VDH Plan for Equitable Distribution of COVID-19 Vaccine (March 1, 2021)
Summary
The VDH Plan for Equitable Distribution of COVID-19 Vaccine, dated March 1, 2021, a monthly report from the Office of Health Equity in the Virginia Department of Health under the supervision of the Chief Diversity, Equity, and Inclusion Officer and the Equity Leadership Task Force. The executive summary states that 217,426 COVID-19 vaccine doses have been administered at long-term care facilities and that 1,140,940 Virginians have received at least one dose. It reports lower vaccination rates for Black and Hispanic populations and rural counties, and compares Virginia with other states in Region 3 of the Federal Emergency Management Agency (FEMA). An appendix reproduces the 2020 Appropriation Act Item 299 charging language.
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“VDH Plan for Equitable Distribution of COVID-19 Vaccine (March 1, 2021).”
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VDH Plan for
Equitable
Distribution
of COVID-19
Vaccine
MARCH 1, 2021
Office of Health Equity in the Virginia
Department of Health
Under the supervision of the
Commonwealth of Virginia’s Chief Diversity,
Equity, and Inclusion Officer
and the Equity Leadership Task Force
Contents
Executive Summary ......................................................................................................................2
1. Key Equity Accomplishments ..................................................................................................4
2. Vaccination Equity in Virginia ..................................................................................................5
Elderly Vaccination .................................................................................................................... 5
Race/Ethnicity ............................................................................................................................ 7
Rural Areas ................................................................................................................................ 8
3. Vaccinations in FEMA Region 3 ...............................................................................................9
FEMA Region 3 and Race/Ethnicity ..........................................................................................10
FEMA Region 3 and the Elderly ................................................................................................12
4. Policy and Administrative Updates ........................................................................................12
Legislative Updates...................................................................................................................12
Executive Updates ....................................................................................................................14
Agency Updates .......................................................................................................................15
Court Updates...........................................................................................................................15
5. Achieving Equitable Distributions of Vaccinations in Virginia ............................................16
Appendix ......................................................................................................................................17
Charging Statutes .....................................................................................................................17
Vaccine Equity Report | March 2021 Page 1
Executive Summary
This monthly report is the first from the Office of Health Equity in the Virginia Department of Health
under the supervision of the Governor’s Chief Diversity, Equity, and Inclusion Officer and the
Equity Leadership Task Force. It provides an overview of vaccination equity in the Commonwealth,
including key equity accomplishments.
COVID-19 infection rates, hospitalizations, and deaths have disproportionately impacted
individuals in long-term care facilities, the elderly, and Black and Hispanic populations.
Additionally, individuals in rural communities are at higher risk for serious illness if they contract
COVID-19 due to fewer hospitals, ICU units, and infectious disease physicians.
In addition to reporting equity distribution of the COVID-19 vaccine, this report also compares
Virginia to other states in Region 3 of the Federal Emergency Management Agency (FEMA),
namely Delaware, the District of Columbia, Maryland, Pennsylvania, and West Virginia. It also
presents an overview of recent legislative and executive activities at both the federal and state
levels, as well as equity considerations for future vaccine distribution.
Summary key equity findings include:
● Virginia is doing relatively well in vaccinating individuals in long-term care facilities
and the elderly. At present, 217,426 COVID-19 vaccine doses have been administered at
long-term care facilities (Source). Additionally, 1,140,940 Virginians have received at least
one vaccine dose. Those age 60-69 (216,488) make up 19% of those receiving at least one
dose, and those age 70+ (390,306) comprise 34.2% of those receiving at least one dose.
● Black and Hispanic populations are receiving vaccinations at far lower rates than
whites. This is particularly concerning because Blacks and Hispanics are
disproportionately infected and die from COVID-19, but whites are disproportionately
receiving vaccinations (Source).
% of total population % of % of COVID % of COVID
in Virginia Vaccinations Cases Deaths
White 61% 72% 52% 63%
Black 19% 12% 22% 24%
Hispanic 10% 6% 17% 7%
Source: Kaiser Family Foundation (Click here).
Vaccine Equity Report | March 2021 Page 2
● Rural counties have lower vaccination rates: More rural counties experience a higher
risk due to COVID-19 (Source), yet rural counties have lower vaccination rates, per
100,000 population (Source). Some of the challenges facing rural areas include limited
supply based on population per capita, limited broadband access for a high technology
driven enrollment process, and limited regional health care centers and vaccinators.
● Within FEMA Region 3, Virginia is currently ranked third in terms of COVID-19
vaccine doses administered. West Virginia and the District of Columbia rank higher than
Virginia. Delaware, Maryland, and Pennsylvania rank lower.
● To address inequities in vaccinations in Virginia, vaccine allocations and vaccination
strategies should be targeted at vulnerable populations. This includes prioritizing equity
in mass vaccinations plans, community vaccination plans, and most importantly, including
monitoring and accountability of vaccination equity outcomes.
Vaccine Equity Report | March 2021 Page 3
1. Key Equity Accomplishments
● January 12: Virginia Department of Health Office of Health Equity and the Health Equity
Task Force presented an equitable vaccine allocation/prioritization plan (Source)
● January 29: Procured the Research Institute for Social Equity (RISE) in the L. Douglas
Wilder School of Government and Public Affairs at Virginia Commonwealth University to
conduct equity research and develop community vaccination plans.
● February: Added a statement to the VDH website which encourages all individuals to self-
report race and ethnicity data when they register for a vaccine and on the day they are
vaccinated (Source); added a statement encouraging providers to enter that data if it is
missing (Source)
● February: The Office of Health Equity shared the updated guidebook tailor-made for
helping local health districts respond to COVID-19 equitably (Source)
● February 16: Launched the Vaccinate.Virginia.gov website, a “one-stop-shop” allowing
individuals to pre-register for a vaccine, verify their pre-registration status, and receive
additional information about vaccination (Source)
● February 17: Launched the Vaccinate Virginia Call Center (1-877-VAX-IN-VA) as a
centralized pre-registration call center for those without internet access and for those who
prefer to pre-register by phone. It is open seven days a week, is accessible to the hearing
impaired, and is accessible in 100+ languages (Source)
● February 19: Changed vaccination allocation strategy from a population-based/per capita
strategy to a strategy prioritizing vulnerable populations with higher rates of hospitalizations
and deaths (e.g. those in long-term care facilities, those in correctional facilities, and Black
and Hispanic communities) (Source)
● February 26: Over 14,000 inmates and 5,600 staff within the Virginia Department of
Corrections have received a first round COVID-19 vaccination (Source)
● February 26: Deputy Secretary of the Commonwealth and Director of Black/African
American Outreach, Office of Governor Ralph S. Northam, was named the Director of
Vaccination Outreach and will be working with the community-based outreach for vaccine
distribution across the Commonwealth
● February 26: Governor Northam Introduces First-Ever Statewide Strategic Plan, One
Virginia Online Toolkit, to Advance Diversity, Equity, and Inclusion (Source)
Vaccine Equity Report | March 2021 Page 4
2. Vaccination Equity in Virginia
Over 1.93 million vaccine doses have been administered in Virginia. At present, 14.8% of
Virginians have received at least one dose of a vaccine. Over 660,000 people have been fully
vaccinated in Virginia, which represents 7.8% of the population (Source; Source).
Elderly Vaccination
● Of those Virginians receiving at least one dose (1,140,940), those age 60+ account for
606,794, or roughly 53.2% of all those receiving at least one dose. Those age 60-69
(216,488) make up roughly 19% of all those receiving at least one dose, and those age 70+
(390,306) comprise roughly 34.2% of all those receiving at least one dose.
Figure 1: Vaccinations by Age (One Dose + Two Doses)
One Dose
Two Doses
Source: Click here.
Vaccine Equity Report | March 2021 Page 5
Vaccinations in long-term care facilities (LTCFs) have been very successful, as these critical
efforts continue (see Figure 2).
● As context, there have been 29,881 COVID-19 cases in LTCFs (5% of all cases in Virginia)
and 3,477 deaths (45% of all deaths in Virginia) (Source). Currently, 217,426 COVID-19
vaccine doses have been administered (of 223,470 doses received) at long-term care
facilities (LTCFs). Virginia has an estimated 19,550 nursing facility residents among roughly
6.36 million adults (~0.31% of the adult population) (Source). Vaccine doses administered
at LTCFs account for roughly 11% of all total doses administered (Source).
● These efforts are part of a federal program, the Pharmacy Partnership for Long-Term Care
Program, in which Virginia is enrolled (Source; Source; Source). CVS and Walgreens are
providing vaccination clinics at LTCFs across the state (Source).
● It is critical that LTCF residents and workers continue to receive the vaccine as these
populations are particularly vulnerable (Source) and as this population represents 6.1% of
the priority population as a share of total adults (Source).
● Among those who reside in LTCFs, the vast majority (77.9%) are white (Source). These
racial differences are due to several factors, including the high cost of LTCFs and
differences in cultural norms regarding the use of LTCFs to care for the elderly (Source;
Source). While LTCF vaccination rates are encouraging, they also underscore the need to
prioritize vaccination efforts for Black and Hispanic elderly who do not reside in such
settings.
Figure 2: Vaccinations in Long-Term Care Facilities
Source: Click here.
Vaccine Equity Report | March 2021 Page 6
Race/Ethnicity
Black and Hispanic populations are receiving vaccinations at far lower rates than whites in Virginia.
As Table 1 depicts, while whites constitute 61% of Virginia’s population, they have received 72% of
vaccinations. By comparison, Blacks constitute 19% of Virginia’s population and have received
12% of vaccinations; Hispanics constitute 10% of Virginia population and have received 6% of
vaccinations. This is particularly concerning because Black and Hispanics are disproportionately
impacted by COVID-19, but whites are disproportionately receiving vaccinations. As Figure 3
displays, white Virginians are being vaccinated at almost twice the rate of Black and Hispanic
populations.
Table 1: Race, COVID Cases and Deaths, and Vaccinations in Virginia
% of total population % of % of COVID % of COVID
in Virginia Vaccinations Cases Deaths
White 61% 72% 52% 63%
Black 19% 12% 22% 24%
Hispanic 10% 6% 17% 7%
Source: Kaiser Family Foundation (Click here).
Figure 3: Vaccinations by Race (One Dose)
One Dose
Source: Click here.
Vaccine Equity Report | March 2021 Page 7
Rural Areas
While Virginia has seen improvements in the urban-rural divide in terms of COVID-19 vaccinations,
overwhelmingly, rural areas continue to experience equity issues in terms of access to vaccines
(Figure 4). Many rural areas in Virginia have elevated risk (Figure 5). A number of challenges
persist for vaccination efforts in Virginia's rural communities (Source):
● Limited supply of vaccines as a result of the rate per population distribution process
● Poor broadband access which impacts the heavily technology driven vaccination
registration system
● Limited regional healthcare centers which impact vaccine access and the number of
vaccinators
Figure 4: Vaccinations by Locality – Rate per 100,000 Population
Source: Click here.
Figure 5: COVID-19 Risk Levels by Local Level (Source)
Vaccine Equity Report | March 2021 Page 8
Source: Click here.
3. Vaccinations in FEMA Region 3
Virginia is a part of FEMA Region 3 which also includes Delaware, the District of Columbia,
Maryland, Pennsylvania, and West Virginia. As shown in Figure 6, Virginia has the second highest
daily new cases in the region, at 22.7 new cases per 100,000 people. Virginia is currently ranked
third in the region in terms of COVID-19 vaccine doses administered (Figure 7). West Virginia and
the District of Columbia rank higher than Virginia; Delaware, Maryland, and Pennsylvania rank
lower. The neighboring state of North Carolina (not included in map below) also ranks lower than
Virginia, although it is not a part of FEMA Region 3.
Figure 6: COVID-19 Risk Levels* by County across FEMA Region 3
Source: Click here.
Vaccine Equity Report | March 2021 Page 9
Figure 7: FEMA Region 3 + North Carolina Vaccination Trends
Source: Click here.
FEMA Region 3 and Race/Ethnicity
All areas in FEMA Region 3 show clear racial disparities in percentages of vaccines administered
to populations versus those in the population, except for the District of Columbia. Overall, whites
have received a disproportionately higher share of vaccinations, compared to Blacks, Hispanics,
and Asians. Comparative state tracking of vaccines by race and ethnicity is challenging because
not all vaccine providers record and report this data. (Source). Figure 8 is based on multiple
sources of data, including each state’s and the District of Columbia’s COVID-19 vaccination
dashboards; US Census data; and other demographics and vaccination data.
Vaccine Equity Report | March 2021 Page 10
Figure 8: Comparative Charts (Population and Vaccination Demographics)
Delaware Washington, DC
80.0% 50.0%
70.0%
40.0%
60.0%
50.0% 30.0%
40.0%
30.0% 20.0%
20.0%
10.0%
10.0%
0.0% 0.0%
White Black Hispanic Asian Other White Black Hispanic Asian Other Unknown
Population Vaccination Population Vaccination
Maryland Pennsylvania
70.0% 100.0%
60.0% 90.0%
80.0%
50.0% 70.0%
40.0% 60.0%
50.0%
30.0%
40.0%
20.0% 30.0%
10.0% 20.0%
10.0%
0.0%
0.0%
White Black Hispanic Asian Other
White Black Hispanic Asian Other
Population Vaccination
Population Vaccination
Virginia West Virginia
80.0% 100.0%
70.0%
80.0%
60.0%
50.0% 60.0%
40.0%
30.0% 40.0%
20.0%
20.0%
10.0%
0.0% 0.0%
White Black Hispanic Asian Other Unknown
White Black Hispanic Asian Other
Population Vaccination
Population Vaccination
Vaccine Equity Report | March 2021 Page 11
FEMA Region 3 and the Elderly
As shown in Table 2, within FEMA Region 3, individuals age 60+ and 65+ have received roughly
50%+ of vaccines. Comparisons across states are complicated given differences in publicly
reported data (e.g., cumulative doses versus one dose versus two doses), age groupings (e.g.,
listing ages 60-69 or ages 65-69), and numbers of persons outside of those age 65+ working in
critical areas necessitating vaccination priority.
Table 2: Comparison of Population and Vaccination Demographics, FEMA Region 3
District of West
Virginia1 Delaware2 Maryland1 Pennsylvania
Columbia Virginia
# Receiving at
least one dose, 607K 116K 22.8K 442K 548K 238K
Age 65+
% of Persons
53.2% 55% 70.3% 49.2% 59% 54.4%
Receiving Doses
% of Age 65+ in
15.9% 19.4% 12.4% 15.9% 18.7% 20.5%
Population
1
Publicly reports data for 60+. Figures reported in this table reflect persons age 60+.
2
State publicly reports cumulative doses only.
Sources: US Census 2019 estimates and data portals for FEMA Region 3.
4. Policy and Administrative Updates
Legislative Updates
● United States Congress
o President Biden has proposed a $1.9 trillion COVID relief package. It includes a
stimulus payment of $1,400 for single taxpayers or $2,800 for married joint filers,
plus $1,400 per dependent. Individuals earning up to $75,000 would receive the full
amount, as would married couples with incomes up to $150,000. It also includes
billions of dollars of funding for schools, state and local governments, and
businesses. Biden’s proposal is being considered by Congress, where it has been
approved in the U.S. House of Representatives.
● Virginia General Assembly
o During the 2021 regular and special sessions, the General Assembly passed several
significant pieces of COVID-19 legislation, including emergency legislation aimed to speed
up vaccine distribution efforts by widening the pool of those who are eligible to be
vaccinated and adding vaccination sites. This legislation also requires the mandatory
collection of race and ethnicity data for all individuals vaccinated. This bill has been signed
Vaccine Equity Report | March 2021 Page 12
by Governor Northam. Other bills are currently being considered by the Governor, and,
depending on the Governor’s actions, could be reconsidered during the Reconvened
Session on April 7. A summary description of each COVID-related bill is below.
o Legislative bills passed by the Senate of Virginia and House of Delegates:
§ Senate Bill 1445 and House Bill 2333 | Passed both houses with an
emergency clause; Governor signed and the bill became effective 2.15.21.
The bill requires the Department of Health (the Department) to establish a
program to enable eligible health care providers to volunteer to administer
the COVID-19 vaccine to residents of the Commonwealth during a state of
emergency related to the COVID-19 pandemic declared by the Governor.
The bill defines "eligible health care provider" and provides that the program
shall include (i) a process by which an eligible health care provider may
register to participate in the program and (ii) the training requirements for
participating eligible health care providers related to the administration of the
COVID-19 vaccine, including training on the intramuscular injection of the
COVID-19 vaccine and contraindications and side effects of the COVID-19
vaccine. The bill also requires the collection of race and ethnicity data of
people receiving the vaccine.
§ House Bill 2124 | Passed both houses; Governor’s action deadline 3.31.21
Directs the Department of Medical Assistance Services to, during a public
health emergency related to COVID-19 declared by the United States
Secretary of Health and Human Services, deem testing for, treatment of, and
vaccination against COVID-19 to be emergency services for which payment
may be made pursuant to federal law for certain aliens not lawfully admitted
for permanent residence.
§ Senate Bill 1375 and House Bill 2207 | Conference Committee report
approved by both houses; Governor’s action deadline 3.31.21
Establishes a presumption that COVID-19 causing the death or disability of
firefighters, emergency medical services personnel, law-enforcement
officers, and correctional officers is an occupational disease compensable
under the Workers' Compensation Act.
§ Senate Bill 1296 | Passed both houses; Governor’s action deadline
3.31.21
Provides for the State Coordinator of Emergency Management to establish
an Emergency Management Equity Working Group to ensure that
emergency management programs and plans provide support to at-risk
individuals and populations disproportionately impacted by disasters.
§ House Bill 1985 | Conference Committee report passed both houses;
Governor’s action deadline 3.31.21
Vaccine Equity Report | March 2021 Page 13
Establishes a presumption that COVID-19 causing the death or disability of
health care providers is an occupational disease compensable under the
Workers' Compensation Act.
§ House Bill 1993 | Passed both houses; Governor’s action deadline 3.31.21
Requires state agencies to establish and maintain a comprehensive
diversity, equity, and inclusion strategic plan in coordination with the
Governor's Director of Diversity, Equity, and Inclusion.
§ Virginia Budgetary Actions
Both chambers are anticipating federal aid from a $900 billion relief package
Congress adopted in December to replace or augment state funds that
Governor Northam had proposed to cover the costs of COVID 19 vaccine
distributing, continue testing for the coronavirus disease and track people
exposed to it, as well as other responses to the pandemic. The Virginia State
Budget passed both bodies of General Assembly on February 27, 2022.
Executive Updates
● President Biden has proposed a $1.9 trillion COVID relief package. Biden’s proposal is
being considered by Congress, where it has been approved in the U.S. House of
Representatives.
● President Biden has signed the following executive orders that have direct impact on the
Commonwealth of Virginia.
o Executive Order on a Sustainable Public Health Supply Chain; Executive Order on
Improving and Expanding Access to Care and Treatments for COVID-19
▪ State governors will receive 16% more vaccines weekly.
▪ The US will increase the total vaccine order by 50% from 400 million to 600
million.
▪ FEMA will create federally supported community vaccination centers.
▪ Create the COVID 19 Health Equity Task Force to ensure equitable
pandemic response and recovery.
o Executive Order on Economic Relief Related to the COVID-19 Pandemic
▪ Reducing barriers for access to government supportive programs for
individuals, families, small business; state, local, tribal, and territorial
governments.
o Executive Order on Improving and Expanding Access to Care and Treatments for
COVID-19
▪ Improve the capacity of the Nation’s healthcare system to address
coronavirus disease 2019 (COVID-19), to accelerate the development of
Vaccine Equity Report | March 2021 Page 14
novel therapies to treat COVID-19 and to improve all American’s access to
quality and affordable healthcare.
o Executive Order on Ensuring an Equitable Pandemic Response and Recovery
▪ Creation of a COVID-19 Health Equity Task Force within the Department of
Health and Human Services (HHS).
o Executive Order on Ensuring a Data-Driven Response to COVID-19 and Future
High-Consequence Public Health Threats
▪ All executive departments and agencies shall facilitate the gathering,
sharing, and publication of COVID-19 related data, in coordination with the
Coordinator of the COVID-19 Response and Counselor to the President.
o Executive Order on Organizing and Mobilizing the United States Government To
Provide a Unified and Effective Response To Combat COVID-19 and To Provide
United States Leadership on Global Health and Security
● Governor Northam has signed the following executive orders regarding COVID 19 for
Commonwealth of Virginia.
o Extend COVID 19 related restrictions to last through the end of February. These
include modified stay at home order; universal mask requirements; reduction in
social gatherings; continued limitations for dining establishments and teleworking.
o Governor Northam has implemented the following processes regarding COVID 19
for Commonwealth of Virginia. Elimination of the second dose withholding and
instead is asking all hospitals holding second doses to instead use them as first
does vaccines.
● The Governor included language in his budget to support expected COVID-19 vaccine
expenditures through June 2022. The budget passed both bodies of General Assembly.
Agency Updates
● Governor Northam has made the following changes to VDH processes regarding COVID
19 for Commonwealth of Virginia.
o Health districts are asked to split vaccine doses equally between people 65 and
older and front-line healthcare workers and those with increased risk of serious
illness.
o Vaccines to be allocated by population.
o Updating the VDH data dashboard to provide more descriptive data regarding those
who have been vaccinated.
● Governor Northam had VDH develop a state-wide pre-registration website and COVID-19
call center (Source).
Court Updates
● None
Vaccine Equity Report | March 2021 Page 15
5. Achieving Equitable Distributions of Vaccinations in Virginia
Increasing equity in vaccinations throughout Virginia, particularly among Black and Hispanic
individuals, necessitates continued development, implementation, and monitoring of efforts
targeted at vulnerable populations. This includes prioritizing equity in Virginia’s state vaccination
allocation strategy, as well as in mass vaccinations planning, private sector vaccination partners,
community vaccination plans, and most importantly, in tracking equity in vaccination equity
outcomes.
Further, FEMA’s Office of Equal Rights has reminded all government agencies and their partners
of the need “to collect and, when requested, submit demographic data to ensure compliance with
civil rights laws,” including best practices like: 1) including “the geographic distribution of
individuals by race, color, and national origin, limited English proficiency, age, and disability status;
and can include additional data sets regarding the reliance of communities on public transit, the
proximity of different groups to emergency or disaster danger zones, and the geographic
distribution of damage;” 2) considering multiple data sources, such as consulting other states’
vaccine monitoring dashboards as well as Census Bureau information; and including that states
should 3) “actively engage in information collection and sharing with community organizations,
nonprofits, advocacy groups, and local community leaders, to determine what populations are
affected. Use data collected through these efforts, including anecdotal and qualitative data, to
formulate recovery and mitigation plans, make changes to address gaps in services and barriers,
and to ensure that plans do not disproportionately exclude or negatively affect populations in
violation of federal civil rights laws.” (Source). Further, all such efforts should correspond with
practices laid out in the checklist provided by FEMA’s Office of Equal Rights (Source).
Importantly, vaccination hesitancy is decreasing nationally, with 71% of Virginians expressing
willingness to get the vaccine (Source). To achieve equity in vaccinations, factors to consider
include language accessibility, location of vaccination sites relative to Black and Brown
communities, providing transportation to vaccination sites, and providing in-home vaccinations to
the home-bound. Early indicators suggest some localities in Virginia, such as Chesapeake and
Danville, are prioritizing vaccination equity through active engagement of community leaders and
resources to assist with vaccination registration and access, general vaccination education, and
vaccination planning and implementation. The success of these initiatives more broadly is
dependent upon active support and community collaboration from key Virginia agencies, such as
the Virginia Department of Health (VDH) and the Virginia Department of Emergency Management
(VDEM).
Vaccine Equity Report | March 2021 Page 16
Appendix
Charging Statutes
2020 Appropriation Act Item 299 I. The Department of Health shall convene a work group, which
shall include the Commonwealth's Chief Diversity, Equity, and Inclusion Officer and
representatives of the Office of Health Equity of the Department of Health, the Department of
Emergency Management, and such other stakeholders as the department shall deem appropriate
and which may be an existing work group or other entity previously convened for a related
purpose, to (i) evaluate the methods by which vaccines and other medications necessary to treat
or prevent the spread of COVID-19 are made available to the public; (ii) identify and develop a plan
to implement specific actions necessary to ensure such vaccines and other medications are
equitably distributed in the Commonwealth to ensure all residents of the Commonwealth are able
to access such vaccines and other medications; (iii) make recommendations for any statutory,
regulatory, or budgetary actions necessary to implement such a plan.), including: a) Statutes
Regarding Plans; b) regulatory changes; c) budgetary changes; d) changes needed to the any
Virginia vaccination plan.
Vaccine Equity Report | March 2021 Page 17
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