In Missouri and Other States, Flawed Data Makes It Hard to Track Vaccine Equity

Lambert here: “Vaccine equity” seems very much to me a case of “epidemiologically all other things being equal.” If, say, the rich and powerful were disproportionately super-spreaders, due to their personal habits, general Tom and Daisy-like carelessness, and propensity to travel, wouldn’t it make sense to bump them up in the queue? Isn’t the real equity bringing the pandemic to an end as rapidly as possible?

By Alex Smith, KCUR 89.3 FM Health Reporter. Originally published at Kaiser Health News.

Throughout the covid-19 vaccination effort, public health officials and politicians have insisted that providing shots equitably across racial and ethnic groups is a top priority.

But it’s been left up to states to decide how to do that and to collect racial and ethnic data on vaccinated individuals so states can track how well they’re doing reaching all groups. The gaps and inconsistencies in the data have made it difficult to understand who’s actually getting shots.

Just as an uneven approach to containing the coronavirus led to a greater toll for Black and Latino communities, the inconsistent data guiding vaccination efforts may be leaving the same groups out on vaccines, said Dr. Kirsten Bibbins-Domingo, an epidemiologist at the University of California-San Francisco.

“At the very least, we need the same uniform standards that every state is using, and every location that administers vaccine is using, so that we can have some comparisons and design better strategies to reach the populations we’re trying to reach,” Bibbins-Domingo said.

Now that federal, state and local governments are easing mask requirements and ending other measures to prevent the spread of the virus, efforts to boost vaccination rates in underserved communities are even more urgent.

At St. James United Methodist Church, a cornerstone for many in the Black community in Kansas City, Missouri, in-person services recently resumed after being online for more than a year. St. James has also been hosting vaccination events designed to reach people in the neighborhood.

“People are really grieving not only the loss of their loved ones, but the loss of a whole year, a loss of being lonely, a loss being at home, not being able to come to church. Not being able to go out into the community,” said Yvette Richards, St. James’ director of community connection.

Missouri’s population is 11% African American, but covid cases among African Americans accounted for 25% of the total cases for the state, according to an analysis by KFF.

Richards said St. James has lost many congregants to the coronavirus, and the empty pews where they once sat on Sundays serve as stark reminders of all this community has been through during the pandemic.

Missouri’s public covid data appears to show robust data on vaccination rates broken down by race and ethnicity. But several groups are seen lagging far behind on vaccinations, including African Americans, who appear to have a vaccination rate of just 17.6%, nearly half of the 33% rate for the state as a whole.

To Dr. Rex Archer, director of the Kansas City health department, one number is a giveaway that this data isn’t right. It shows a completed vaccination rate of 64% for “multiracial” Missourians. Such an exceptionally high rate for one group beggars belief, according to Archer.

“So, there’s some huge problem with the way the state is collecting race and ethnicity under covid vaccination,” Archer said.

Missouri state officials have acknowledged since February that this data is wrong, but they haven’t managed to fix it or explain exactly what’s causing it. Archer suggested the inflated multiracial rate is probably due to different racial data being reported when individuals receive first and second shots.

Other problems have been detected, including missing racial and ethnic data for many people who have been vaccinated, and the use of multiple categories such as “other” and “unknown.”

The state also noted it used national racial percentages in the state’s vaccination data rather than actual percentages based on the state’s population. For example, earlier in the vaccination effort, the state used national racial data, which shows nearly 6% of the population is Asian, even though Missouri’s population is 2.2% Asian.

Health officials are working to target vaccination campaigns in communities where rates are low, but Archer said the state’s data provides little help.

“I mean, we have to look at it, but it’s got too many variables to be something we can count on,” Archer said.

Though racial and ethnic categories are clearly defined in national U.S. Census data, the same data is not collected uniformly by states.

For example, South Carolina’s vaccination data lumps together Asians, Native Americans and Pacific Islanders in one category. In Utah, residents can pick more than one race. Wyoming doesn’t report racial or ethnic data for vaccinations at all.

Bibbins-Domingo said the missing or inconsistent data doesn’t necessarily mean tracking equity is a lost cause. Vaccination rates for census tracts where racial and ethnic data is known can be used as a proxy to estimate vaccine allocations.

However, Bibbins-Domingo argued that the pandemic has shined a light on racial data problems that have persisted far too long in U.S. public health.

“What my hope is, is that our lessons from covid really cause all of us to think about the infrastructure we need within our state and nationally to make sure we are prepared next time,” Bibbins-Domingo said. “Data is our friend.”

Local leaders and health officials in Missouri are scrambling to boost vaccination rates, especially among vulnerable communities, after Republican Gov. Mike Parson recently announced steps to urge residents back to working in person.

Parson ordered state workers back to the office in May and said he would end additional federal pandemic-related benefits for unemployed workers in June, despite vaccination rates across the state being well below what Missouri health experts had hoped to achieve.

Jackson County, Missouri, which includes most of Kansas City, authorized $5 million in federal CARES funding last month to increase vaccinations in six ZIP codes with large Black populations and low vaccination rates. The project will address problems of both access and hesitancy and focus on reaching out to individuals and neighborhoods.

Although many of the state’s vaccination efforts have involved large mass events, St. James Pastor Jackie McCall said she’s been talking with many in her church and community who need encouragement to have faith in the vaccines.

“So let’s go ahead and let’s trust,” McCall told congregants. “Let’s trust the process. Let’s trust God. Let’s trust the science.”

This story is part of a reporting partnership that includes KCUR, NPR and KHN.

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About Lambert Strether

Readers, I have had a correspondent characterize my views as realistic cynical. Let me briefly explain them. I believe in universal programs that provide concrete material benefits, especially to the working class. Medicare for All is the prime example, but tuition-free college and a Post Office Bank also fall under this heading. So do a Jobs Guarantee and a Debt Jubilee. Clearly, neither liberal Democrats nor conservative Republicans can deliver on such programs, because the two are different flavors of neoliberalism (“Because markets”). I don’t much care about the “ism” that delivers the benefits, although whichever one does have to put common humanity first, as opposed to markets. Could be a second FDR saving capitalism, democratic socialism leashing and collaring it, or communism razing it. I don’t much care, as long as the benefits are delivered. To me, the key issue — and this is why Medicare for All is always first with me — is the tens of thousands of excess “deaths from despair,” as described by the Case-Deaton study, and other recent studies. That enormous body count makes Medicare for All, at the very least, a moral and strategic imperative. And that level of suffering and organic damage makes the concerns of identity politics — even the worthy fight to help the refugees Bush, Obama, and Clinton’s wars created — bright shiny objects by comparison. Hence my frustration with the news flow — currently in my view the swirling intersection of two, separate Shock Doctrine campaigns, one by the Administration, and the other by out-of-power liberals and their allies in the State and in the press — a news flow that constantly forces me to focus on matters that I regard as of secondary importance to the excess deaths. What kind of political economy is it that halts or even reverses the increases in life expectancy that civilized societies have achieved? I am also very hopeful that the continuing destruction of both party establishments will open the space for voices supporting programs similar to those I have listed; let’s call such voices “the left.” Volatility creates opportunity, especially if the Democrat establishment, which puts markets first and opposes all such programs, isn’t allowed to get back into the saddle. Eyes on the prize! I love the tactical level, and secretly love even the horse race, since I’ve been blogging about it daily for fourteen years, but everything I write has this perspective at the back of it.


  1. chris

    This is one of those times that I wish the people pushing “equity” would listen to the people who aren’t getting vaccinated and why they aren’t getting vaccinated. Equity in this case IS equal opportunity to be vaccinated and recover from the effects (if any) from receiving the medication. Equity would be giving people access to post vaccine care and a day off.

    Using the term equity and throwing racial nonsense into this discussion is a way to show people you’re performatively nodding in the socially correct direction without actually doing anything to help anyone. Poor people and laborers with no time off and no ability to handle the scheduling requirements of receiving and recovering from a vaccine need help. It doesn’t matter what their skin color is. If people were concerned about potentially racial implications from this pandemic they’d be pushing Medicare For All and the kind of public health programs that would give poor people access to vitamins and good food and time off to be in the sunshine.

    1. Mantid

      Chris, Good points all. However, “divide and conquer” has proven more effective, for some with vested (invested?) interests. One hand is waving a shiny and deceptive sign spouting black, Asian, Latino, indigenous, white, etc., while the other hand is in your purse. Old trick that’s still quite effective. If we were “all” as in Medicare for All, we’d be united. But no, we’re separate and fighting over that one lump of sugar. Great link: three minutes

  2. Maritimer

    From the article:
    “…African Americans, who appear to have a vaccination rate of just 17.6%, nearly half of the 33% rate for the state as a whole.”

    So we have that rate, do we have the rate for the previously mentioned “rich and powerful”. No? Why not? The rich and powerful have many more prophylactic/treatment and vaccine options. I would think they are very, very careful about stepping into the $5 “free” beer and crapshoot vaccine line.

    In the same vein, what about all those private jets circling the Globe during this Humanity threatening pandemic? Oh, that is essential travel.

    If Trust is to be built, for starters, let’s have data transparency and then equal treatment and dictat enforcement.

  3. chris

    Sharing this because it’s related to this topic and so many others discussed on NC. John Oliver spouted off about the model minority myth on his show. His use of the terms “white supremacists” as well as “we” and “our” were telling.

    Who exactly is pushing the idea that minorities need different solutions for COVID in this country? Who is promoting the use of statistics that roll white and Asian Americans into one category because they’re not deemed challenged compared Hispanic and Black Americans? It’s not white supremacists. Who is going on NPR and crying that we really want to help these people but we don’t have the data? Not white supremacists. Who is steadfastly refusing to offer citizens the concrete material benefits and support needed to eliminate this epidemic? Not white supremacists.

    It’s so convenient that Democrats have a bogeyman to shield their eyes everytime they might have to look in a mirror :/

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