New data about the U.S. vaccination effort suggests that some communities will struggle to recover not only because of people's reluctance to get shots but also due to difficulties accessing health care and other barriers.
So far, demand for the vaccine has outpaced supply. Many Americans have jumped at the chance to get jabbed and now more than half of all adults have received at least one COVID-19 vaccine shot. But the second half of the rollout may look different, especially depending on where you live.
NBC analyzed data for nearly every county in the country and found those estimated to be the most vaccine hesitant also rated higher, on average, on an index measuring longstanding vaccine coverage barriers, such as historic under-vaccination and weak health care systems.
The most vaccine hesitant U.S. counties are also more likely to face a host of other rollout challenges
These barriers include historic under-vaccination rates, constrained healthcare systems and community lack of access to information.
Source: Vaccine hesitancy estimates from the Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evalution. Covid-19 Vaccine Coverage (CVAC) Index data is from Surgo Ventures, a non-profit organization focusing on health and social problems.
Amy O’Kruk/NBC
The findings suggest some communities may struggle to reach herd immunity, potentially making them vulnerable to waves of infection for years to come. Of the 500 most vaccine-hesitant counties, over two thirds also rated high or very high on an index measuring an array of other vaccination barriers.
The COVID-19 Vaccine Access Coverage index, created by Surgo Ventures, a non-profit organization focusing on health and social problems, looks at five major factors influencing which communities are at risk of poor vaccination coverage: historic under-vaccination rates, socioeconomic disadvantages, under-resourced health care systems, inaccessible health care and community patterns of failure around seeking routine care.
The link between vaccine hesitancy and the index's other barriers is likely rooted in demographics. Vaccine hesitancy is higher in rural, low-income communities, which are also more likely to face health care workforce shortages along with challenges related to vaccine distribution and communication.
Rural Americans are more than five times as likely as urban Americans to live in counties with very high levels of vaccine barriers, according to Surgo Ventures.
Politics also plays a role. States that favored Democrats and President Joe Biden in the 2020 election have reported higher rates of vaccinations, according to polling from The Associated Press and NORC Center for Public Affairs Research. New Hampshire is leading at 71%, followed by New Mexico, Connecticut, Maine and Massachusetts at 55% or greater.
Conversely, the states that favored Republicans and former President Donald Trump are at the bottom, with fewer than 40% getting vaccinated. Those include Mississippi, Alabama, Louisiana and Tennessee.
Southern and western states are at higher risk of falling behind in the next phase of vaccine distribution
Source: Vaccine hesitancy estimates from the Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evalution. Covid-19 Vaccine Coverage (CVAC) Index data is from Surgo Ventures, a non-profit organization focusing on health and social problems.
Amy O’Kruk/NBC
Until recently, state-determined eligibility rules have influenced who gets the vaccine and when. But with all American adults qualifying for shots since Monday, efforts will soon shift to more challenging groups and starker differences in vaccination rates between regions may emerge.
Some disparities are already evident. On average, the 500 counties where people were least hesitant to get the COVID-19 vaccine, according to federal estimates, have fully vaccinated 26.7 percent of residents as of April 22. The 500 counties where people were most hesitant have fully vaccinated only 19.5 percent.
But there are ways forward. West Virginia, which tends to score low on many national health measures, emerged as one of the early leaders in vaccinations during the pandemic. Many credited its reliance on local pharmacies with strong community ties, along and low tech information systems, like a robust telephone hotline.
The Biden administration also has plans for targeted outreach. On Thursday, it launched a campaign targeting young people through social media with the help of celebrities and professional athletes.
With many Americans itching to get back to "normal" and countries around the world watching the U.S. rollout, all eyes are on the march to herd immunity. And as Dr. Anthony Fauci, the federal government’s top infectious disease expert, said at a White House briefing Monday, “the highway to that normalcy is vaccination."
COVID-19 vaccination may be more difficult in counties with a higher CVAC Index
Source: Surgo Ventures' Covid-19 Vaccine Coverage (CVAC) Index.
Andrew Williams/NBC
