vaccination rollout,” he said. “It shows how much more we need to do to make proactive efforts to reach the most vulnerable.”
STAT examined discrepancies in 10 states with the highest wealth gap, as measured by the Gini coefficient, that provided county-level or equivalent local data on population vaccination rates.
For each state, we examined the vaccine distribution rates in the richest 10% and poorest 10% of counties. For most states, we used federal data on median household income. In Connecticut, we used vaccine data and median household income for cities and towns. And we analyzed the median household income and vaccination rates for each ward in Washington, D.C. In New Jersey, which has 22 counties, we compared the richest and poorest three counties.
STAT used vaccination rates posted on local health department websites from Feb. 6 to 10. Connecticut, Florida, and New Jersey provided the percentage of residents who had received their first doses; Mississippi provided the vaccine doses administered by county of residence; California provided the vaccine doses administered per 10,000 residents; Washington, D.C. provided the number of residents fully vaccinated by ward.