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

Summary

The Office of Health Equity in the Virginia Department of Health issued this August 2021 Vaccine Equity Report, under the supervision of the Chief Diversity, Equity, and Inclusion Officer and the Equity Leadership Task Force. The contents list key equity accomplishments, vaccinations for 65+ and for under 45, race and ethnicity, rural areas, and infections and deaths since vaccine availability. They also list FEMA Region 3, trends over time, vaccine hesitancy and Virginia's efforts to reduce it, and data gaps involving COVID-19 case, testing and vaccine dashboards. The appendix quotes 2020 Appropriation Act Item 299 I.

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Full text

VDH Plan for
Equitable
Distribution
of COVID-19
Vaccine

AUGUST 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 .................................................................................................. 5
2. Vaccination Equity in Virginia ................................................................................................ 10
Vaccinations for 65+............................................................................................................... 10
Vaccinations for Under 45 ..................................................................................................... 10
Race and Ethnicity ................................................................................................................. 11
Other Updates......................................................................................................................... 12
Rural Areas ............................................................................................................................. 13
Infections and Deaths Since Vaccine Availability ................................................................ 14
3. Vaccinations in FEMA Region 3 ............................................................................................. 17
FEMA Region 3 and Race/Ethnicity....................................................................................... 19
FEMA Region 3 and 65+ Vaccinations .................................................................................. 21
FEMA Region 3 and Under 40 Vaccinations ......................................................................... 21
4. Trends Over Time.................................................................................................................... 22
COVID-19 Infections and Death Rates .................................................................................. 22
Racial Groups as a Share of Total Vaccinations in Virginia ................................................ 22
Doses Administered ............................................................................................................... 23
5. Vaccine Hesitancy................................................................................................................... 23
Virginia’s Efforts to Reduce Hesitancy ................................................................................. 25
6. Data Gaps Impacting Equity ................................................................................................... 25
COVID-19 Cases and Testing Dashboards ........................................................................... 26
COVID-19 Vaccine Dashboards ............................................................................................. 26
7. Policy and Administrative Updates........................................................................................ 27
Legislative Updates ................................................................................................................ 27
Executive Updates.................................................................................................................. 27
Agency Updates ..................................................................................................................... 27
Court Updates......................................................................................................................... 27
8. On the Horizon ........................................................................................................................ 27
Charging Statutes................................................................................................................... 29

Vaccine Equity Report | August 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 July 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 administrative actions is also included. Key findings include:

→ The Delta Variant
• The COVID-19 Delta variant is causing significant issues in that it is far more
transmissible than other strains of the coronavirus and it disproportionately affects
vulnerable populations (Source).

• In mid-April, the Delta variant was fewer than 1% of all new U.S. COVID-19 cases. By early
July, it was the nation's dominant strain. As of mid-July, an estimated 65.6% of all new
COVID-19 cases in FEMA Region 3 were due to this more transmissible Delta variant
(Source). By July 20, Delta comprised 83% of new COVID-19 cases nationwide (Source).

• With increased spread of the Delta variant, COVID-19 infections, hospitalizations, and
deaths are once again increasing, largely among the unvaccinated. Persistently lower
vaccination rates among Blacks and Hispanics/Latinos compared to Whites leave them at
increased risk as the variant Delta continues to spread across the country (Source). Despite
earlier progress, a continued focus on vaccine equity remains critical.

• Amid the rise of the more contagious Delta variant, on July 27 the CDC released new public
health recommendations for vaccinated persons, schools, and those in areas of substantial
or high transmission (Source; Source).

• Virginia could be on the path to exceeding its worst months of the pandemic in
September 2021 if cases and vaccination rates stay the same while the Delta variant
spread accelerates, according to projections from the University of Virginia’s weekly
COVID-19 report (Source; Source).

→ Continued Vaccination Efforts
• Virginia has made substantial progress in vaccine equity. As a result of the “Impact of
the Educate and Vaccinate Program,” vaccination rates among Black/African American
residents have tripled since the start of the program. Vaccinations among Hispanic/Latino
residents are more than six times the prior amount of people vaccinated. The vaccination
rate per 100,000 population by race and ethnicity shows Native Americans,
Hispanics/Latinos, and Black/African Americans leading the most recent round of COVID-19
vaccinations. These data showcase more equitable distributions of vaccines across the

Vaccine Equity Report | August 2021 Page 2
Commonwealth, which are supported by coordinated, collaborative contributions of
numerous entities across the state (Source).

• Critical equity work remains. Blacks and Hispanics/Latinos still disproportionately
contract COVID-19, and Blacks disproportionately die from it. According to VDH data,
Whites continue to have the highest overall numbers and percentages of cases and deaths
close to their proportion of the Virginia population. However, Blacks represent 19% of the
population, yet 22% of cases and 25% of deaths. Hispanics are 10% of the population, yet
19% of cases.

Table 1: Race, COVID Cases and Deaths, and Vaccinations in Virginia, as of 7/19/21
% of % with at least % of % of % of Total
Vaccinations one dose Cases Deaths Population
White 59% 53.8% 51% 64% 61%
Black 16% 47.8% 22% 25% 19%
Hispanic 9% 61.7% 19% 7% 10%
Asian 10% 74.1% 4% 4% 7%
Sources: Kaiser Family Foundation and VDH Data portals

• 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 (Source).

• “Breakthrough cases,” or instances in which someone fully vaccinated contracts
COVID-19, remains an issue, and VDH’s data portals now tracks such cases. However,
state health commissioner Dr. M. Norman Oliver cautioned that “[o]ver 99% of COVID-19
cases in Virginia have occurred in people who were not fully vaccinated” (Source; Source)

→ Persistent Hesitancy
• Many Virginians are still unwilling to get vaccinated against COVID-19. In a recent poll
conducted by the Research Institute for Social Equity at Virginia Commonwealth
University’s Wilder School of Government and Public Affairs, adults in Virginia were asked
about their thoughts on getting vaccinated (Source). Among the 17% of poll participants
who said that they were not likely to get vaccinated, major reasons for hesitancy included:
concern about side effects (77%); a belief that the vaccines were developed and tested too
quickly (72%); a desire to know more about how well the vaccines work (44%); and a belief
that the vaccine is not needed (43%).

→ Vaccination Mandates
• Organizations, private companies, and state governments across the US have begun
announcing vaccination mandates. Doctors, nurses, and medical groups called for
mandatory vaccinations of all U.S. health personnel against the coronavirus, framing the
move as a moral imperative as new infections mount sharply (Source).

Vaccine Equity Report | August 2021 Page 3
• The Department of Veterans Affairs announced it would mandate coronavirus
vaccines for its front-line workers, becoming the first federal agency to do so and
signaling what some experts anticipate could be a national pivot to mandates (Source).

• Facebook, Google, and Netflix each announced they would require employees to be
vaccinated for COVID-19, with limited exceptions for medical or religious reasons. The
companies joined Morgan Stanley, The Washington Post and several other high-profile
private employers (Source).

• President Biden announced a required vaccine attestation for federal employees to
help contain the spread of the coronavirus. Additionally, Biden announced several
measures to encourage holdout Americans to get vaccinated in the form of incentives
(Source; Source).

Vaccine Equity Report | August 2021 Page 4
1. Key Equity Accomplishments
● July: The Vaccinate Virginia campaign provides equity communications for specific
communities, including law enforcement, families, breastfeeding mothers, and women
(Source: Vance-Siddall Communications Weekly Report).

● July: In view of concerns about significant COVID vaccine hesitancy, the Virginia
Department of Health is now focused on community outreach to increase uptake of COVID
vaccinations, especially among Black, Hispanic/Latino, Native American and all populations
who are hesitant to receive these vaccinations (Source: Communications with VDH team).

● July: To support vaccination efforts, Greene Street Communications, an ELT partner
created several marketing and communication materials, including: a series of four one-
minute “Vaccination Mythbusters: Ask the Expert” videos featuring a diverse group of
physicians and pharmacists who will speak directly to the concerns and questions of
marginalized demographics; an interfaith toolkit to appeal to demographics in Virginia’s less
populated areas; producing three 30-second videos targeting interfaith communities; the
“Vaccination Mythbusters” digital campaign, which directly contradicts vaccine
disinformation; and, printing, design and art support for health districts and partners across
the Commonwealth of Virginia (Source: Communications with Greene Street team).

● July 7: Over 9.13 million COVID-19 vaccine doses have been administered in Virginia
(Source).

● July 9: The VDH announced a new dashboard that shows COVID-19 cases by vaccination
status and tracks COVID-19 vaccine breakthrough cases (Source). The CDC defines a
vaccine breakthrough infection as “the detection of SARS-CoV-2 RNA or antigen in a
respiratory specimen collected from a person ≥14 days after they have completed all
recommended doses of a U.S. Food and Drug Administration (FDA)-authorized COVID-19
vaccine” (Source).

● July 9: Pfizer announced it would seek U.S. authorization for a third dose of its COVID-19
vaccine (Source).

● July 9: The CDC issued new guidance for states, noting that vaccinated students and
teachers do not need to wear masks while in school (Source; Source).

● July 10: The Virginia Beach Department of Public Health hosted walk-in COVID-19
vaccination clinics at three locations: New Jerusalem Ministries, Mt. Olive Baptist Church,
and Ebenezer Baptist Church (Source).

● July 11: According to a poll conducted by the L. Douglas Wilder School of Government and
Public Affairs at Virginia Commonwealth University, Virginians of color were more likely to
lose their job or income due to the COVID-19 pandemic. The poll revealed that 30% of
Black residents reported that a member of their household lost their job, was furloughed, or
had hours or wages cut over the past three months. Further, 26% of Hispanic/Latino
respondents and 23% of Asian respondents reported similar challenges. Only 15% of
Whites experienced the same challenges (Source).

Vaccine Equity Report | August 2021 Page 5
● July 11: As part of the statewide Vaccinate Virginia campaign, health officials discussed the
COVID-19 vaccine information campaign in an online session organized by the VDH.
Panelists said that health officials face a “challenge in helping people determine fact from
fiction.” Dr. Joe Smyser, the CEO of a public health nonprofit in Washington, D.C., noted: “It
really is the messenger who’s more important than the message.” Smyser believes groups
formed to expand vaccination access must include more community and neighborhood
leaders around the table” (Source; Source).

● July 12: The VDH COVID-19 Dashboard was updated to include missing race data for 1.3
million vaccinated Virginians (Source).

● July 13: Despite the economic and public health crises caused by the COVID-19 pandemic,
Virginia was again named America’s Top State for Business for 2021. Virginia captured top
honors in CNBC’s 2021 competitiveness rankings, just as it did in the previous study
published in 2019. The top three areas included the education system, workforce, and
diversity/inclusion (Source).

● July 13: FEMA personnel began pushing coronavirus vaccines in areas with low
vaccination rates by assisting with door-to-door efforts in Hampton Roads (Source).

● July 14: As of this date, over 9.2 million doses of COVID-19 vaccine had been administered
in Virginia (Source).

● July 15: Highlights of the Equity Leadership Task Force were featured in the ONE Virginia
Newsletter. Highlights included ways the Equity-in-Action and Equity-at-Glance
dashboards could be used to inform American Rescue Plan decision making and final
metrics of the community engagement strategy (Source).July 15: The Educate and
Vaccinate Program deployed 21 teams and participated in 1,229 program activities,
reaching 332,764 Black/African American and Hispanic/Latino residents. It is estimated that
door-to-door campaigns reached 111,154 houses across the Commonwealth with a
household engagement of 290,112 residents (Source).

● July 15: As a result of the “Impact of the Educate and Vaccinate Program,” vaccination
rates among Black/African American residents have tripled since the start of the program.
Vaccinations among Hispanic/Latino residents are more than six times the prior amount of
people vaccinated. The vaccination rate per 100,000 population by race and ethnicity
shows Native Americans, Hispanic/Latinos, and Black/African Americans leading the most
recent round of COVID-19 vaccinations. These data showcase more equitable distributions
of vaccines across the Commonwealth, which are supported by coordinated, collaborative
contributions of numerous entities across the state (Source).

● July 15: New coronavirus cases began slowly increasing in Virginia and surrounding areas.
Public health experts say the rise is being fueled by three factors: relaxed restrictions on
gatherings and mask mandates, persistent pockets of unvaccinated people, and a rise in
the highly contagious Delta variant. (Source).

● July 16: The Delta variant was confirmed as the most dominant strain of COVID-19
infections in the southwest Virginia region (Source).

Vaccine Equity Report | August 2021 Page 6
● July 16: Rappahannock-Rapidan Health District announced a new campaign to encourage
COVID-19 vaccinations. A new video series aims to inform and answer questions for
individuals who may feel hesitant about receiving a COVID-19 vaccine. Supported in part
by the PATH Foundation, the video series features testimonials from patients, doctors, and
community leaders who have received a vaccine (Source; Source)

● July 17: In mid-April, the Delta variant was less than 1% of all new US COVID-19 cases. By
early July, it was the nation's dominant coronavirus strain. An estimated 83% of all new US
COVID-19 cases during the two weeks ending July 17 were due to this more transmissible
Delta variant (Source).

● July 18: The Virginia Hospital and Healthcare Association released a statement supporting
COVID-19 vaccine requirements for hospital and health system employees (Source).

● July 19: VDH and VDOE partnered on a comprehensive campaign—which includes a new
website page and additional resources for the COVID Comms Hub Parents K-12 Resource
Page—will provide families, school staff, providers, and communities the information they
need for a healthy return to in person school (Source; Source).

● July 20: To facilitate access to vaccinations, on July 20 and July 22, VDH held COVID-19
vaccination clinics at Military Circle Mall in Norfolk (Source). This location was the former
location of the FEMA center. It will now be supervised by the Norfolk Health District on a
reduced schedule.

● July 20: According to the CDC, the more contagious Delta variant now constitutes 83% of
sequenced samples in the United States; an estimated 65.6% of all new COVID-19 cases
in FEMA Region 3 were due to this more transmissible Delta variant (Source; Source).

● July 21: VDH and the Virginia Department of Education released updated guidance for
PreK-12 schools where local school districts will make decisions on mask and preventative
measures, as informed by the CDC (Source).

● June 21: The Crater Health District announced that the health district and localities will be
hosting a Community Information Team. The team’s mission is to support COVID-19
vaccine outreach efforts throughout the health district (Source).

● July 25: Over 61% of Virginians have received at least one dose of the COVID-19 vaccine,
and 54.1% are fully vaccinated (Source).

● July 26: Doctors, nurses, and medical groups called for mandatory vaccinations of all U.S.
health personnel against the coronavirus, framing the move as a moral imperative as new
infections mount sharply (Source).

● July 26: The Department of Veterans Affairs, which runs one of the nation’s largest health
systems, announced it would mandate coronavirus vaccines for its front-line workers,
becoming the first federal agency to do so and signaling what some experts anticipate
could be a national pivot to such requirements (Source).

Vaccine Equity Report | August 2021 Page 7
● July 26: Virginia Union University announced students who take in-person classes, live on
campus, work in university facilities or use university facilities will be required to have a
COVID-19 vaccine two weeks before arriving on campus (Source).

● July 26: Children’s Hospital of Richmond at VCU created back to school videos to
encourage parents to maintain and strengthen the health of their school-aged children
through vaccines, the four-W’s of COVID prevention, other healthy practices (Source).

● July 27: VDH partnered with the Washington Football Team to promote COVID prevention
and on-site vaccinations at training camp (Source).

● July 27: Fairfax County Health Department announced they, along with trusted partners
across the community, have vaccinated over 75% of people 18 and older against COVID-
19 (Source).

● July 27: CDC released new public health recommendations given new evidence on the
Delta variant currently circulating in the United States. The new guidance included:
o Recommendation for universal indoor masking for all teachers, staff, students, and
visitors to schools, regardless of vaccination status
o Recommendation for fully vaccinated people to wear a mask in public indoor
settings in areas of substantial or high transmission;
o Information that fully vaccinated people might choose to wear a mask regardless of
the level of transmission (Source; Source).

● July 27: LeadingAge Virginia, an association representing nursing homes and nonprofit
aging services across the Commonwealth, called on facilities to require COVID-19
vaccinations for all staff working in the long-term care industry (Source).

● July 27: Amid the rise of the more contagious Delta variant, Prince William Health District
health officials encouraged fully vaccinated local residents to wear masks indoors in public
places or when they are in close contact with people outside of their households (Source).

● July 28: The Sullivan County Regional Health Department medical director warned of a
potential rise of COVID-19 cases in the region as more than six in 10 people are
unvaccinated (Source).

● July 28: The U.S. Department of Defense has issued directions that require anyone inside
its facilities to wear a mask, even if they are vaccinated (Source).

● July 28: VDH reported 1,000 new COVID-19 cases statewide — a first since late April.
Additionally, the percentage of people testing positive has more than tripled from 1.3% to
4.7% in the past month (Source).

● July 28: Facebook, Google and Netflix each announced they would require employees to
have been vaccinated for COVID-19, with limited exceptions for medical or religious
reasons. The companies joined Morgan Stanley, The Washington Post and several other
high-profile private employers (Source).

Vaccine Equity Report | August 2021 Page 8
● July 28: Amid a rise COVID-19 cases and lagging vaccination rates, several U.S. states
have announced state employees would be required to show proof of vaccination or face
weekly testing (Source).

● July 28: A recent study reports that the recent increases in government aid, prompted by
the coronavirus pandemic, will cut poverty nearly in half this year from pre-pandemic levels
and push the share of Americans in poverty to the lowest level on record (Source).

● July 29: President Biden announced a required vaccine attestation or testing mandate for
federal employees to help contain the spread of the Delta variant of the coronavirus
(Source).

● July 29: In Virginia, 60% of the population has received a least one dose of COVID-19
vaccine; 71.9% of the adult population has been vaccinated with a least one dose (Source).

● July 29: Reversing an earlier decision, the College of William & Mary announced it will
require all faculty, staff and students to be fully vaccinated by mid-September (Source).

● July 30: Since early summer, the #VaccinateVirginia Hope campaign has concentrated
media outreach in rural markets across Virginia resulting in increased vaccination uptake in
rural communities. In June, 24% of all vaccinations were administered in rural health
districts (Source: Vance-Siddall Communications Weekly Report).

● July 30: According to projections from the University of Virginia’s weekly COVID-19 report,
Virginia could be on the path to exceeding its worst months of the pandemic in September
if cases and vaccination rates stay the same while the Delta variant spread accelerates
(Source; Source).

● July 30: Governor Ralph Northam announces his proposed budget bill to appropriate 4.3
billion dollars of American Rescue Plan funding (Source).

● July 31: Over 5.1 million (60.4%) Virginians have received at least one dose of COVID-19
vaccine; over 4.6 million (54.1%) are fully vaccinated (Source).

● July 31: The Peninsula Health District held a youth back-to-school COVID-19 vaccine clinic
in partnership with the Prescription Shoppe and New Zion Baptist Church on July 10 and
July 31. Residents who participated also received gift cards for back-to-school shopping
(Source).

Vaccine Equity Report | August 2021 Page 9
2. Vaccination Equity in Virginia
At the end of July, over 9.4 million COVID-19 vaccine doses have been administered in Virginia,
and over 10.2 million vaccines have been received (Source). Virginia ranked 12th in the country for
the percentage of distributed vaccines that have been administered (Virginia was 13th at the end of
June), and 89.43% of vaccines received have been administered (Source). At present, 60.3% of all
Virginians ages 12 and above have received at least one dose of a vaccine, up from 58.9% at the
end of June (Source). This figure compares favorably with the 57.5% national vaccination rate
(total population) receiving at least one dose (Source). Over 4.6 million Virginians have been fully
vaccinated, which represents 54% of the population, which compares favorably with the 49.5%
national fully vaccinated rate. On average, Virginia is administering approximately 12,350
vaccinations per day (Source).

Figure 1: Vaccinations by Age (One dose)

Source

Vaccinations for 65+
As seen in Figure 1, the age ranges are reported for those 65-74, 75-84, and 85+ (Source). Those
ages 65+ represent roughly 24.7 (1.1 million) of the number of people who have received at least
one dose, and 81.7% of people in this group are vaccinated (Source).

Vaccinations for Under 45
Since May, Virginia has been vaccinating those ages 12 and older. Again, reported age ranges for
July differ from those ranges reported in previous months. In previous months’ reports, data were

Vaccine Equity Report | August 2021 Page 10
reported for those younger than 40 years of age, and the new reported age ranges are: 12-15, 16-
17, 18-24, 25-34, and 35-44.

Virginia is making strides in vaccinations for those younger than 45 years old. As seen in Figure 1,
48.6% (307,249) of those younger than 18 have been vaccinated with at least one dose, and
63.1% (4.21 million) of those 18+ have been vaccinated with at least one dose. Data are also
reported for percentages of the population vaccinated with at least one dose: 44.7% (189,053) of
12-15-year-olds; 56.4% (118,196) of 16-17-year-olds; 50.1% (399,026) of 18-24-year-olds; 48.7%
(580,081) of 25-34-year-olds; and 57.9% (644,505) of 35-44-year-olds.

Race and Ethnicity
Missing data has been a significant limitation in assessing vaccine equity, especially relative to
race and ethnicity. As documented in the June report, roughly 2 million vaccinations had no race
and ethnicity identification data. At the end of July, missing data is somewhat less of an issue in
that the number of vaccinations with no reported race and ethnicity data declined to roughly
297,000 due to a statistical imputation procedure implemented by VDH. These changes are
discussed further in Section 6 below.

According to VDH data and as shown below in Table 2 and Figures 2, as of July 26, the key race
and ethnicity breakdowns for those receiving at least one dose are as follows: Blacks have
received 16% of all vaccinations, and 47.8% (686,890) have been vaccinated; Hispanics have
received 9% of all vaccinations, and 61.7% (400,228) have been vaccinated; Asians or Pacific
Islanders have received 10% of all vaccinations, and 74.1% (399,821) have been vaccinated;
Whites have received 59% of all vaccinations, and 53.8% (2.5 million) have been vaccinated
(Source). There are no major changes for any group concerning their representation in the
percentage of cases or in the percentage of deaths.

Some positives are evident. First, Asians represent 7% of Virginia’s population and have received
10% of vaccinations, and nearly 75% of this population have at least one dose. Second, while
Hispanics/Latinos’ share of the percentages of vaccinations have gone down slightly in July (which
is reflective of vaccinations in other groups), almost two-thirds of Hispanics/Latinos in Virginia have
received at least one dose. Third, for Blacks, the disparity between their percentages in the total
population and their percentage of vaccinations narrowed somewhat in July, with Blacks
constituting 19% of Virginia’s total population and 16% of vaccinations (up from 15% at the end of
June) with 47.8% of this population receiving at least one dose, which is up from 23.3% at the end
of June.

Despite progress, caution is still warranted. The population percentages of people with at least one
dose remain the lowest for Blacks (47.8%), and vaccinations for Asians and Hispanics/Latinos
have seen more progress. Given that those who are unvaccinated comprise the bulk of COVID-19
deaths and that the CDC considers nearly every new COVID-19 death to be now entirely
preventable (Source), it is critical to maintain progress made thus far. Further, the Delta variant is
causing significant issues in that it is known to be far more transmissible than other strains of the
coronavirus and is also known to disproportionately affect vulnerable populations (Source).
Persistently lower vaccination rates among Blacks and Hispanics/Latinos compared to Whites

Vaccine Equity Report | August 2021 Page 11
leave them at increased risk as the variant Delta continues to spread across the country (Source).
Despite earlier progress, a continued focus on vaccine equity remains critical.

Table 2: Race, COVID Cases and Deaths, and Vaccinations in Virginia, as of July 19, 2021
% with at
% of % of % of % of Total
least one
Vaccinations Cases Deaths Population
dose
White 59% 53.8% 51% 64% 61%
Black 16% 47.8% 22% 25% 19%
Hispanic 9% 61.7% 19% 7% 10%
Asian 10% 74.1% 4% 4% 7%
Sources: Kaiser Family Foundation and VDH Data portals
Figure 2: Vaccinations by Race (One Dose)

Source

Other Updates
While COVID-19 vaccinations have slowed significantly, Virginia state agencies continue to
provide updates concerning COVID-19 vaccinations. For instance, while the state’s emergency
declaration ended on June 30, VDH continues to remind Virginians of the importance of masks to
prevent the spread of COVID-19, especially for those ages 2 or older who are not fully vaccinated
and/or have a compromised immune system (Source). On July 27, the CDC recommended
universal masking in K-12 schools (Source). However, the decision to require masks in Virginia is
being left up to local school divisions (Source; Source). On July 8, VDH announced the second
confirmed COVID-19 related fatality of a child younger than 10 years, reminding Virginians of the
eligibility for vaccines and also of key safety practices (Source). Finally, “breakthrough cases,” or
instances in which someone fully vaccinated contracts COVID-19, remains an issue, and VDH’s
data portals now tracks such cases. However, state health commissioner Dr. M. Norman Oliver

Vaccine Equity Report | August 2021 Page 12
cautioned that “[o]ver 99% of COVID-19 cases in Virginia have occurred in people who were not
fully vaccinated” (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).

Figure 3: Rural and Non-Rural Areas in Virginia

Source
Rural areas, especially in south-central and south-west Virginia, continue to have low vaccination
rates (Figure 4). Further, vaccination hesitancy remains an issue throughout the Commonwealth,
and demand for vaccines has dropped significantly, although VDH’s new data dashboards
showcase clear linkages between higher vaccination rates and significantly reduced cases of
COVID-19 (Source; Source). In July and as seen in Figure 5, Virginia saw a rise in elevated risk
levels, especially in rural areas (Source).

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

Source

Vaccine Equity Report | August 2021 Page 13
Figure 5: COVID-19 Risk Levels by Locality

Source
Infections and Deaths Since Vaccine Availability
The data clearly reveal that vaccinations have saved lives, and only about one percent of current
COVID-19 cases occur in those who are fully vaccinated (Source). Still, vaccine hesitancy remains
an issue in the Commonwealth of Virginia and throughout the United States (Source). Despite
some progress in June, disparities remain in infections and deaths since the availability of
vaccines, especially concerning: 1) race; 2) age and sex; and 3) urban-rural divides.

First, as shown in Table 3, concerning race, Whites continue to have the highest overall numbers
and percentages of cases and deaths: Whites represent 61% of the population, they represent
51% of cases (a rise of 1% from last month) and 64% of deaths (no change from last month).
Blacks represent 19% of the population yet 22% of cases (a rise of one percent from last month)
and 25% of deaths (no change from last month). Further, Hispanics are 10% of the population yet
19% of cases. When comparing the percentages in the population, both Blacks and Hispanics still
disproportionately contract COVID-19, and Blacks disproportionately die from it.

Table 3: Comparisons of COVID-19 Cases, Deaths, and Population
% of Cases % of Deaths % of Total Population
White 51% 64% 61%
Black 22% 25% 19%
Hispanic 19% 7% 10%
Asian 4% 4% 7%
Source: Kaiser Family Foundation

Vaccine Equity Report | August 2021 Page 14
Second, as evident in Figure 6 and in addition to the concerns about racial equity discussed
above, patterns in cases also emerge in terms of age and sex. Concerning age, those ages 20-29
continue to comprise the group with the single largest number of cases. Concerning sex, those
identifying as females tend to represent slightly more COVID-19 cases. As seen in Figure 7 and in
addition to the racial equity inequities discussed above, 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 noted rises in deaths for successive age groups and with the bulk of deaths
occurring in the age 80+ category. However, as was the case in June, 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 | August 2021 Page 15
Figure 7: Deaths of COVID-19 in Virginia: Demographics

Source

Third, as shown in Figures 8 and 9, urban and rural disparities continue to be 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 | August 2021 Page 16
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 includes Delaware, the District of Columbia, Maryland,
Pennsylvania, and West Virginia. In July, Virginia ranked third in the region in terms of COVID-19
vaccine doses administered per 100 people, which was the same as for June (Source). Regarding
risk levels in July (Figure 10), Virginia is seeing some concerning trends. The Commonwealth has
886 new cases (seven day rolling average, up from 253.6 cases in June) at 10.4 cases per

Vaccine Equity Report | August 2021 Page 17
100,000 people (up from 3 cases in June). This places Virginia second out of sixth in terms of
COVID-19 risk level (no change from June’s ranking).

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

Source

Further, as seen in Figure 11 below, updated FEMA data are available concerning linkages
between vaccination coverage (low to high) and rankings on the social vulnerability index (SVI). As
shown below, Virginia’s rural areas experience issues with a high ranking on the SVI as well as low
vaccination coverage. Other areas in Region 3, particularly Delaware, Maryland, and Pennsylvania
tend to experience moderate-high SVI while also having high vaccine coverage. This FEMA data
suggest that promoting vaccine equity should continue to be a priority for rural areas.

Vaccine Equity Report | August 2021 Page 18
Figure 11: Percent of Population Fully Vaccinated by Social Vulnerability Index, FEMA
Region 3

Source

FEMA Region 3 and Race/Ethnicity
All areas in FEMA Region 3 continue to show racial disparities in the percentages of vaccines
administered. As noted earlier, across Region 3, both Blacks and Hispanics/Latinos have seen
some improvements in vaccination percentages. Virginia remains a leader in working to close gaps
between the percentage of cases and the percentage of vaccinations for Blacks,
Hispanics/Latinos, and Asians. Still, comparing state vaccination rates by race and ethnicity is
challenging because of reporting inconsistency and missing data (Source). Kaiser Family
Foundation data are current as of July 19, 2021.

Vaccine Equity Report | August 2021 Page 19
Figure 12: Blacks as a Share of COVID-19 Trends, FEMA Region 3

Source

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

*Data unavailable for West Virginia; Source

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

*Data unavailable for West Virginia; Source

Figure 15: Whites as a Share of COVID-19 Trends, FEMA Region 3

Source

Vaccine Equity Report | August 2021 Page 20
FEMA Region 3 and 65+ Vaccinations
In July, across FEMA Region 3, there continue to be improvements from June in the percentages
of vaccinations (at least one dose) for those ages 65+. Vaccinations for this group have typically
risen from between 2-4%, although vaccinations continue to slow down (Table 4). In most cases,
those ages 65+ who have at least one dose are near or over 90% of the given populations, a
change from 85% in June. Previously, both Maryland and Virginia reported age ranges differently
than other Region 3 states, but in June, Virginia changed its reporting of age ranges to match
reporting both in other states as well as by the federal government. Maryland data for those ages
65+ are available through federal government resources.

Table 4: Comparison of Population and Vaccination Demographics, 65+, FEMA Region 3

Virginia Delawar District of Maryland Pennsylvania West
e Columbia Virginia

% of population
65+ with at 90% 94% 87% 92% ~100% 78%
least one dose

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

Estimated
Numbers in 1,357,147 188,910 87,512 961,263 2,393,971 367,390
Population: 65+
Sources: US Census, CDC, and data portals for FEMA Region 3, and HealthData.gov state profiles.

FEMA Region 3 and Under 40 Vaccinations
The recent changes in Virginia’s reported age range categories are more closely aligned with the
age reported by many other states and the federal government. This facilitates easier comparisons
between Virginia, other states, and the United States in general. As shown in Table 5, Virginia is
well ahead of the national average for vaccinations for those under 40 years of age. Improvements
for Virginia are notable in each category, although nationally, vaccinations for those under 40 only
rose by 1% or so between June and July.

Table 5: Virginia-U.S. Vaccination Comparisons, Ages 12-39

Virginia Ages 12-15 Ages 16-17 Ages 18-24 Ages 25-34
(at least one dose)
44.7% 56.4% 50.1% 48.7%

United States Ages 12-15 Ages 16-17 Ages 18-24 Ages 25-39
(at least one dose) 3.4% 2.1% 8.4% 20.2%
Sources: CDC estimates, VDH COVID-19 Vaccine Data Portal, and USA Facts.

Vaccine Equity Report | August 2021 Page 21
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 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
The Biden administration initially set a goal of having 70% of all Americans vaccinated by July 4.
However, that goal was narrowly missed with 67% of all Americans vaccinated by the target date
(Source). When looking at demographic breakdowns, only the Asian population was on track to
meet the 70% target. Other groups, such as Blacks and Hispanics/Latinos, had lower vaccination
rates and thus remained at higher risk of infection (Source).

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.
Overall, the percent of vaccinations among White and Asian populations is higher than their
percentages of infections and deaths (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 proportionately represent a much
smaller share of Virginia’s total vaccinations than Whites (Source).

Figure 16: Share of Total Vaccinations in Virginia
Black Hispanic White

100%

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

40%

14% 14% 14% 14% 14% 14% 14% 15% 15% 16%
20%12%

13% 14% 14%
0% 6% 10% 11% 12% 9%
6% 7% 8%
2/16/21 3/16/21 4/16/21 5/16/21 6/16/21 7/16/21

Source

Vaccine Equity Report | August 2021 Page 22
Doses Administered
Demand for the vaccine 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 14,523 on July 23 (Source).
While this drop in demand is due in part to increases in the total vaccination number (i.e., not as
many people need the vaccine), there is still a large percentage of the population that remains
unvaccinated.

Figure 17: 7-day Doses Administered Average in Virginia
80000
70000
60000
50000
40000
30000
20000
10000
0

Source

5. Vaccine Hesitancy
Figure 18 displays estimated vaccination hesitancy by the U.S. Department of Health and Human
Services by county in Virginia. The estimated hesitancy rate is comparatively low across Virginia.

Figure 18: Vaccinations Hesitancy by County across FEMA Region 3

Source

Vaccine Equity Report | August 2021 Page 23
Figure 18 shows vaccination hesitancy by county across FEMA Region 3. Virginia’s estimated
hesitancy rate is lower in comparison to other FEMA Region 3 states, with 53% of Virginia’s
population fully vaccinated and nearly 60% vaccinated with at least one dose (Source). Virginia’s
vaccination rates surpass those of many other states (Source). Though Virginia is doing well, the
rise of the Delta variant is alarming. As of mid-July, an estimated 65.6% of all new COVID-19
cases in FEMA Region 3 were due to the more transmissible Delta variant (Source). In an effort to
combat this variant and in addition to past variants, efforts are being made to increase vaccination
rates (Source). Still, many individuals remain hesitant to get a vaccine.

In a recent poll conducted by the Research Institute for Social Equity at Virginia Commonwealth
University’s Wilder School of Government and Public Affairs, adults in Virginia were asked about
their thoughts on getting vaccinated (Source). Among the 17% of poll participants who said that
they were not likely to get vaccinated, major reasons for hesitancy included:

• Concern about side effects (77%)
• A belief that the vaccines were developed and tested too quickly (72%)
• A desire to know more about how well the vaccines work (44%)
• A belief that the vaccine is not needed (43%)

Findings from a nationwide poll were similar (Source):

• A belief that the vaccine is too new (53%)
• Concern about side effects (53%)
• The participant just didn’t want to get vaccinated (43%)
• Distrust of the government (38%)
• A belief that the vaccine is not needed (38%)
• A belief that the vaccine is not safe (37%)
• Distrust of vaccines in general (26%)

Participants in the VCU Wilder School poll were also asked about vaccination incentives. Overall,
incentives did not appear to have a large impact on decreasing vaccine hesitancy rates. Only
seven percent of those who were not likely to get vaccinated said that a cash reward or paid time
off of work would be incentivizing, and only three percent said that a gift card would be
incentivizing.

However, some populations seemed to be more interested in these incentives than others. While
only seven percent of people overall liked the idea of a cash reward incentive, 15% of those with a
family income of $100,000 or more as well as 27% of Hispanic respondents found a cash reward
to be incentivizing. When considering what type, if any, of incentive should be offered, using
different incentives for different populations may prove to be successful.

Nationwide, people were more incentivized by offerings that were related to the vaccines, rather
than incentives in the form of cash or gifts. Thirty-one percent said that the vaccines receiving full
FDA approval would be an incentive, 17% said that a mobile vaccine clinic in their neighborhood
would be an incentive, and 13% said that free childcare while they get vaccinated and recover from
side effects would be an incentive. Additionally, 23% said that they would be incentivized to get
vaccinated if they were entered into a million dollar lottery (Source).

Vaccine Equity Report | August 2021 Page 24
In addition to these external incentives, personal incentives (i.e., personal reasons for getting
vaccinated) can also be considered and used in messaging. Nationwide, reasons for choosing to
get vaccinated included (Source):

• Protect myself/reduce risk (27%)
• Afraid of catching the virus/avoid getting sick (16%)
• Was at-risk of getting sick due to age/health (10%)
• Protect family members (7%)
• Herd immunity/protect the community or society (6%)
• General safety (6%)
• Get back to normal life (3%)
• Self or family member previously had COVID: (3%)
• Required for work/essential worker/health care worker (3%)
• Travel (3%)

Those designing vaccine messaging should be cognizant not only about what is said in any
messaging but also be attentive to who it is directed to and who is delivering it. In a nationwide
poll, parents were asked which sources they trusted most to provide information about
vaccinations for their children (Source). Trusted sources included:

• Their child’s pediatrician (85%)
• Their own doctor (83%)
• Their health insurance company (73%)
• Their employer (72%)
• The CDC (71%)
• The FDA (69%)
• Their state government officials (56%)

Virginia’s Efforts to Reduce Hesitancy
In view of concerns about significant COVID vaccine hesitancy, the Virginia Department of Health
is now focused on community outreach to increase uptake of COVID vaccinations, especially
among Black, Hispanic/Latino, Native American, and all populations who are hesitant to receive
these vaccinations. VDH has met with leadership of all of the health districts to discuss challenges
and efforts to engage community leaders and influencers. The goal is to engage community
influencers as public health partners to encourage COVID vaccinations among all populations in
the immediate future, and then work with community partners to address a broad range of public
health issues to ensure optimal health for all Virginians. The impact on COVID vaccinations will be
tracked closely as part of the CDC funded vaccination initiative. This is a long-term project and
health districts are working together in cohorts to share challenges, experiences and best
practices.

6. Data Gaps Impacting Equity
As mentioned above, the VDH COVID-19 in Virginia Dashboard has been updated to improve the
quality of information used to understand how COVID-19 has impacted Virginia residents (Source).
Previous efforts to examine the burden of disease were complicated by the amount of missing

Vaccine Equity Report | August 2021 Page 25
data, particularly in race and ethnic demographic profiles. Updates on VDH vaccination counts by
race and ethnicity were completed using statistical imputation methods. As detailed in the June
report, nearly 2 million vaccinations were missing race and ethnicity data.

Virginia COVID-19 demographics indicated that 694,384 cases, 31,336 hospitalizations, and
11,532 deaths have been reported across health districts. While data “not reported” remains a
concern for all demographic profiles on the VDH Dashboard, missing race and ethnicity data
continue to lag behind age and sex demographic profiles reported for cases, hospitalizations, and
deaths (Source). The cumulative impact of missing data and data gaps incrementally impact
Virginia's equitable response to COVID-19.

COVID-19 Cases and Testing Dashboards
In COVID-19 cases, missing data are reported for all of the demographic profile groups (e.g., age,
race and ethnicity, and sex). However, missing data by race and ethnicity are almost always the
largest proportion of unknown cases in all health districts (Source). For example, concerning age,
0.5% (3,579) of the 694,384 cases are “not reported,” for sex 0.8% (5,354) are “not reported,”
however, 14.7% (102,318) of race and ethnicity are “not reported.” In health districts, the number
of testing encounters by lab report do not report demographic profiles by age group, race and
ethnicity, or sex for the 7-day moving average. While testing encounters by health districts help to
monitor service delivery, demographic profiles are needed to understand the risk of infection and
burden of disease for communities of color in each locality.

COVID-19 Vaccine Dashboards
At the end of July, Virginia COVID-19 vaccine demographics reveal that 5,157,082 people have
been vaccinated with at least one dose, and 4,614,836 Virginians have been fully vaccinated. For
Virginians receiving at least one dose, complete data counts are reported by age group. In
comparison, 298,651 vaccination counts by race and ethnicity (5.7%) and 11,660 (0.22%)
vaccination counts by sex are “not reported.” Similarly, among fully vaccinated groups, complete
vaccinate counts are reported by age group. However, 255,103 (5.5%) vaccination counts by race
and ethnicity, as well as 9,901 (0.2%) vaccinations by sex are “not reported” (Source).

During the COVID-19 pandemic, collecting, coordinating, and managing state data governance
and analytics has been led by the Chief Data Officer for the Commonwealth of Virginia (Source).
By race and ethnicity and sex, missing data continues to complicate understanding and improving
planned interventions to mitigate the spread of disease and reduce the impact of COVID-19 on
communities of color. The coordination of effort to use imputation for missing data, with the
expressed goal of disaggregating data by local districts, can and should take priority for the
Commonwealth of Virginia (Source). The state should continue to prioritize imputations for missing
data so as to launch an ethical and equitable response that mitigates the risk of COVID-19
infection. Similarly, to further understand the differences in risk profiles and the opportunity to
receive the COVID-19 vaccine, the state should rely on complete data to further examine the
burden of disease on people of color, as well as design race-conscious solutions for communities
of color. Understanding the risk of infection and rate of vaccinations is critical to improving disease
outcomes for all residents in Virginia.

Vaccine Equity Report | August 2021 Page 26
7. Policy and Administrative Updates
Legislative Updates

• A special session of the Virginia General Assembly has been scheduled for Monday,
August 2, 2021. This session is set to address the American Rescue Plan Act's
Coronavirus State Fiscal Recovery Fund for Virginia (Source).

Executive Updates

• On July 12, 2021, Governor Northam announced that his first budget proposal for
American Rescue Plan Act funding invests $353 million to boost recovery among
Virginia’s small businesses and industries hardest-hit by the COVID-19 pandemic
(Source).
• On July 29, President Biden announced a required vaccine attestation or testing
mandate for federal employees to help contain the spread of the Delta variant of the
coronavirus (Source).

Agency Updates

• On June 15, the Virginia Department of Health and the Virginia Department of Education
released new guidance for PreK-12 schools in Virginia for the upcoming 2021-2022
school year (Source).
• The CDC’s eviction moratorium expired on July 31, 2021 (Source).

Court Updates

• On July 7, the Supreme Court of Virginia extended the Twenty-Fifth Order of Declaration
of Judicial Emergency through August 11, 2021 (Source).

8. On the Horizon
July began with optimism across the US, including in Virginia, as COVID-19 cases were down and
rates of hospitalizations and deaths were significantly decreasing (Source). In Virginia, the
emergency declaration had expired (Source) and people across the Commonwealth were eager to
resume “normal” Independence Day celebrations (Source; Source). However, a few weeks earlier,
the COVID-19 Delta variant was classified by the CDC as a variant of concern (Source). As of July
20, the Delta variant comprised 83% of new COVID-19 cases nationwide and an estimated 65.6%
of all new COVID-19 cases in FEMA Region 3 (Source; Source). By the end of July, the Delta
variant was spreading significantly across the country (Source). Amid the rise of the more
contagious Delta variant, the CDC released new public health recommendations for vaccinated
persons, schools, and those in areas of substantial or high transmission (Source; Source). With
increased spread of the Delta variant, COVID-19 infections, hospitalizations, and deaths are once
again growing, largely among the unvaccinated (Source). According to projections from the
University of Virginia’s weekly COVID-19 report, Virginia could be on the path to exceeding its

Vaccine Equity Report | August 2021 Page 27
worst months of the pandemic in September if cases and vaccination rates stay the same while the
Delta variant spread accelerates (Source; Source).

The data clearly reveal that vaccinations have saved lives, and only about one percent of current
COVID-19 cases occur in those who are fully vaccinated (Source). Still, vaccine hesitancy remains
an issue in the Commonwealth of Virginia and throughout the United States (Source). Despite
some progress in June, disparities remain in infections and deaths since the availability of
vaccines, especially concerning: 1) race; 2) age and sex; and 3) urban-rural divides.

In addition, vaccine mandates are on the rise in government and in the private sector. In late July,
President Biden announced a required vaccine attestation for federal employees to help contain
the spread of the coronavirus (Source). Organizations, private companies, colleges and
universities, and state governments across the US have begun announcing vaccination mandates.
Facebook, Google, Netflix, Morgan Stanley, and The Washington Post each announced they
would require employees to have been vaccinated for COVID-19, with limited exceptions for
medical or religious reasons (Source).
Changes that have occurred in July have significant implications for re-opening of in-person
schools and equity. The Delta variant spreads widely among the unvaccinated (Source; Source).
Persistently lower vaccination rates among Blacks and Hispanics/Latinos compared to Whites
leave them at increased risk as the variant Delta continues to spread across the country (Source).
Across the Commonwealth there have been recent surges of infection in those ages 10-19, and
the majority of Virginia’s Delta variant cases are among those under the age of 40 (Source;
Source). Thus, a combination of a massive resurgence in cases driven by the Delta variant
(Source) in tandem with continued disparities for Blacks and Hispanics (i.e., cases, deaths, and
vaccinations), suggest that Virginia not only cannot and should not lose the progress already
made, but also must continue to center equity in all aspects of addressing the pandemic. Despite
earlier progress, a continued focus on vaccine equity remains critical. Concern about virus spread
and breakthrough infections necessitates the critical need to accelerate vaccinations and re-
prioritize equity.

Vaccine Equity Report | August 2021 Page 28
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 | August 2021 Page 29

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