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COVID-19 Vaccination Rates: State-level and Subpopulation Evidence from the Household Pulse Survey - Update 3March 12, 2021:
Update 3: Feb 17 to Mar 1
Newly available COVID-19 vaccines promise to help protect individual Americans against infection and eventually provide population-level herd immunity. The pace of COVID-19 vaccination rollout in the United States has been somewhat unsteady, with a sizeable share of ups and downs from week to week—reports of slow early going were followed by states’ responsive attempts to pick up the pace in following period, only to be hampered by storms across the southern region interfering with supply. However, signs of vaccination progress have resumed, with the recent approval and release of the one-dose Johnson & Johnson vaccine, manufacturers ramping up vaccine production, and achieving the benchmark of 100 million COVID vaccination shots administered to Americans far earlier than anticipated.
The initial groups prioritized for vaccination were health care workers on the front lines of the pandemic and nursing facility residents, many of whom are especially vulnerable to COVID-19 infection and severe outcomes. While these groups continue to hold priority in vaccination slots, many states have since expanded vaccine access to other (still high-priority) segments of the general population such as older adults, K-12 and child care workers, essential workers, and those with high-risk medical conditions, with further vaccine eligibility expansion guidelines potentially coming soon. However, there are concerns that these prioritization decisions and the existing mechanisms of the vaccine rollout—in addition to evidence that lower-income individuals, people of color, and individuals without strong connections to the health care system are less likely to get vaccinated—are inadequate to narrow the clear disparities in the vaccine rollout so far and could worsen existing pandemic-related health inequities.
The available data have not assuaged these concerns, and show patterns of lower vaccination rates among people with lower incomes and levels of education, and marginalized racial and ethnic groups. The U.S. Census Bureau recently released updated data on take-up of COVID-19 vaccines from the most recent wave of its Household Pulse Survey (HPS), collected February 17-March 1, 2021.1 The HPS is an ongoing, weekly tracking survey designed to measure impacts of the COVID-19 pandemic. These data provide an updated snapshot of COVID-19 vaccination rates and are the only data source to do so at the state level by subpopulation.
This blog post presents top-level findings from these new data, focusing on rates of vaccination (one or more doses) among U.S. adults (age 18 and older) living in households and comparing to results from the most recent wave of the HPS, collected February 3-15, 2021.2 As of publication, no HPS data collection past March 1 has been announced, so this may be the final post in this series. SHADAC will continue to monitor any further data collection announcements related to the HPS and will update our readers accordingly.
More than one in four adults received a vaccination, but this varied by state
According to the new HPS data, 25.5% of U.S. adults had received one or more COVID-19 vaccinations during this two-week period in the second half of February, though this varied by state from a low of 21.8% in Tennessee to a high of 39.7% in Alaska. More than three in ten adults had received a vaccine in five states: Alaska, Connecticut, Hawaii, New Mexico, and North Dakota.
Vaccination rates increased substantially across nearly all states; states with lower rates catching up
Nationally, adult vaccination rates were up from the previous wave of the HPS, increasing from 19.9% during February 3-15, 2021, to 25.5% during February 17-March 1, 2021. Most states also experienced increases in their vaccination rates, though again the size of these increases varied across the states, from an increase of 1.8 percentage points (PP) in Georgia to an increase of 10.6 PP in North Dakota.
Percent of Adults Who Had Received a COVID-19 Vaccine
Disparities in vaccination rates have not improved
COVID vaccination rates continued to vary to a great degree by demographic and socioeconomic factors, and disparities were largely unchanged from previous weeks. There has been little progress in getting more vaccines to certain groups such as low-income, Hispanic, and Black adults, for instance, and new vaccination strategies and greater emphasis on equity may be needed to close the gaps for the hardest-to-reach groups.
By race and ethnicity, non-Hispanic Asian and non-Hispanic White adults continued to have above-average vaccination rates at 29.2% and 28.0%, respectively. Rates among non-Hispanic adults identifying with “Multiple” races or “Some other” race (21.2%), non-Hispanic Black adults (20.2%), and Hispanic/Latino adults of any race (18.9%) remained below the national average.
Percent of Adults Who Had Received a COVID-19 Vaccine by Race/Ethnicity
Disparities in vaccination rates by income, which had narrowed somewhat in previous weeks, were relatively unchanged from earlier in February. Adults with household incomes below $50,000 continued to have vaccination rates below the national average, whereas adults with household incomes above $50,000 had vaccination rates higher than the national average. These gaps failed to appreciably improve. The gap between the lowest income adults (household incomes of less than $25,000) and the national average was especially large, with low-income adults being 9.6 PP less likely to have received a vaccine than all adults (15.9% vs. 25.5%).
Percent of Adults Who Had Received a COVID-19 Vaccine by Income
Disparities by level of education remained, with adults holding a bachelor’s degree or higher continuing to have the highest vaccination rate at 34.7%, and adults without a high school diploma having the lowest vaccination rates at 17.2%. However, disparities by education did narrow slightly, and vaccination rates among both adults with a high school diploma or equivalent and adults with less than a high school education increased somewhat faster than the overall adult rate.
Percent of Adults Who Had Received a COVID-19 Vaccine by Education
More than half of older adults received a COVID vaccine as the U.S., and many states, continued to make large progress in vaccinating older adults
Nationally, 54.6% of older adults (age 65 and older) had received at least one dose of the COVID-19 vaccine, which was 29.1 percentage points higher than the rate among all adults (25.5%). Vaccination rates for older adults ranged from 27.0% in Oregon to 73.3% in Louisiana. Older adult vaccination rates were below 40% in six states (Hawaii, New Jersey, Oregon, Pennsylvania, Vermont, and Virginia) and at or above 70% in four states (Alaska, California, Indiana, and Louisiana) as well as in the District of Columbia (D.C.)
Percent of Adults Age 65+ Who Had Received a COVID-19 Vaccine
As in the previous period, states continued to make good progress in rates of vaccination among older adults. Compared to the first half of February, 23 states increased their age 65+ vaccination rates by at least 0.5x, and two states (Rhode Island and Connecticut) more than doubled their 65+ vaccination rates. Only a handful of states failed to make substantial progress in increasing vaccination rates among older adults.
Notes about the Household Pulse Survey Data
The estimated rates presented in this post were calculated from the count estimates published by the Census Bureau. Though these counts are accompanied by standard errors, standard errors are not able to be accurately calculated for rate estimates. Therefore, we are not able to determine if the differences we found in our analysis are statistically significant or if the estimates themselves are statistically reliable. Estimates and differences for subpopulations at the state level should be assumed to have large confidence intervals around them and caution should be taken when drawing strong conclusions from this analysis. However, the fact that patterns of inequities in other vaccination rates are mirrored by these early indications of COVID-19 vaccination inequities demonstrates reason for concern.
Though produced by the U.S. Census Bureau, the HPS is considered an “experimental” survey and does not necessarily meet the Census’s high standards for data quality and statistical reliability. For example, the survey has relatively low response rates (7.3% for February 17 - March 1), and sampled individuals are contacted via email and text message, asking them to complete an internet-based survey. These issues in particular could be potential sources of bias, but come with the tradeoffs of increased speed and flexibility in data collection as well as lower costs. A future post will investigate differences between COVID vaccination rates estimated from survey data (such as the HPS) and administrative sources. The estimates presented this post are based on responses from 77,788 adults. More information about the data and methods for the Household Pulse Survey can be found in a previous SHADAC blog post.
Previous Blogs in the Series
COVID-19 Vaccination Rates: State-level and Subpopulation Evidence from the Household Pulse Survey (Update 2: Feb 3 to Feb 15)
COVID-19 Vaccination Rates: State-level and Subpopulation Evidence from the Household Pulse Survey (Update: Jan 20 to Feb 1)
COVID-19 Vaccination Rates: State-level and Subpopulation Evidence from the Household Pulse Survey (Jan 6 to Jan 18)
State-level Flu Vaccination Rates among Key Population Subgroups (50-state profiles) (SHADAC Infographics)
50-State Infographics: A State-level Look at Flu Vaccination Rates among Key Population Subgroups (SHADAC Blog)
Anticipating COVID-19 Vaccination Challenges through Flu Vaccination Patterns (SHADAC Brief)
New Brief Examines Flu Vaccine Patterns as a Proxy for COVID – Anticipating and Addressing Coronavirus Vaccination Campaign Challenges at the National and State Level (SHADAC Blog)
Ensuring Equity: State Strategies for Monitoring COVID-19 Vaccination Rates by Race and Other Priority Populations (Expert Perspective for State Health & Value Strategies)
SHADAC Webinar - Anticipating COVID-19 Vaccination Challenges through Flu Vaccination Patterns (February 4th) (SHADAC Webinar)
 The estimates presented here represent an average of this time period.
 It is important to mention that the HPS does not collect data for institutionalized adults, such as those living in nursing facilities, or in correctional facilities such as prisons or jails.