Black, Latino SC residents vaccinated at much lower rates than whites, data show
White South Carolinians have been vaccinated against COVID-19 at twice the rate of Black residents and more than three times the rate of Latinos in the state, according to demographic vaccination data state health officials released this week.
A month since the state began vaccinating seniors in addition to health care workers and long-term care facility residents and staff, about 10% of white residents have gotten COVID-19 shots compared to 5% of Black residents and only 3% of Latinos, The State’s analysis of vaccination and census data found.
Viewed another way, Blacks comprise 27% of South Carolina’s population, but have received only 12.5% of vaccine doses, while Latinos, who make up nearly 6% of the state’s residents, have gotten less than 2% of the doses.
The nearly two-thirds share of COVID-19 doses white residents have received, on the other hand, is virtually identical to their proportion in the population.
Georges C. Benjamin, a physician and former Maryland state health secretary who now serves as executive director of the American Public Health Association, said the presence of racial disparities in South Carolina’s COVID-19 vaccination rates is neither unusual nor surprising.
“We are seeing these disparities quite frequently, so I’m not surprised that South Carolina is having the same challenges that many states are having,” he said.
A recent analysis of racial vaccination disparities by Kaiser Health News found white residents were being vaccinated at higher rates than Black residents in all 23 states that had released demographic vaccination data. South Carolina was not included in that analysis, but would slot into the middle of the pack in comparison to the states that were.
Just because the state is not an outlier, however, doesn’t mean officials shouldn’t make an effort to reduce vaccination disparities, Benjamin said.
“I think disparity is typical,” he said. “The issue here is whether it’s avoidable, and I believe it’s avoidable. States should do whatever they can to eliminate disparities.”
In recent weeks, state Department of Health and Environmental Control officials have stressed their commitment to equitable vaccine distribution, particularly in relation to reaching more rural areas, while acknowledging that more work is needed.
“We are now very focused on how do we make sure we’re getting into every area — rural, urban whatever it is,” DHEC director Edward Simmer said Tuesday during a House Legislative Oversight Committee hearing on COVID-19 vaccine distribution. “Many of those areas are underserved medically. That adds to the challenge of getting vaccine. But we are committed to finding those places and, ultimately, we need to take the vaccine to people not ask them to come to us. And until we can do that, we won’t be successful.”
People of color bear brunt of COVID-19
The coronavirus pandemic has taken an outsize toll on communities of color, both nationally and in South Carolina, making vaccination of those populations crucial to saving lives.
Black people and Latinos across the country have died of COVID-19 at roughly 1.4 times and 1.2 times the rate of whites, respectively, according to the COVID Racial Tracker.
In South Carolina, Blacks account for nearly 28% of coronavirus deaths and 36% of COVID-19 hospitalizations, despite comprising 27% of the population, according to state health data.
State Rep. Pat Henegan, who chairs the S.C. Legislative Black Caucus, said she attributed racial disparities in the state’s vaccination rates to three distinct issues: longstanding systemic inequalities that affect communities of color, DHEC’s initial failure to prioritize underserved populations and Black residents’ concerns about the safety of the vaccine.
Henegan said state health officials have stepped up efforts to vaccinate rural communities in recent weeks under pressure from lawmakers, but that DHEC had erred initially by failing to recognize that many seniors in rural areas — which in South Carolina have significantly higher Black populations than do urban centers — would struggle to schedule vaccination appointments online and often lacked reliable access to transportation.
“Many people in rural areas don’t have broadband and don’t even know how to use a computer,” said Henegan, a Marlboro Democrat. “So you’re asking them to fill out an (online) form and they don’t even have a computer.”
She credited DHEC for adding a dedicated telephone line that people can call with vaccination scheduling questions and for holding more vaccination clinics in rural parts of the state in recent weeks.
“They’re doing what they’re supposed to do now,” Henegan said.
Another reason why vaccination rates may be lower among Black South Carolinians, she said, is skepticism about the COVID-19 vaccine.
“I’ve heard many people say they don’t want to do it because they don’t trust it,” said Henegan, who attributed Black residents’ concerns to the country’s dark history of experimenting on African Americans and failing to gain their informed consent for medical research.
“They’re going back into history and talking about what had happened with the Black race before, how they have suffered because of that.”
Multiple studies have shown that Black and Latino adults are more likely to take a wait-and-see approach with the COVID-19 vaccine than white adults.
While the share of U.S. adults who want to be vaccinated as soon as possible has increased for all races since December, according to a recent Kaiser Health News survey, Black and Hispanic adults continue to express significantly more hesitation than white adults.
Vickie Mays, a public health professor at UCLA whose research focuses on racial health disparities, said it’s important to acknowledge the legitimate concerns African Americans have about the COVID-19 vaccine rather than blaming them for having questions about its safety.
“I think vaccine hesitancy is a term that should get out of all the media’s vocabulary,” she said, adding that framing African Americans as overly hesitant to receive the vaccine stigmatizes them for behaving as any astute patient should.
Mays said once Black patients have their questions about the COVID-19 vaccine answered, vaccine uptake rates increase, although that can take more time for people who are disconnected from the health care system and lack an obvious point of contact to ask about their concerns.
“That’s not hesitancy,” she said. “Any person who has a very complex health profile, they should be asking these questions to health providers.”
Structural inequality may explain racial vaccination disparity
Mays said it’s also important to consider more structural explanations for the differences in South Carolina’s vaccination rates before jumping to the conclusion that explicit racial bias played a role in the distribution of doses.
“There are a lot of issues that don’t stem from right now someone is trying to keep (the COVID-19 vaccine) out of someone’s arm,” she said, explaining that racial disparities may be a product of who was prioritized for the vaccine rather than how it’s since been distributed.
Without knowing how many Black and Latino people are included in South Carolina’s initial vaccine phase, it’s impossible to know if they’re being vaccinated at lower rates than whites, she said.
DHEC has said only that about 1.3 million South Carolinians comprise Phase 1a, but has not provided a racial breakdown of its members.
Since the state’s vaccination campaign began at hospitals, which are generally located in urban centers, and prioritized medical workers, who tend to be whiter than the population at large — a recent study by the South Carolina Office for Healthcare Workforce found only 12% of the state’s nurses were Black and Latino -- it’s possible vaccination rates are lower for African Americans and Latinos simply because they’re underrepresented in Phase 1a, Mays said.
“The majority of our vaccine went out to 1a,” she said. “Everyone is screaming about race, but the race issue is that we don’t have enough health care participants who are racial and ethnic minorities.”
Another structural issue that could be driving racial differences in vaccination rates is relative life expectancy, Mays said.
Because Black South Carolinians have life expectancies that are about four years shorter than whites’ on average, their representation in Phase 1a may have shrunk further when DHEC expanded vaccine eligibility to people age 65 and older because there are proportionally fewer elderly African Americans, she said.
State epidemiologist Linda Bell said she attributes disparities in the state’s vaccination data to the racial makeup of the health care workforce.
“In prioritizing health care providers, racial and ethnic minorities are not as high a proportion of workers in that health care industry,” she said during a media briefing Wednesday in response to a question about the reason for the state’s racial vaccination disparities. “And we also acknowledge that they may be more likely to work in settings that were not prioritized and are more likely to be in Phase 1b.”
Bell said because DHEC’s demographic vaccination dashboard includes data for Phase 1a individuals only, it doesn’t provide an entirely accurate picture of who is and who isn’t getting vaccinated in South Carolina.
As more of the general population gets vaccinated, however, she said the agency would seek to identify and rectify any disparities observed in local communities across the state.
“This (demographic vaccination data) will help us make direct connections with neighborhoods and communities to identify and remove any barriers or limitations,” Bell said. “We want all South Carolinians to have fair, equal and ethical access to their COVID-19 vaccines, and our agency and our key community partners are working to ensure that happens.”
Simmer, the DHEC director, said Tuesday the agency plans to address vaccination inequities by holding more clinics in rural areas, onboarding more rural vaccine providers, ramping up vaccine education efforts and speaking engagements, and working with local leaders whose words carry weight in rural communities.
“They’re much more likely to listen to the people that they know and trust, and that’s going to be the people in their local community,” Simmer said Tuesday, citing faith leaders, civic group leaders, neighborhood association leaders and politicians. “We want to get those folks engaged with us, get them on the team, educating folks about the vaccine, (and) when they’re eligible, have them getting the vaccine publicly, so the folks who look up to them for guidance know it’s the right thing to do as well.”
The agency is also in the process of developing what it hopes will be a more equitable way of allocating vaccine.
DHEC currently uses vaccine supply, demand and uptake to determine how to disperse doses across the state, but plans soon to move to a per capita model in which population dictates how much vaccine flows into various corners of the state.
After previously requesting that state health officials consider a county-based vaccine distribution plan, the agency’s board last week asked officials to evaluate a plan to distribute doses to each of South Carolina’s four public health regions on a per capita basis, as a recently approved COVID-19 funding bill requires.
The agency plans to create panels to provide recommendations on how most equitably to distribute vaccine in each public health region, as lawmakers have requested, taking into consideration factors like poverty level, infection rate, age and high-risk populations, DHEC spokeswoman Laura Renwick said.
This story was originally published February 17, 2021 at 2:46 PM.