Report — Vaccine Equity Report, Office of Health Equity, Virginia Department of Health (July 2021)

Summary

The Office of Health Equity in the Virginia Department of Health issued this July 2021 Vaccine Equity Report, under the supervision of the Chief Diversity, Equity, and Inclusion Officer and the Equity Leadership Task Force. Its contents list key equity accomplishments, over 60 and under 40 vaccinations, race and ethnicity, rural areas, and infections and deaths since vaccine availability. Other sections cover FEMA Region 3, trends over time, vaccine hesitancy (including vaccinations for children), data gaps impacting equity, and policy and administrative updates. The appendix quotes 2020 Appropriation Act Item 299 I on the work group the Department of Health shall convene.

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Full text

VDH Plan for
Equitable
Distribution
of COVID-19
Vaccine

JULY 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 .................................................................................................. 9
Over 60 Vaccinations ............................................................................................................... 9
Under 40 Vaccinations ............................................................................................................. 9
Race and Ethnicity ................................................................................................................. 10
Community Vaccination Centers, Mobile Vaccination Units, and Other Updates ............. 11
Rural Areas ............................................................................................................................. 11
Infections and Deaths Since Vaccine Availability ................................................................ 13
3. Vaccinations in FEMA Region 3 ............................................................................................. 16
FEMA Region 3 and Race/Ethnicity....................................................................................... 17
FEMA Region 3 and Over 60 Vaccinations ........................................................................... 19
FEMA Region 3 and Under 40 Vaccinations ......................................................................... 19
4. Trends Over Time.................................................................................................................... 20
COVID-19 Infections and Death Rates .................................................................................. 20
Racial Groups as a Share of Total Vaccinations in Virginia ................................................ 20
Doses Administered ............................................................................................................... 21
5. Vaccine Hesitancy................................................................................................................... 22
Demographic Breakdown ...................................................................................................... 23
Hesitancy in the United States .............................................................................................. 23
Hesitancy in Virginia .............................................................................................................. 24
Vaccinations for Children ...................................................................................................... 24
6. Data Gaps Impacting Equity................................................................................................... 25
Reporting Age Ranges ........................................................................................................... 25
7. Policy and Administrative Updates........................................................................................ 26
Legislative Updates ................................................................................................................ 26
Executive Updates.................................................................................................................. 26
Agency Updates ..................................................................................................................... 26
Court Updates......................................................................................................................... 26
8. On the Horizon ........................................................................................................................ 26
Charging Statutes................................................................................................................... 28

Vaccine Equity Report | July 2021 Page 1
Executive Summary
This monthly report is 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 (ELT). It provides an overview of vaccination equity in the Commonwealth
of Virginia, including key equity accomplishments, for the month of June 2021.
This report compares Virginia’s equitable vaccination progress with other states in Region 3 of the
Federal Emergency Management Agency (FEMA), namely Delaware, the District of Columbia,
Maryland, Pennsylvania, and West Virginia. This report explores vaccine trends over time,
vaccination hesitancy, and equity considerations for future vaccine distribution. An overview of
recent legislative, executive, and administration actions is also included. Key findings include:
→ Targeted Community Efforts
• VDH and VDEM are continuing to engage in promising practices to reduce inequities.
These promising practices include: eliminating vaccination pre-registration requirements and
increasing walk-up vaccination clinics (Source; Source); collaborating with trusted
community leaders (Source); creating targeted outreach efforts to at-risk communities
(Source; Source); providing information in multiple languages (Source); and removing ID
requirements at registration and check-in during vaccination events (Source).
• Virginia continues to operate mobile vaccination efforts in locations across the
Commonwealth to reach vulnerable populations. Starting in mid-May, the Virginia
Department of Health began regularly announcing information about opening mobile sites
(Source), especially in areas in which vaccine access is difficult, like rural and underserved
locations (Source). Community clinics are also helping to vaccinate underserved populations
(Source; Source).
→ Trends Over Time
• Vaccination numbers continued to increase, but the pace of vaccinations has slowed.
More Virginians are getting vaccinated. Over 9 million COVID-19 vaccine doses have
been administered in Virginia (Source). At present, 58.9% of Virginians have received at
least one dose of a vaccine, up from 54.7% at the end of April (Source). Over 4.3 million
Virginians have been fully vaccinated, which represents 50.7% of the population.
• The State of Emergency brought on by the COVID-19 pandemic expired on June 30th
in Virginia. This ended the last remaining public-health restrictions across the
Commonwealth including, mandatory mask requirements for unvaccinated individuals and
social distancing (Source). Despite the state reaching the goal of 70% of adults having
received one vaccine dose, many local vaccination rates are well below what public health
experts consider safe for population health (Source: Source; Source).
• Decrease in life expectancy in the US due to the COVID-19 pandemic, greatest loss in
Hispanic/Latino and non-Hispanic Black populations. A new VCU study was released
on the effects of the COVID-19 pandemic on life expectancy of showing the life expectancy
loss of ~2 years for the average US adult, but the greatest loss was in the Black and
Hispanic/Latino populations (Source; Source).
• Vaccines have made significant and positive differences in the COVID-19 pandemic in
that they are safe, effective, and overwhelmingly successful at reducing risk of severe illness
(Source). Moreover, both cases and deaths have been flattening out because of vaccines
(Source). The CDC now indicates that every COVID-19 death is largely preventable, and
nearly all COVID-19 deaths now are in people who were not vaccinated (Source; Source).

Vaccine Equity Report | July 2021 Page 2
• Racial disparities persist: Black and Hispanic/Latino populations continue to receive
vaccinations at far lower rates than Whites in Virginia. Whites have the highest overall
numbers and percentages of cases and deaths. Still, disparities are evident. While Whites
represent 61% of the population, they represent 50% of cases and 64% of deaths. However,
Blacks represent 19% of the population yet 21% of cases and 25% of deaths. When
comparing the percentages in the population, Blacks still disproportionately contract COVID-
19 and die from it. Similarly, Hispanics/Latinos represent 10% of the population and 19% of
cases, yet 7% of deaths.
Table 1: Race, COVID Cases and Deaths, and Vaccinations in Virginia, as of 6/28/21
% of % of Total
% of Cases % of Deaths
Vaccinations Population
White 58% 50% 64% 61%
Black 15% 21% 25% 19%
Hispanic 14% 19% 7% 10%
Asian 6% 4% 4% 7%
Source: Kaiser Family Foundation
• Looking ahead, the actual vaccination rates of most racial/ethnic groups (Black,
Hispanic/Latino, and White) are expected to fall behind July 4 projections. Only the
vaccination rate for Asians is expected to meet the target. If this trend continues, chances
increase that Black and Hispanic/Latino communities will remain at increased risk for
contracting and dying from COVID-19 (Source).
• Virginia received additional CDC funding to help tackle health disparities. The CDC
awarded $30.6 million to Virginia to address health inequities created and exacerbated in
high-risk and underserved communities by the COVID-19 pandemic (Source).
→ Vaccine Hesitancy
• Virginia reports a higher unvaccinated rate of Blacks and Hispanics/Latinos than the
national average, but a far lower rate than the national average for Whites. This is an
important equity point. Virginia is not doing well in vaccinating racial/ethnic minorities
compared to the US generally, but is doing well compared to the US on almost all other
factors (Source).
• Vaccine hesitancy continues to decrease nationally and within the Commonwealth
(Source; Source), yet hesitancy remains. Those who are still unvaccinated tend to be
younger, people of color, less educated, Republican (or Republican-leaning), and the
uninsured (Source).
• In many instances, the reasons for vaccine hesitancy are decreasing. Concern over the
rapid development, and the belief that the vaccine is not needed have remained steady.
However, concern over side effects has dropped by 10% since last reported, and testing of
vaccines and the desire to know more about how well the vaccines work has dropped by 7%
points (Source; Source).
→ Reducing Hesitancy
• Vaccine hesitant individuals say several factors could decrease hesitancy. These
factors include: the COVID-19 vaccine receiving full approval from the FDA, rather than the
current Emergency Use Authorization; being able to get the COVID-19 vaccine at a place
they normally go to for health care; and requiring vaccinations for certain activities (Source).

Vaccine Equity Report | July 2021 Page 3
1. Key Equity Accomplishments
● June: The Equity Leadership Task force (ELT) partnered with Elite Business Strategies and
Greene Street Communications to coordinate community engagement and outreach efforts
to historically underserved communities (Source). The contract with Elite Business
Strategies that provided the hyper-local community outreach expired on June 30. There is a
small carry-over contract for Greene Street to provide interim marketing support local health
districts from June 30-August 30 until VDH can award a new contract for a statewide
communications contractor. As of July 1, each local health district will assume the
responsibility for community engagement and outreach. Local health districts will seek the
support of the COVID marketing and communications hub exclusively managed by Kelly
Vance and Siddall Communications, the current statewide communications contractor
(Source: Communications with Kelly Vance and Siddall Communications).

● June: The “Test, Know & Go COVID-19” testing campaign expanded to include messaging
about symptomatic testing. These new ads encourage people to get a COVID-19 test when
they feel sick or experience symptoms, regardless of vaccination status (Source).

● June: VDH has introduced new tools on the Communication Hub page that focus on: Rural
Virginians Resources; Young Adult; and, Children + Parents pages (Source).

● June: To support vaccination efforts, Greene Street Marketing, an ELT partner, provided
extensive outreach collateral to support health districts including: Central Shenandoah,
Blue Ridge, Cumberland Plateau, West Piedmont, Rappahannock Area and Mount Rogers
(Source: Communications with Greene Street team).

● June: To support partners in the field promoting mobile unit efforts across the
Commonwealth, Greene Street Marketing, an ELT partner, produced more than 40 pieces
of collateral specifically geared toward individual vaccination efforts to assist health districts
and canvassers in their grassroots efforts (Source: Communications with Greene Street
team).

● June 1: Based on available data at the time, Latinos became the second most vaccinated
group in Virginia due in part to the efforts of community clinics across the Commonwealth
(Source).

● June 3: The Richmond and Henrico Health Districts shifted to a model where organizations
can request a small team to vaccinate people at a variety of sites (Source).

● June 3: VDH began partnering with Dollar General to expand access to no-cost COVID-19
testing at select store locations in Altavista, Williamsburg, and Norfolk. Designed to make
testing opportunities readily available for vulnerable communities, the pilot testing program
ran June 3-23 on staggered days at participating locations (Source).

Vaccine Equity Report | July 2021 Page 4
● June 4: Governor Northam declared June LGBTQ+ Pride Month in the Commonwealth of
Virginia to celebrate the state’s LGBTQ+ communities and their fight for inclusion and
equality (Source).

● June 7: Virginia Commonwealth University joined other larger universities in Virginia and
announced that vaccinations will be required for all students who live, learn, work, or will be
on campus for any reason (excluding those with religious or health exemptions). VCU is
strongly encouraging employees to follow the guidance of the Public Health Response
Team in choosing to be vaccinated as soon as possible (Source; Source).

● June 8: Virginia’s COVIDWISE exposure notification app campaign is honored with a Telly
award and two Emmy nominations (Source). A marketing campaign led by Madison and
Main will continue to promote the COVIDWISE application.

● June 14: The Vaccinate Virginia campaign expanded its reach into rural Virginia by
launching a texting and email campaign, new print advertisements, a direct mail campaign,
and posters in bars, restaurants, and convenience stores across the state (Source).

● June 15: The CDC awarded $30.6 million to Virginia to address health inequities created
and exacerbated in high-risk and underserved communities by the COVID-19 pandemic
(Source).

● June 18: About 60% of the state’s ZIP codes reported no new cases of the coronavirus
over the past week (Source).

● June 18: COVID-19 vaccines were distributed as part of Governor Northam Juneteenth
commemoration at Fort Monroe National Monument in Hampton, Virginia (Source).

● June 19: Fairfax County exceeded President Biden’s goal for COVID-19 vaccines with
72.8% of people 18 and older in Fairfax having received at least one vaccine dose
(Source).

● June 20: It was reported that 4.29 million Virginians had been fully vaccinated as of this
date (Source).

● June 20: Vaccinations of children ages 12-15 in the Washington D.C. metro area surged in
the first month of eligibility for this age group (Source).

● June 20: As of June 20, 318 million COVID-19 vaccine doses have been administered in
the U.S. In the last week, an average of 1.24 million doses per day were administered
(Source).

● June 20: Dispelling misinformation about vaccinations, the “Vaccination MythBusters”
digital materials continue to reach many Virginians with extremely important messaging.
Twelve ads reached more than 1.2 million viewers – six of these ads were in Spanish
(Source: Communications with Greene Street team).

Vaccine Equity Report | July 2021 Page 5
● June 20: The Central Shenandoah Health District, in coordination with the VDEM and other
supporting partners, offered free COVID-19 vaccines to anyone ages 18+ at World Refugee
Day in Harrisonburg (Source).

● June 20: More than 2 million Virginians heard radio advertisements produced by Greene
Street airing on fifteen radio stations across the Commonwealth (Source: Communications
with Greene Street team).

● June 21: Governor Northam announced that 70% of adults 18+ in the Commonwealth
have received at least one dose of the COVID-19 vaccine – a COVID-19 vaccination target
outlined by President Biden (Source; Source).

● June 21: VDH announces nearly 150 pharmacies will expand hours for COVID-19
vaccination as part of the National Vaccine Month of Action (Source).

● June 21: Central Shenandoah Health District announced they will host a Community
Information Team to promote COVID-19 vaccine efforts throughout the health district.
Outreach will include door-to-door canvassing in residential neighborhoods and at local
businesses in Rockingham, Augusta, Rockbridge, Bath, and Highland counties, as well as
in the cities of Harrisonburg, Staunton, Waynesboro, Lexington, and Buena Vista. The
Community Information Team will provide health education, information about upcoming
COVID-19 vaccine clinics, and registration opportunities for specific clinics (Source).

● June 21: Arlington County collaborates with local restaurants to encourage residents to get
vaccinated by using cocktail napkins and coasters with QR codes to schedule a vaccine
appointment (Source).

● June 21: The Research Institute for Social Equity (RISE) at the L. Douglas Wilder School of
Government and Public Affairs at Virginia Commonwealth University (VCU) released the
results of the most recent VDEM COVID-19 vaccine hesitancy and return to work poll
indicating African American households were twice as likely to have a member lose a job,
be placed on furlough, or who had their work pay or hours reduced compared to Whites
(15%). Asian and Hispanic/Latino respondents reported the same hardships almost as
frequently as African Americans (26% and 23% respectively) (Source; Source).

● June 22: VDH added the new Delta variant to the Variants of Concern dashboard (Source).

● June 22: As of midnight, 319 million vaccine doses had been administered in the U.S. with
an average of 1.05 million doses per day in the last week (Source).

● June 22: VDH announced that its free COVID-19 exposure app, COVIDWISE is now easier
for users to find and schedule a COVID-19 vaccine in addition to providing valuable
vaccination-related information and resources from VDH and the CDC (Source).

● June 22: UVA faculty and staff will be required to get vaccinated for COVID-19 or will be
required to submit to weekly testing (Source).

Vaccine Equity Report | July 2021 Page 6
● June 22: Dr. Danny Avula completed a satellite media tour where he spoke one-on-one
with morning TV and radio hosts across the Commonwealth about what Virginia parents
need to know to keep their children safe from COVID-19 this summer (Source; Source:
Communications with Kelly Vance and Siddall Communications).

● June 23: Governor Northam issued a proclamation calling the General Assembly into a
special session on Monday, August 2, 2021. This session is set to address possible uses
for the almost $4.3 billion that Virginia is receiving under the American Rescue Plan Act's
Coronavirus State Fiscal Recovery Fund (Source).

● June 23: Mount Rogers Health District and the Bristol State Liners team provided a free
ticket, free popcorn, and a free soft drink to everyone who gets vaccinated at their Vaccine
Night event (Source).

● June 23: CDC Director Dr. Rochelle Walensky said: "[COVID-19 vaccines] are nearly 100%
effective against severe disease and death – meaning nearly every death due to COVID-19
is at this point entirely preventable" (Source).

● June 23: 65.5% of the adult population in the US had received at least one dose of a
COVID-19 vaccine, according to the CDC (Source).

● July 23: A new VCU study was released on the effects of the COVID-19 pandemic on life
expectancy of showing the life expectancy loss of ~2 years for the average US adult, but
the greatest loss was in the Black and Hispanic/Latino populations (Source).

● June 24: Approximately 40% of the Tidewater region, which includes King and Queen, New
Kent, and King William counties, is fully vaccinated (Source).

● June 24: The Piedmont Health District, in coordination with VDEM, announced they will
begin hosting a Community Information Team to support COVID-19 vaccination efforts
throughout the health district, including door to door canvassing in residential
neighborhoods and local businesses (Source).

● June 24: The CDC Director extended the eviction moratorium, which was scheduled to
expire on June 30, 2021 through July 31, 2021. She said this was the final extension
(Source).

● June 24: VDH partnered with Nexstar media to host its 5th virtual town hall to answer
questions Virginia parents have about the COVID-19 vaccine and talk about what teens
and children can expect in the upcoming school year (Source).

● June 24: The “It’s Our Shot, Virginia!” campaign continues to reach the Hispanic and Latino
communities – three ads in Spanish have achieved more than 19,000 impressions each,
amounting to more than 57,000 impressions since their debut earlier this spring (Source:
Communications with Greene Street team).

Vaccine Equity Report | July 2021 Page 7
● June 25: The One Virginia Plan Online Toolkit continues to expand diversity, equity, and
inclusion throughout Virginia through creating collective impact, sustainable change,
innovation, and productivity across state government and other sectors of Virginia. The
ONE Virginia Plan is helping to build access and success for all state agencies, but in
particular prioritizing those state agencies that are COVID-19 facing (Source).

● June 25: Virginia’s newly launched Equity Dashboards provide a transparent view of how
the Commonwealth and each of its 95 counties and 38 independent cities compare with
other communities across seven different social determinants of health (Source). The
Equity-in-Action dashboard shows where some COVID funding has been allocated, and the
Equity-at-a-Glance dashboard provides policy makers with real time data for future decision
making about America Rescue Plan funding from a state and locality perspective (Source;
Source).

● June 27: Television advertisements have aired on Northern Virginia’s Telemundo Station
designed to appeal to a broad Hispanic and Latino audience encouraging free, safe, and
effective COVID-19 vaccinations, educating communities about how to get vaccinated.
More than 1.2 million viewers have seen the commercials weekly. Additional television
advertisement encourages the African American audience to get vaccinated have aired on
multiple television stations throughout the Commonwealth and have been seen weekly by
more than 12.5 million viewers (Source: Communications with Greene Street team).

● June 27: Advertisements encouraging COVID-19 vaccinations among marginalized
populations were seen on more than 300 buses throughout the Commonwealth – more
than 7 million people saw the advertisements (Source: Communications with Greene Street
team).

● June 30: 58.9% of the entire Virginia population has received at least one dose of the
COVID-19 vaccine; 50.7% of Virginians have been fully vaccinated (Source).

● June 30: Vance/Siddall Communications created a tool kit for vaccines at pharmacies
statewide (Source: Communications with Kelly Vance).

● June 30: The State of Emergency brought on by the COVID-19 pandemic expired in
Virginia (Source). The state prepares for new equity focused laws to become effective as of
July 1 (Source).

Vaccine Equity Report | July 2021 Page 8
2. Vaccination Equity in Virginia
At the end of June, over 9 million COVID-19 vaccine doses have been administered in Virginia,
and over 9.7 million vaccines have been received (Source). At the end of June, Virginia ranked 13th
in the country for the percentage of distributed vaccines that have been administered (Virginia was
12th in May), and 88.99% of vaccines received have been administered (Source). At present,
58.9% of all Virginians have received at least one dose of a vaccine, up from 54.7% at the end of
May (Source). This figure compares favorably with the 54.4% national vaccination rate (total
population) receiving at least one dose (Source). Over 4.3 million Virginians have been fully
vaccinated, which represents 50.7% of the population and that compares favorably with the 46.7%
national fully vaccinated rate. On average, Virginia is administering approximately 16,045
vaccinations per day (Source).

Figure 1: Vaccinations by Age (One dose)

Source

Over 60 Vaccinations
Those ages 60+ represent roughly 34.2% (1.51 million) of the number of people who have
received at least one dose. The percentage of those 60+ receiving vaccines continues to decline
as more people outside of this age range get vaccinated. The percentage of people with at least
one dose of the reported ages are: Those age 60-69 account for 17.1% (754,978); those age 70-
79 comprise 11.6% (509,699); and those age 80-89 account for 5.6% (246,253) (Source).

Under 40 Vaccinations
Virginia began vaccinating those ages 12 and above in May 2021 (Source). As per Virginia’s
COVID-19 vaccine data, the percentage of people with at least one dose of the reported ages are:
ages 10-19 account for 8.7% (382,763); 20-20 account for 12.1% (532,506); and 30-39 account for
13.7% (601,878). These numbers represent roughly 34.4% (1.51 million) of the people who
received at least one dose, which is up from 32.5% (1.32 million) at the end of May.

Vaccine Equity Report | July 2021 Page 9
Race and Ethnicity
According to VDH data as of June 30, the percentages of vaccinations for Blacks and
Hispanics/Latinos have risen slightly from last month. In June, Blacks received 15% of
vaccinations (up from 14% in May) whereas Hispanics/Latinos have received 14% of
vaccinations (up from 13% in May). There has been no change in the percent of Asians
vaccinated. Whites received 58% of vaccinations (down from 61% last month), which is reflective
of Blacks and Hispanics/Latinos receiving slightly more vaccines. There have been no reported
percentage changes in the percent of cases and deaths from last month (Source).

While these findings show some progress, the data continue to reveal important racial inequities.
Whites continue to disproportionately receive vaccines (58%) when compared with their
percentage of COVID cases (50%). Disparities remain for Blacks and Hispanics/Latinos regarding
percentage of cases and percentage of vaccinations, with Blacks constituting 21% of cases yet
15% of vaccinations and Hispanics/Latinos constituting 19% of cases and 14% of vaccinations. A
positive is that Asians account for 4% of cases yet 6% of vaccinations. Further, missing race data
continue to complicate analyses; however, VDH will be providing updates to this data in the
coming days or weeks, which could provide a different snapshot. As those who are unvaccinated
comprise the bulk of COVID-19 deaths and now that the CDC considers nearly every new COVID-
19 death to be entirely preventable (Source), it is critical to expand the focus of achieving equity.

Table 1: Race, COVID Cases and Deaths, and Vaccinations in Virginia, as of June 28, 2021
% of Vaccinations % of Cases % of Deaths % of Total Population
White 58% 50% 64% 61%
Black 15% 21% 25% 19%
Hispanic 14% 19% 7% 10%
Asian 6% 4% 4% 7%
Source: Kaiser Family Foundation
Figure 2: Vaccinations by Race (One Dose)

Source

Vaccine Equity Report | July 2021 Page 10
Community Vaccination Centers, Mobile Vaccination Units, and Other Updates
Community Vaccination Centers (CVCs) continue to be open across the Commonwealth,
although many are ending operations in June. As a reminder from the May equity report, the
Virginia Department of Emergency Management (VDEM) and the Virginia Department of Health
(VDH) opened CVCs earlier this year to administer COVID-19 vaccinations on a larger scale while
also targeting high-risk communities to improve equitable access and distribution (Source). These
CVCs were made possible through FEMA funding and are not designed to replace existing local,
small-scale efforts (Source). In May, state-run CVCs began offering the two-dose Pfizer vaccine to
adolescents (ages 12-15), and eight CVCs are offering walk-in appointments (Source). CVCs have
been important places for communities to receive vaccines (Source; Source).

Virginia is currently disbanding CVCs and moving into operating more mobile vaccination sites.
Starting in mid-May, the Virginia Department of Health began regularly announcing information
about opening mobile sites (Source), especially in areas in which vaccine access is difficult, like
rural and underserved locations (Source). Mobile health units give underserved communities a way
to access COVID-19 vaccinations when they might have tremendous difficulty doing so otherwise.

In June, other developments reinforced the need for a long-term focus on vaccine equity. First, the
CDC “awarded $30.6 million to Virginia to address health inequities created and exacerbated in
high-risk and underserved communities by the COVID-19 pandemic” (Source). Second, on June
22, VDH announced improvements to the free COVID-19 exposure app, COVIDWISE. This app
now makes finding and scheduling a COVID-19 vaccination easier while also providing critical
vaccination information, such as resources, notifications, and also alerts if users “have been in
close contact with an individual who anonymously reported a positive COVID-19 test result”
(Source; Source). On June 8, this app was honored with a Telly Award and two Emmy nominations
(Source). Third, on June 21, VDH announced that nearly 150 pharmacies will expand their hours
for COVID-19 vaccinations as part of the National Vaccine Month of Action (Source). Fourth, on
June 22, VDH added the new Delta variant to the Variants of Concern dashboard (Source).

Rural Areas
Figure 3 below displays the rural (non-metropolitan) areas in Virginia as defined by the Office of
Management and Budget (OMB) (Source). Areas in blue are rural localities while areas in white
are considered non-rural (as defined by the OMB).

Vaccine Equity Report | July 2021 Page 11
Figure 3: Rural and Non-Rural Areas in Virginia

Source
In both May and June, the elevated risk for rural areas showed marked improvements, yet
vaccination disparities remain an issue (Source; Source). Some rural areas continue to experience
equity issues in terms of access to vaccines (Figure 4), although risk levels for rural areas in
Virginia are declining and, in some cases, show marked improvements with far more areas being
classified as low risk levels (Figure 5). Vaccination hesitancy remains an issue throughout the
Commonwealth (Source; Source).

Figure 4: Vaccinations by Locality – Rate per 100,000 Population

Source

Vaccine Equity Report | July 2021 Page 12
Figure 5: COVID-19 Risk Levels by Locality

Source
Infections and Deaths Since Vaccine Availability
Vaccines have made significant and positive differences to the COVID-19 pandemic in that
vaccines are safe, effective, and overwhelmingly successful at reducing risk of severe illness
(Source). Moreover, both cases and deaths have been flattening out because of vaccines
(Source). The CDC now indicates that every COVID-19 death is largely preventable, and nearly all
COVID-19 deaths now are in people who were not vaccinated (Source; Source). As shown below,
vaccines appear to have positively affected public health, yet disparities in cases and deaths are
still evident concerning race, age, and for rural populations. Given the intersectionality between
these categories, there have been some improvement in equity, yet inequities in cases and deaths
remain.

Despite the existence of life-saving vaccines, numerous disparities are still evident in terms of
infections and deaths. These are especially critical concerning: 1) race; 2) age and sex; and 3)
urban-rural divides.

First, as shown in Table 2, concerning race, Whites have the highest overall numbers and
percentages of cases and deaths. Still, disparities are evident. While Whites represent 61% of the
population, they represent 50% of cases and 64% of deaths. However, Blacks represent 19% of
the population yet 21% of cases and 25% of deaths. Thus, when comparing the percentages in the
population, Blacks still disproportionately contract COVID-19 and die from it. Similarly,
Hispanics/Latinos represent 10% of the population and 19% of cases yet 7% of deaths.

Vaccine Equity Report | July 2021 Page 13
Table 2: Comparisons of COVID-19 Cases, Deaths, and Population
% of Cases % of Deaths % of Total Population
White 50% 64% 61%
Black 21% 25% 19%
Hispanic 19% 7% 10%
Asian 4% 4% 7%
Source: Kaiser Family Foundation

Second, as evident in Figures 6 and 7, patterns emerge in terms of age and sex concerning cases.
Concerning age, those ages 20-29 comprise the group with the single largest number of cases.
Concerning sex, those identifying as females tend to represent slightly more COVID-19 cases.
Patterns are also evident in terms of age and sex concerning deaths. As expected, those ages 50+
comprise most of the deaths from COVID-19 with the bulk occurring in the age 80+ category.
However, those identifying as male tend to die at a higher rate than those identifying as female.

Figure 6: Cases of COVID-19 in Virginia: Demographics

Source

Vaccine Equity Report | July 2021 Page 14
Figure 7: Deaths of COVID-19 in Virginia: Demographics

Source

Third, as shown in Figures 8 and 9, urban and rural disparities are evident in terms of cases as
measured by rates per 100,000 people. More rural counties continue to show disproportionate
cases, with particularly notable clusters in the southwest and southeast portions of Virginia.
Similarly, more rural counties continue to show disproportionate deaths with notable clusters in the
southwest, southeast, and central-north regions.

Vaccine Equity Report | July 2021 Page 15
Figure 8: Cases of COVID-19 in Virginia, Urban and Rural

Source

Figure 9: Deaths from COVID-19 in Virginia: Urban and Rural

Source

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. Virginia is currently ranked third in the region in terms
of COVID-19 vaccine doses administered per 100 people (Source). Regarding risk level (Figure
10) in June, Virginia has seen improvements over past months. The Commonwealth has 253.6
daily new cases (seven day rolling average and down from 376 in May), at 3 new cases per

Vaccine Equity Report | July 2021 Page 16
100,000 people (down from 4.4 in May). This places Virginia second out of six in terms of COVID-
19 risk level.

Figure 10: COVID-19 Risk Levels* by County across FEMA Region 3

Source

FEMA Region 3 and Race/Ethnicity
All areas in FEMA Region 3 continue to show clear racial disparities in percentages of vaccines
administered to populations versus those in the population. As noted earlier, across Region 3, both
Blacks and Hispanics/Latinos have seen small improvements in vaccination percentages. Virginia
is a leader in starting to close gaps between the percentage of cases and the percentage of
vaccinations for Blacks, Hispanics/Latinos, and Asians. Still, comparative state vaccination rates
by race and ethnicity is challenging because of reporting inconsistency (Source). Data are current
as of June 28, 2021.

Vaccine Equity Report | July 2021 Page 17
Figure 11: Blacks as a Share of COVID-19 Trends, FEMA Region 3

Source

Figure 12: Hispanics as a Share of COVID-19 Trends, FEMA Region 3*

*Data unavailable for West Virginia; Source

Figure 13: Asians as a Share of COVID-19 Trends, FEMA Region 3*

*Data unavailable for West Virginia; Source

Figure 14: Whites as a Share of COVID-19 Trends, FEMA Region 3

Source

Vaccine Equity Report | July 2021 Page 18
FEMA Region 3 and Over 60 Vaccinations
As shown in Table 3, across FEMA Region 3, there continue to be improvements in the
percentages of those age 65+ receiving at least one vaccine dose, although vaccinations are
clearly slowing down. In most cases, those ages 65+ who have at least one dose are at or over
85% of the given populations. Comparisons across states remain complicated given: a) differences
in publicly reported data (e.g., cumulative doses versus one dose versus two doses); b) age
groupings (e.g., listing ages 60-69 or ages 65-69); c) numbers of persons outside of those age 65+
working in critical areas necessitating vaccination priority; and d) those who cross state lines to
receive vaccinations. Further, reporting by doses administered is complicated by publicly
accessible data often not distinguishing between the two-dose vaccines (Modern and Pfizer) and
the single dose vaccine (Johnson and Johnson).

Table 3: Comparison of Population and Vaccination Demographics, 65+, FEMA Region 3

Virginia1 Delaware District of Maryland1 Pennsylvania West
Columbia Virginia

% of
population
65+ with at 89% 92% 85% 90% 99% 75%
least one
dose

% of Age 65+
15.9% 19.4% 12.4% 15.9% 18.7% 20.5%
in Population

Estimated
Numbers in
1,357,147 188,910 87,512 961,263 2,393,971 367,390
Population:
65+
1
Publicly reports data for 60+. Figures reported in this table reflect persons age 60+.
Sources: US Census, CDC, and data portals for FEMA Region 3, and HealthData.gov state profiles.

FEMA Region 3 and Under 40 Vaccinations
Comparisons of vaccinations by age using publicly reported state- and national-level data are
complicated by states and the federal government often reporting age ranges differently. However,
as data continue to emerge, Virginia compares well with national trends when examining
vaccinations for people ages 10-39 as percentages of the population. In every category, Virginia is
well ahead of the current national average and has shown slight improvements in all categories as
compared to May. The FDA and CDC approved the Pfizer COVID vaccine for use with children
ages 12 to 15 in May (Source; Source).

Vaccine Equity Report | July 2021 Page 19
Table 4: Virginia-U.S. Vaccination Comparisons, Ages 10-39

Virginia Ages 10-19 Ages 20-29 Ages 30-39
(at least one dose) 30.43% 43.67% 49.4%

United States Ages 12-15 Ages 16-17 Ages 18-24 Ages 25-39
(at least one dose) 2.8% 2% 8.1% 20%
Sources: CDC estimates, VDH COVID-19 Vaccine Data Portal, and USA Facts.

4. Trends Over Time
As the push to get “shots in arms” continues in Virginia and across the U.S., progress is being
made as more people become eligible to get vaccinated and become more willing to get
vaccinated. However, disparities remain. This section further examines progress and disparities,
and it covers topics including: COVID-19 infection and death rates; racial groups as a share of total
vaccinations in Virginia; and the 7-day average in Virginia.

COVID-19 Infections and Death Rates
Since COVID-19 vaccines became available, rates of infections and deaths from COVID-19 have
dropped dramatically. However, disparities in who is able to get vaccinated and who is choosing to
get vaccinated have also led to further disparities in COVID-19 infections and deaths. As Blacks
and Hispanics/Latinos have received smaller shares of vaccinations than Whites have received,
Blacks and Hispanics/Latinos also typically experience larger shares of infections and deaths.
Conversely, the percent of vaccinations among White and Asian populations is higher than their
percentages of infections and deaths (Source).

Looking ahead, the actual vaccination rates of most racial/ethnic groups (Black, Hispanic/Latino,
and White) are expected to fall behind July 4 projections. Only the vaccination rate for Asians is
expected to meet the target. If this trend continues, chances increase that Black and
Hispanic/Latino communities will remain at increased risk for contracting and dying from COVID-19
(Source).

Racial Groups as a Share of Total Vaccinations in Virginia
In Virginia, the percentage of Whites as a share of total vaccinations has decreased over time,
while the percentages of Blacks and Hispanic/Latinos as shares of total vaccinations have
increased (Source). However, Blacks and Hispanic/Latinos still represent a much smaller share of
Virginia’s total vaccinations than Whites proportionately.

Vaccine Equity Report | July 2021 Page 20
Figure 11: Share of Total Vaccinations in Virginia
100%

80%72%
70% 68% 66%
64% 62% 62% 61% 59% 58%
60%

40%

20%12% 14% 14% 14% 14% 14% 14% 14% 15% 15%

13% 14% 14%
10% 11% 12%
0% 6% 6% 7% 8%

Black Hispanic White

Source

Doses Administered

While there is still demand for vaccines, this demand is decreasing in Virginia and across the
United States (Source). In Virginia, the 7-day average has declined from 74,566 on April 28 to
16,776 on June 25 (Source).

Figure 12: 7-day Doses Administered Average in Virginia

80000

70000

60000

50000

40000

30000

20000

10000

0
28-Apr 5-May 12-May 19-May 26-May 2-Jun 9-Jun 16-Jun 23-Jun 30-Jun

Source

Vaccine Equity Report | July 2021 Page 21
5. Vaccine Hesitancy
Figure 13 displays estimated vaccination hesitancy by county in Virginia. The estimated hesitancy
rate is relatively low across the Commonwealth.

Figure 13: Vaccinations Hesitancy by County across FEMA Region 3

Source

Figure 13 shows vaccination hesitancy by county across FEMA Region 3. Virginia’s estimate
hesitancy rate is lower in comparison to other FEMA Region 3 states. Overall, vaccine hesitancy
continues to decrease nationally and within the Commonwealth (Source; Source), yet hesitancy
remains. Vaccination rates vary across the Virginia and those who are still unvaccinated tend to be
younger, people of color, less educated, Republican (or Republican-leading), and uninsured
(Source; Source).

Vaccine Equity Report | July 2021 Page 22
Demographic Breakdown
Demographic breakdowns of the unvaccinated in the United States and Virginia are as follows:

Table 5: Virginia-U.S. Unvaccinated Comparisons, Ages
Ages 18-34 Ages 35-54 Ages 55+
Virginia
36% 32% 14%

Ages 18-29 Ages 30-49 Ages 50-64 Ages 65+
United States
29% 41% 20% 9%
Sources: Kaiser Family Foundation and the May 2021 VDEM COVID-19 Vaccine Hesitancy and
Return to Work Poll

Table 6: Virginia-U.S. Unvaccinated Comparison Profiles
Virginia United States

Race White 26% 56%

Black 30% 14%

Hispanic 25% 19%

Party ID Democrat 16% 29%

Republican 34% 49%

Education Level High school or less 30% 46%

Some college 35% 34%

College degree or more 18% 19%
Sources: Kaiser Family Foundation and the May 2021 VDEM COVID-19 Vaccine Hesitancy and
Return to Work Poll

Table 6 displays comparison profiles of unvaccinated individuals in Virginia and the United States.
Virginia reports a higher unvaccinated rate of Blacks and Hispanics/Latinos than the national
average, but a far lower rate than the national average for Whites. This is an important equity
point. Virginia is not doing well in vaccinating racial/ethnic minorities compared to the US generally,
but is doing well compared to the US on almost all other factors (Source).

Hesitancy in the United States
Across the United States, reasons for vaccine hesitancy vary. Of those who report that they want
to “wait and see” before getting vaccinated, concerns include:

Vaccine Equity Report | July 2021 Page 23
• The possibility that the COVID-19 vaccine is not as safe as reported (78%)
• The possibility that the COVID-19 vaccine may negatively impact fertility (44% of those
ages 18-49)
• Being unable to get the vaccine from a trusted place (37%)
• Worry over having to pay an out-of-pocket cost to get a COVID-19 vaccine (33%) (Source).

Despite these concerns, there are also factors that those who are hesitant say could help them feel
less hesitant. These factors include:

• The COVID-19 vaccine receiving full approval from the FDA, rather than the current
emergency use approval (44%)
• Being able to get the COVID-19 vaccine at a place they normally go for health care (46%)
• A requirement to be vaccinated before air travel (41%)
• A requirement to be vaccinated before attending large gatherings such as sporting events
and concerts (40%) (Source).

Hesitancy in Virginia
As is the case across the United States, reasons for hesitancy in the Commonwealth of Virginia
vary. These include:

Table 7: Reason for Not Getting Vaccinated
April 2021 May 2021

How quickly the vaccines were developed and tested 72% 72%

Concern of side effects 77% 67%

Feeling that that the vaccine is not needed 43% 42%

Wanting to know more about how well the vaccines work 44% 37%
Sources: April 2021 and May 2021 VDEM COVID-19 Vaccine Hesitancy and Return to Work Polls

As is shown in Table 7 above, in many instances, the reasons for vaccine hesitancy are
decreasing. Concern over the rapid development, and the belief that the vaccine is not needed
have remained steady. However, concern over side effects has dropped by 10% since last
reported, and testing of vaccines and the desire to know more about how well the vaccines work
has dropped by 7% points (Source; Source). These changes indicate increased messaging may
be having an impact on vaccination hesitancy across the commonwealth.

Vaccinations for Children
As COVID-19 vaccines become available to younger age groups, parents must decide if they wish
to have their child vaccinated or not. Typically, in both the United States in general as well as in the
Commonwealth, hesitancy to vaccinate children is strongly correlated to parent vaccine hesitancy
(Source; Source).

Vaccine Equity Report | July 2021 Page 24
In the United States, 24% of parents reported that their child is already vaccinated. Of those
remaining, 18% of parents reported that they would get their child vaccinated right away; 21%
preferred to “wait and see;” 14% would only vaccinate their child if required; and 20% of parents
said that they would definitely not get their child vaccinated (Source).

In Virginia, parents seem more willing to vaccinate their children than parents in the United States
as a whole. 66% of parents with children age 12 to 17 said that they were likely to vaccinate their
children, while 63% of those with children 11 and under said that they would be willing to vaccinate
them (Source).

6. Data Gaps Impacting Equity
The VDH Dashboard displays vaccination counts on three demographic groups, by age, by race
and ethnicity, and by sex. Concerning age data, no data are currently listed as “not reported”
(Source).

Concerning race and ethnicity data, 1,683,333 out of 4,974,594 vaccinations (at least one dose) do
not report race data, or 34% missing data (Source). Missing race data alone are close to being
more than the combined total number of vaccinations administered in Washington, D.C. and West
Virginia, who are also in FEMA Region 3 (Source; Source). VDH has taken steps to impute
missing race and ethnicity data in COVID-19 cases (Source), but predicting race by “surname and
neighborhood demographics” is fraught with racial inequity and bias commensurate with unethical
uses of technology, data, and artificial intelligence (Source). Thus, other more equitable strategies
to address missing data in vaccination reporting are needed (Source; Source).

Concerning gender, 13,088 out of 4,974,594 vaccinations (at least one dose) do not report data on
sex, or 0.26% missing data. Further, the categories for sex are limited to male and female, and no
data on gender identity or sexual orientation are being collected, thus raising equity concerns for
LGBTQ communities (Source) especially in that LGBTQ people of color were twice as likely to
contract the virus than White cisgender people (Source). Due to historical discrimination and
medical mistreatment, vaccine hesitancy amongst LGBTQ populations is evident, so more
outreach efforts may be needed to ensure vaccine uptake (Source; Source).

Reporting Age Ranges
The Pfizer vaccine was approved for those ages 12+ in May, and Moderna announced that its
vaccine is safe and effective for children ages 12 to 17 ((Source; Source). At present, Virginia’s
publicly reported age breakdown is as follows: 0-9, 10-19; 20-29; 30-39; 40-49; 50-59; 60-69; 70-
79; 80+. However, such data are incongruent for capturing the vaccination uptake for the 12 to 17
age group (Source). As more vaccinations take place, it will be critical to continually examine the
efficacy of vaccinations for adolescents.

Vaccine Equity Report | July 2021 Page 25
7. Policy and Administrative Updates
Legislative Updates

• Virginia General Assembly is not currently in session (Source).
• On June 23, 2021 Governor Northam issued a proclamation calling the General
Assembly into a special session on Monday, August 2, 2021. This session is set to
address possible uses for the almost $4.3 billion that Virginia is receiving under the
American Rescue Plan Act's Coronavirus State Fiscal Recovery Fund (Source).

Executive Updates

• On June 18, 2021, COVID-19 vaccines were distributed as part of Governor Northam
Juneteenth commemoration at Fort Monroe National Monument in Hampton, Virginia
(Source).
• On June 21, 2021, Governor Northam announced that 70% of adults 18 years and older
in the Commonwealth have received at least one dose of the COVID-19 vaccine
(Source).
• On June 30, 2021 the State of Emergency brought on by the COVID-19 pandemic
expired (Source).

Agency Updates

• The CDC Director extended the eviction moratorium that was scheduled to expire on
June 30, 2021 is now extended through July 31, 2021 and this is intended to be the final
extension of the moratorium (Source).

Court Updates

• On June 15, the Supreme Court of Virginia extended the Twenty-Third Order of
Declaration of Judicial Emergency through July 11, 2021 (Source).

8. On the Horizon
In Virginia, the primary vaccination equity efforts during June 2021 consisted of increased
operations of mobile vaccinations units across the Commonwealth and the continuation of a
comprehensive “on-the-ground” community engagement strategies. Although more Virginians have
received vaccinations, the pace of vaccinations has slowed. In addition, racial equity vaccination
gaps remain largely unchanged from the June report.

Starting in mid-May, VDH began regularly announcing information about opening mobile sites
(Source), especially in areas in which vaccine access is difficult, like rural and underserved
locations (Source). As the state continues to disband large-scale community vaccination centers,
increased mobile vaccination units located at places of interest (i.e. beaches, amusement parks,

Vaccine Equity Report | July 2021 Page 26
houses of worship, low-income neighborhoods, college and K-12 school campuses, local carnivals,
and outdoor festivals and concerts) will play a significant part in reducing vaccination inequity,
especially before the fall season. Community clinics have also played significant roles in reducing
disparities for minoritized and underserved communities (Source).

While vaccine hesitancy is still concerning, there are factors that those who are hesitant say could
help them feel less hesitant. These factors include: COVID information being accessible in diverse
languages; the COVID-19 vaccine receiving full approval from the FDA, rather than the current
Emergency Use Authorization; being able to get the COVID-19 vaccine at a place they normally go
to for health care; and, requirements to be vaccinated before doing certain activities (Source).

Lastly, the federal government has provided substantial funding for the Commonwealth and VDH
to build equity, remove barriers, and build sustainability (Source). Further, Virginia has received an
additional $4.3 billion in American Rescue Plan funds, which provides a “unique opportunity to
equitably invest in Virginia’s long-term future” (Source). As a result, many diverse stakeholder
groups and policy makers have called for fixing systems that have for generations been neglected
or under-funded in Virginia. This includes providing increased language and functional needs
access for services and supports across state government that include equitable access for the
COVID-19 vaccine but also goes beyond the needs for vaccine equity to provide support for
accessing social services, 211, unemployment insurance, food services, rent/mortgage support,
and building/measuring diversity-lead innovation in our state agencies. Thus, it will be critical that
leaders, policy makers, and decision makers equitably and responsibly leverage these funds to
increase vaccine equity and fix the systems that caused the disproportionate impact of COVID-19
on underserved and under resourced communities. This will require that policy makers and local
leaders expand their ideas about ways to invest in and build an infrastructure that advances
measurable diversity, equity, and inclusion across Virginia and in particular, services provided by
state and local government. Lastly, the Equity-at-a-Glance dashboard reveals where Virginians
need the most help across 133 localities; and therefore, can provide guidance on how to invest
American Rescue Plan funds for long-term sustainability and change (Source).

Vaccine Equity Report | July 2021 Page 27
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 | July 2021 Page 28

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