U.S. counties with lower COVID-19 vaccination rates among people 65 years or older also have higher numbers of older adults living in poverty or with other social vulnerabilities, according to researchers from the Centers for Disease Control and Prevention (CDC).
Older adults were among those prioritized to receive the vaccine early during the country’s rollout, as they are at higher risk of severe illness or deathTrusted Source from COVID-19.
But CDC researchers found that between December 2020 and April of this year, the percentage of older adults who had received at least one dose of a COVID-19 vaccine varied widely across the country.
During this time, 79.1 percent of older Americans received at least one dose of a COVID-19 vaccine. Rates were slightly higher in men (79.6 percent) than women (77.5 percent). They were also slightly higher among 65- to 74-year-olds (79.6 percent) than people 75 years or older (78.3 percent).
First-dose vaccination rates ranged from 68.9 percent in Alabama and 69.2 percent in West Virginia to 92.9 percent in Vermont and 99.9 percent in New Hampshire.
Researchers also found that counties with lower vaccination rates among older adults were more likely to have higher numbers of older adults living in poverty, living alone, or without access to a computer or the internet.
The results were published May 14 in the CDC’s journal Morbidity and Mortality Weekly Report (MMWR)Trusted Source.
Health disparities occurred across pandemic
Anne Sosin, MPH, a policy fellow at Dartmouth’s Nelson A. Rockefeller Center for Public Policy and the Social Sciences, is not surprised that the study found that counties with higher levels of social vulnerability have lower rates of vaccination among older adults.
“This tracks with what we’ve seen during the whole pandemic,” she said. “There are distinct risk factors that have produced really significant disparities [in some areas], and many of these disparities are being replicated in the process of vaccination.”
The CDC researchers wrote that their results are consistent with earlier studies that found disparities in shingles vaccination and in COVID-19 vaccination across all age groupsTrusted Source.
Some states have tried to address vaccination barriers faced by older adults.
But Dr. Preeti Malani, chief health officer and a professor of medicine in the division of infectious diseases at the University of Michigan, says there’s not just one solution to this problem
Instead, health officials need to look at why older adults in the community are getting missed.
“The solution to each case might be different,” said Malani.
“If it’s someone who is concerned about the safety of vaccination, then they should have a conversation with someone they trust, with their doctor or another healthcare provider, and get good information.”
“If it’s that people don’t know how to schedule an appointment or just didn’t get around to it, then let’s help them get scheduled.”
Transportation can also be a big issue for some older adults.
“For a portion of people, it’s really hard to get them out the door, such as older adults who rely on caregivers,” said Malani. “So we need models where people are combining vaccination with home care visits.”
Some states are trying these kinds of approaches.
Fulton County, Georgia, is offering free Uber and Lyft rides for older adults who don’t have transportation to take them to their vaccination appointment.
The White House announced this week that this service will soon be available to all Americans, not just older adults. This is part of President Biden’s effort to ensure that 70 percent of U.S. adults have received at least one dose of a COVID-19 vaccine by July 4.
In Texas, Gov. Greg Abbott launched an initiative to vaccinate homebound older adults in their own homes.
Early on, there was a rush to vaccinate older adults to protect them from the coronavirus, which led to an all-hands-on-deck approach.
Going forward, different approaches may work.
“The hope now is that as people come to their regular doctor’s office — primary care or otherwise — that the office will be set up to vaccinate people there,” Malani said. “This is where the [Johnson & Johnson] vaccine is a potential option — it’s one dose and you’re done.”
Older adults are one piece of vaccination efforts
While many of these efforts are similar across the country, states have had to tailor their approach to fit the needs of older adults in their communities.
Sosin says Vermont, which has a large rural population, reached older adults spread out across the state by using a decentralized approach — as opposed to just relying on mass vaccination sites.
“The state has used a lot of community sites — schools, firehouses, pharmacies — to deliver the vaccine so that rural residents are not traveling 2 or 3 hours to find a site.”
Vermont’s neighbor was in a similar situation.
Public health officials in New Hampshire “knew that some people would have to drive 2 or more hours to get to a vaccination site,” said Sosin. “At the time, it was still winter, which is a real deterrent for getting vaccinated, especially among people who might be less inclined to do so.”
“So they reorganized the public health network to push vaccine far out into the rural part of the state. And I think those efforts have been really critical to penetrating deep into the rural areas.”
One of the things that is often overlooked with these public health efforts is the importance of trust in the government, which Sosin says is particularly high in Vermont.
“We see relatively high levels of social solidarity and cohesion in the state. There’s also a high level of trust among older populations,” she said. “So it doesn’t surprise me at all that Vermont has consistently been one of the leaders in reaching its older population.”
While Vermont is a leader in doses delivered to older adults, Sosin says the state’s heavy focus on reaching older adults early has come at a cost.
“Vermont has enormous racial disparities in its vaccination rates, and I think that’s a direct effect of opting for an age-based approach,” she said.
In March, vaccination rates were 13 percent higher for non-Hispanic whites in Vermont than for the state’s Black, Indigenous, and People of Color (BIPOC) population, according to the state’s department of health.
This gap has narrowed since then, but remains at 6 percent, with much of this disparity due to lower vaccination rates among BIPOC Vermonters 65 years or older.
“Eventually, the state backed away from the age-based approach, and opened up vaccination to all BIPOC Vermonters and their household members,” Sosin said. “But that happened in April, and we continue to see persistently high persistent racial disparities in infection rates in the state.”