VDH Plan for Equitable Distribution of COVID-19 Vaccine — Vaccine Equity Report (September 2021)

Summary

The September 2021 Vaccine Equity Report, titled VDH Plan for Equitable Distribution of COVID-19 Vaccine, from the Office of Health Equity in the Virginia Department of Health. Its Executive Summary calls it a monthly report for August 2021 that compares Virginia with Delaware, the District of Columbia, Maryland, Pennsylvania and West Virginia in Region 3 of the Federal Emergency Management Agency (FEMA). It states that at the end of August, Delta comprised over 97% of new COVID-19 cases nationwide, and that over 63% of Virginians 12 and older have received at least one vaccine dose, up from 60.39% at the end of July.

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Full text

VDH Plan for
Equitable
Distribution
of COVID-19
Vaccine

SEPTEMBER 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. Critical Updates....................................................................................................................... 9
Virginia Department of Health’s Community Outreach Efforts ........................................ 11
3. Vaccination Equity in Virginia ............................................................................................. 12
Vaccinations for 65+ ............................................................................................................ 12
Vaccinations for Under 45 ................................................................................................... 12
Race and Ethnicity ............................................................................................................... 13
Rural Areas ........................................................................................................................... 14
Infections and Deaths Since Vaccine Availability ............................................................. 15
4. Vaccinations in FEMA Region 3 .......................................................................................... 19
FEMA Region 3 and Race/Ethnicity .................................................................................... 21
FEMA Region 3 and 65+ Vaccinations ............................................................................... 22
FEMA Region 3 and Under 40 Vaccinations ...................................................................... 23
5. Trends Over Time ................................................................................................................. 23
COVID-19 Infections and Death Rates ................................................................................ 24
Racial Groups as a Share of Total Vaccinations in Virginia............................................. 24
Doses Administered ............................................................................................................. 24
6. Education Equity in Virginia ................................................................................................ 25
Pre-Kindergarten – Secondary Schools ............................................................................. 25
Higher Education .................................................................................................................. 27
7. Vaccine Hesitancy ................................................................................................................ 28
8. Data Gaps Impacting Equity ................................................................................................ 29
9. Policy and Administrative Updates ..................................................................................... 29
Legislative Updates .............................................................................................................. 29
Executive Updates ............................................................................................................... 30
Agency Updates ................................................................................................................... 30
Court Updates ....................................................................................................................... 30
10. On the Horizon .................................................................................................................... 30
Charging Statutes ................................................................................................................ 32

Vaccine Equity Report | September 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 August
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 far more infectious and has increased transmissibility
when compared with other variants (Source). At the end of August, Delta comprised
over 97% of new COVID-19 cases nationwide (Source).

• Vaccine equity must remain a priority in Virginia, especially given the rapidly rising
risks associated with the Delta variant as well as the known increased and disproportional
risks faced by historically marginalized populations in experiencing the worst effects and
outcomes of COVID-19, including death (Source). Despite earlier progress, an apathy for
equity has emerged and a continued focus on vaccine equity remains critical.

• Urban and rural disparities continue. COVID-19 cases are exacerbated as the Delta
variant has led to significant increase in risk (Source). More rural counties continue to
show disproportionate cases, although no area of Virginia has been insusceptible to the
rapid rise in risk levels. Rural counties continue to disproportionately experience deaths
related to COVID-19 (Source). Rural areas, especially in south-central and south-west
Virginia, continue to have low vaccination rates (Source).

→ Continued Vaccination Efforts
• Vaccines in the US are highly effective, including against the Delta variant (Source).
VDH data clearly reveal that vaccinations have saved lives, with very few “breakthrough”
cases occurring amongst vaccinated individuals (Source; Source).

• Unvaccinated people remain the greatest concern. The highest risk of transmission is
among the unvaccinated who are much more likely to get infected and transmit the virus
(Source). Over 63% of Virginians 12 and older have received at least one vaccine dose
(up from 60.39% at the end of July), but much progress still remains (Source).

• Critical equity work remains necessary. 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.

Vaccine Equity Report | September 2021 Page 2
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 08/31/21
% of % with at least % of % of % of Total
Vaccinations one dose Cases Deaths Population
White 59% 56.3% 51% 64% 61%
Black 16.6% 51.8% 22% 25% 19%
Hispanic 10% 67.5% 19% 7% 10%
Asian 9% 76.3% 4% 4% 7%
Sources: Kaiser Family Foundation and VDH Data portals

→ COVID-19 and Education Equity
• Cases of COVID-19 in schools have caused problems with the kick-off of the 2021-22
academic year, causing quarantine measures and rapid shifts back to virtual learning for
some schools (Source; Source; Source).

• Many colleges and universities across the commonwealth have mandated COVID-19
vaccines for staff and students, but not all are enforcing their policies (Source).

→ Persistent Hesitancy
• Vaccination hesitancy remains – many Virginians are still unwilling to receive a
COVID-19 vaccination. In a recent poll conducted by the Research Institute for Social
Equity at Virginia Commonwealth University’s Wilder School of Government and Public
Affairs, the number of unvaccinated Virginians willing to get a COVID-19 vaccine has
declined. According to this survey, 87% of unvaccinated adults in Virginia say they do not
plan on getting vaccinated for COVID-19 (Source; Source).

• Opportunities remain for increased vaccination rates. The seven-day average of
vaccines administered had been declining until August. Virginia experienced an increase
in demand between the beginning of July and the middle of August. Although demand is
again trending downward, it remains higher than in mid-summer (Source; Source).

→ Vaccination Mandates
• Vaccination mandate for Virginia state employees. In early August, Governor Northam
announced Virginia will require most state employees to show proof of vaccination or
subscribe to weekly COVID testing. This policy will impact approximately 122,000
employees (Source).

• After full FDA approval, vaccination mandates have increased. After the FDA granted
full licensure to the Pfizer-BioNTech COVID-19 vaccine for persons ages 16 years and
older on August 23, 2021, schools, organizations, private companies, and governments
across the U.S. announced vaccination mandates (Source; Source).

Vaccine Equity Report | September 2021 Page 3
1. Key Equity Accomplishments
This section details major equity accomplishments related to COVID-19 in the
Commonwealth of Virginia during the month. Equity accomplishments from August include:

● August: VDH has continued it focus 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).

● August: During the month of August, interagency leaders across state government
discussed the necessary reforms to see a broadened definition and transformation of
public health, as well as ways to strengthen Virginia’s infrastructure across all social
determinants of health.

● August: To support vaccination efforts, Greene Street Communications, an ELT partner
created several marketing and communication materials, including: conducting a
comprehensive “Mythbusters: Ask the Experts Toolkit” campaign that launches four,
brand-new, compelling videos featuring diverse medical experts answering a range of
questions; produced three 30-second videos to encourage vaccinations among rural,
Hispanic, and interfaith communities; provided printing, design, and art support for health
districts and partners across the Commonwealth; customized previously published
mitigation marketing material to encourage mask-wearing as part of its ongoing support
for Virginia State University’s efforts to combat the spread of COVID-19 among those in
its community; and, produced two radio spots in Spanish encouraging COVID-19
vaccines (Source: Communications with Greene Street team).

● August 2: According to the US Centers for Disease Control and Prevention (CDC), fewer
than 0.004% of people who have been fully vaccinated against COVID-19 have
experienced a breakthrough case resulting in hospitalization. Fewer than 0.001% have
died from the disease (Source).

● August 3: CDC promulgated a new eviction moratorium to include protections for renters
and tenants in areas where the coronavirus is spreading at higher rates. This
moratorium is scheduled to last until October (Source).

● August 3: The Virginia Department of Health (VDH) and Metaculus announced Round 2
of the Keep Virginia Safe Forecasting Tournament, which is focused on forecasting the
Delta COVID-19 variant and other potential variants of concern (Source).

● August 3: As of this date, 65.2% of Virginia’s population (4,654,832 people) were fully
vaccinated (Source).

● August 4: The Virginia Community College System Chancellor declared a universal
indoor mask mandate for Virginia Community Colleges Institutions (Source).

● August 4: The CDC noted that the majority of Virginia localities are “high COVID
transmission areas” (Source).

Vaccine Equity Report | September 2021 Page 4
● August 4: The City of Richmond declared that it is requiring city employees to be fully
vaccinated by October 1 (Source).

● August 5: Governor Northam announced Virginia will require most state employees to
show proof of vaccination or subscribe to weekly COVID testing. This policy will impact
approximately 122,000 employees (Source; Source).

● August 6: The Virginia Department of Corrections reported that 20,686 inmates and
7,120 staff had been vaccinated as of this date (Source).

● August 6: Virginia State University (VSU) reversed a previous decision, announcing it
will now require students to be vaccinated before the fall semester (Source).

● August 6: University of Virginia officials announced that all students, staff, faculty, and
visitors, vaccinated or not, will need to wear masks when entering any university
building. Those who have not been vaccinated will need to wear the masks even when
outdoors (Source).

● August 6: Virginia Tech began requiring that everyone, regardless of vaccination status,
must wear masks indoors in certain areas on campus (Source).

● August 9: Virginia Commonwealth University (VCU) reported that all faculty and staff will
be required to report their COVID-19 vaccination status or submit a request for a medical
or religious exemption by September 1 (Source; Source).

● August 9: A statewide poll found that the number of unvaccinated Virginians willing to
get a COVID-19 vaccine has declined. According to this survey, 87% of unvaccinated
adults in Virginia say they do not plan on getting vaccinated for COVID-19 (Source).

● August 10: Dr. Danny Avula, Virginia’s Vaccine Coordinator, announced the long-
awaited development – that younger children under 12 should be eligible in September –
in a call with reporters on Tuesday, noting how the more than 700,000 kids given
eligibility status could change the conversation around schools reopening and boost
Virginia’s vaccination rates (Source).

● August 10: VDH data showed that 14.3% of young Virginians under the age of 18 had
been fully vaccinated as of this date. Approximately 50% of those between the ages of
16-17 had been vaccinated, yet 12-15-year-olds had a vaccination rate below 40%
(Source)

● August 10: The Piedmont Health District hosted a mass COVID-19 vaccination clinic in
Nottoway County, which provided free Pfizer COVID-19 vaccines for anyone 12 and
older as well as the single-dose Johnson & Johnson COVID-19 vaccine for anyone 18
and older (Source).

● August 10: Christopher Newport University re-mandated its mask policy ahead of the fall
semester (Source).

Vaccine Equity Report | September 2021 Page 5
● August 10: VSU announced that it would change course and require its students to get a
COVID-19 vaccine. VSU also noted it will give students and employees a $500 incentive
for being vaccinated (Source).

● August 10: Children accounted for 15% of new COVID cases reported last week, that is
nearly 94,000 children (Source).

● August 10: Virginia Department of Health’s (VDH) online COVID-19 dashboards have
incorporated vaccination data from jurisdictions in Tennessee. Virginians who received
vaccinations in Tennessee that were not reported through the Virginia Immunization
Information System are now included in the locality and statewide dashboards (Source).

● August 11: VDH announced it will create a new vaccine verification tool that will allow
businesses to quickly and easily verify customers’ vaccination status, simply by scanning
a QR code (Source).

● August 12: The FDA authorized an additional dose of the Moderna or Pfizer vaccine for
people with weakened immune systems (Source).

● August 11: The CDC urged pregnant women to get vaccinated, pointing to data that
indicated no safety concerns (Source).

● August 12: Governor Northam issued a Public Health Emergency Order requiring
universal masking in all indoor settings in Virginia’s K-12 schools. This order reinforces
current state law, which requires Virginia schools adhere to mitigation strategies outlined
by the CDC (Source).

● August 12: Dr. Norm Oliver, Virginia Health Commissioner issued a universal indoor
mask mandate for K-12 schools (Source).

● August 13: The CDC recommended that people who are moderately to severely
immunocompromised receive an additional dose of the COVID-19 vaccine (Source).

● August 13: VDH continued its regional vaccination and testing collaborative at the
Military Circle Mall in Hampton Roads (Source).

● August 13: Virginia will make third doses of the Pfizer-BioNTech and Moderna COVID-
19 vaccines available for moderately and severely immunocompromised Virginians,
starting as early as August 14 (Source).

● August 15: The Rappahannock Area Health District reported it would reoffer free clinics
for COVID-19 testing in the wake of rising case counts (Source).

● August 16: Richmond Public Schools declared that all employees must be vaccinated by
October 1 (Source).

● August 16: The Virginia Education Association, the state’s largest teachers’ union, gave
its support for a vaccination or testing requirement (Source).

Vaccine Equity Report | September 2021 Page 6
● August 17: Virginia instated a new set of tenant protections shortly after the end of the
federal moratorium on July 31 (Source).

● August 17: In a reversal, VDH noted that it will release locations of COVID-19 outbreaks
as cases increase. On July 1, the Virginia Department of Health stopped reporting the
specific locations of COVID-19 outbreaks – including school districts. This decision has
been questioned as outbreaks in schools increase, and a spokesperson for the
Governor says they will begin reporting that information again (Source).

● August 18: Harrisonburg City Schools voted to require public school employees to be
vaccinated, unless given a religious or medical exemption (Source).

● August 19: Virginia Tech changed policy to require employee vaccinations (Source).

● August 20: The Piedmont Health District hosted a mass COVID-19 vaccination clinic in
Blackstone (Source).

● August 21: The Pittsylvania/Danville Health District and Averett University, with the
support of local COVID-19 response partners, held a COVID-19 vaccination clinic at
Averett University Student Center (Source).

● August 23: The FDA granted full licensure to the Pfizer-BioNTech COVID-19 vaccine for
persons ages 16 years and older (Source).

● August 23: The U.S. Department of Defense announced it will require service members
to receive the COVID-19 vaccine now that the Pfizer vaccine has received full approval
(Source).

● August 25: The Norfolk Department of Public Health provided free COVID-19 vaccines
at Maury High School in Norfolk (Source).

● August 25: Virginia Department of Health (VDH) reinstated the Outbreaks by Selected
Exposure Settings Dashboard in the VDH COVID-19 Data Insights dashboards. The
dashboard includes information on outbreaks that occurred in medical care facilities,
residential or day programs licensed by VDH, Department of Social Services (DSS) or
Department of Behavioral Health and Developmental Services (DBHDS), summer
camps, K-12 schools, colleges and universities, and long-term care facilities (Source).

● August 26: The U.S. Supreme Court struck down the Biden administration's temporary
federal moratorium on evictions (Source).

● August 27: As of this date, 63.7% of Virginians have received at least one dose, 56.4%
of the population are fully vaccinated (Source).

● August 27: Most Virginia colleges say they mandated COVID vaccines, but not all are
enforcing their policy. As the first week of college classes come to a close, it’s clear that
some vaccine mandates are being treated by schools more like recommendations
(Source).

Vaccine Equity Report | September 2021 Page 7
● August 30: Parents in Loudoun County ask the school district to reopen signups for
virtual instruction; virtual learning registration closed in June. Parents also urge for an
increase in COVID-19 case reporting transparency (Source).

● August 30: Fairfax County high school athletes participating in Winter and Spring sports
will be required to get vaccinated by November 8th and show documentation. The
vaccine mandate for high school student athletes is one of the first in the nation
(Source).

● August 30: One week after school begins, Liberty University switches to virtual
instruction. The sole local hospital in the area has nearly reached ICU COVID-19
capacity and the rate of positive cases on campus has surpassed the highest numbers
from 2020 (Source).

● August 30: High levels of COVID-19 testing turnout motivate public health officials to
offer more testing events through September or longer (Source).

● August 30: Sentara Healthcare will require full vaccination of all staff, volunteers, and
vendors by mid-October (Source).

● August 30: 90% of qualified tribe members have acquired at least one dose of COVID-
19 vaccine. According to the CDC, Native Americans have a three times greater
hospitalization rate and a 2.4 times greater mortality rate than those who are white
(Source).

● August 30: Richmond and Henrico health districts will open four community vaccination
centers in September. Vaccination hubs will be spaced throughout the city and target the
counties with the lowest vaccination rates. Hubs can be accessed one day a week
(Source).

● August 31: As of this date, 66.5% of the adult population in Virginia (18+) have received
at least one dose, 59.7% of adults are fully vaccinated (Source).

Vaccine Equity Report | September 2021 Page 8
2. Critical Updates
This section provides information on critical updates relevant to Virginia’s responses to COVID-
19. While COVID-19 vaccinations have risen somewhat during the month of August, Virginia
state agencies continue to provide updates concerning COVID-19 vaccinations. VDH has
issued numerous press releases detailing important information concerning COVID-19. These
critical updates from August include:

● August 3: VDH reported that it and Metaculus launched round 2 of the Keep Virginia
Safe Forecasting Tournament in which the second round “will help assess COVID-19’s
epidemiological trajectory and the impacts of variants in the fall” (Source).

● August 4: A previous Kaiser Family Foundation (KFF) analysis examined demographic
groups among the unvaccinated population and found two distinct groups: 1) those who
are open to getting a vaccine (“wait and see”); and 2) those who say they will definitely
not get a COVID-19 vaccine. The July KFF COVID-19 Vaccine Monitor found the key
demographic differences between the “wait and see” and the “definitely not” groups still
center on racial and ethnic identity and political partisanship (Source).

● August 4: Mount Rogers health district sees a 75% rise in cases in the past 7 days
(Source).

● August 5: A child in the Eastern Region passed away from COVID-19 complications.
This is the first reported COVID-related death of a child in Virginia’s Eastern Region
(Source).

● August 5: Researchers at the University of Virginia’s Biocomplexity Institute said Virginia
is averaging about 113 weekly cases per 100,000 residents (Source).

● August 6: The delta variant impacts children much more than the traditional COVID-19
strain, which is prompting alarm among local health leaders (Source).

● August 6: The Delta variant is the dominant strain of COVID-19 nationwide and is the
most common variant in Virginia (Source). Delta is more infectious and is contributing to
a surge of cases in Virginia (Source).

● August 10: Children accounted for 15% of new COVID cases reported last week, which
constitutes nearly 94,000 children across the United States (Source).

● August 11: California became the first state to require teachers to be vaccinated or to be
tested regularly (Source).

● August 13: VDH stated that “Virginia will provide third doses of Pfizer-BionTech and
Moderna COVID-19 vaccines for immunocompromised people” (Source).

● August 15: A forecast from the University of Virginia’s Biocomplexity Institute showed an
increased likelihood of people getting sick and dying from COVID-19 (Source).

Vaccine Equity Report | September 2021 Page 9
● August 17: Over the past four weeks, new COVID-19 cases rose more than 400%
across Southwest Virginia as the region’s vaccination rates lag well behind state and
national averages (Source).

● August 17: VDH reported on a statement from the Virginia state vaccination coordinator,
Dr. Danny Avula, on booster doses of COVID-19 vaccines for the general population as
well as immunocompromised persons. Dr. Avula noted: “If booster vaccine doses are
recommended for the general population, the rollout of those boosters will likely take
place over several months, as the expected recommendation is that a booster dose
should be given within a defined time frame after your second dose. VDH and local
health departments now have experience in planning and carrying out the logistics of a
large-scale vaccination effort, and rebooting that for booster doses will not be an issue.
The infrastructure for administering the booster doses is already in place” (Source).

● August 18: A recent poll conducted by the L. Douglas Wilder School of Government and
Public Affairs at Virginia Commonwealth University, showed minority populations were
among the most impacted from a financial standpoint and that racial and economic
disparities have worsened during the COVID-19 pandemic. The economic gap between
white workers and workers of color has widened during the pandemic (Source; Source).

● August 18: A new VCU Wilder School poll showed that while nearly half of Virginia's
population experienced mental health problems due to the COVID-19 pandemic, the
pandemic led to important positive experiences as well. Forty-four percent said that they
saw improvements in their personal relationships with family and friends. In addition,
43% saw improvements in how they spend their free time, and 40% said that they had
an improved view of the government’s response to safety precautions during a pandemic
(Source; Source).

● August 19: Richmond and Henrico Health Districts (RHHD) received notice of a recent
death of a child caused by COVID-19. The child was between the ages of 0-9 (Source).

● August 19: University of Virginia disenrolled 49 enrolled students for not complying with
vaccine requirement (Source).

● August 19: VDH announced that the Norfolk Health Department will offer free COVID-19
Pfizer vaccines at Maury High School (Source).

● August 23: Rappahannock County Public Schools moved to virtual learning for the
remainder of the week while officials worked to create a new system to mitigate the
spread of COVID-19 since the virus has created many cases within the schools since
the academic year began (Source).

● August 23: Breakthrough COVID-19 infections accounted for 4% of new virus cases in
Virginia (Source).

● August 23: VDH provided two major announcements. First, it announced updates to the
vaccination status dashboard to better inform the public of vaccine effectiveness, noting
particularly that almost all new COVID-19 cases are among the unvaccinated with

Vaccine Equity Report | September 2021 Page 10
“breakthrough cases” representing only 10,712 infections of the 4.7million+ Virginias
who have been fully vaccinated at the time (Source). Second, VDH reported on a further
statement from Dr. Avula on the U.S. Food and Drug Administration (FDA) granting full
licensure for the Pfizer-BioNtech COVID-19 vaccine, noting the nearly 5.5 million Pfizer
doses given in Virginia and that the vaccines are highly effective (Source).

● August 25: Given “the rapid increase in transmission of COVID-19 across the state
spurred by the Delta variant”, VDH reinstated the Outbreaks by Selected Exposure
Settings on the COVID-19 Data Insights dashboards. The dashboard includes
information on outbreaks that occurred in medical care facilities, residential or day
programs licensed by VDH, Department of Social Services (DSS) or Department of
Behavioral Health and Developmental Services (DBHDS), summer camps, K-12
schools, colleges and universities and long-term care facilities (Source; Source).

● August 31: On this date, Virginia Tech announced they disenrolled 134 enrolled students
for not complying with vaccine requirement (Source).

Virginia Department of Health’s Community Outreach Efforts
The Central Office VDH Community Outreach Team, led by Dr. Gloria Addo-Ayensu, has met
with each of the seven health district cohorts to begin discussions of community outreach
efforts; each cohort includes 4-5 health districts. These meetings have resulted in sharing of
challenges in vaccinating Black, Latinx, Native American, and Asian Pacific Islander
populations. In most health districts, the Black population has the lowest COVID vaccination
rate, though vaccination rates are often lagging in Latinx populations as well. In some parts of
the Commonwealth, vaccination hesitancy is also high among conservative White populations.
The districts have also shared a broad range of innovative approaches to reaching these
populations and increasing their vaccination rates. (Source: Communication with VDH
Community Outreach Team).

Health districts have been asked to provide a gap analysis to address inequities in vaccination
rates. These gap analyses will be discussed during upcoming cohort meetings. Dr. Addo-
Ayensu has provided the Fairfax County equity report to all health districts to provide ideas on
strategy and how to focus and track improvement in priority areas within their jurisdictions. In
Fairfax, these priority areas are zip codes with low vaccination rates, which also coincide with
areas with low income, minority populations of color. Follow-up cohort meetings will not occur
until at least October since all health districts are now planning efforts to meet demand for
booster vaccinations, as well as vaccinations of children ages 5-11 – approval of both booster
COVID vaccinations and vaccination of children ages 5- 11 is expected in September or
October, 2021 (Source: Communication with VDH Community Outreach Team).

Vaccine Equity Report | September 2021 Page 11
3. Vaccination Equity in Virginia
At the end of August, over 9.95 million COVID-19 vaccine doses have been administered in
Virginia, and over 11.2 million vaccines have been received (Source). Virginia ranks 13th in the
country for the percentage of distributed vaccines that have been administered (Virginia was
12th at the end of July), and 87.1% of vaccines received have been administered (Source). At
present, 64% of all Virginians have received at least one dose of a vaccine (up from 60.39% at
the end of July) (Source), which is above the 61.8% national vaccination rate receiving at least
one dose (Source). Nearly 4.8 million Virginians have been fully vaccinated, representing 56.7%
of the population, which is above the 52.4% national fully vaccinated rate. On average, Virginia
is administering approximately 15,968 vaccinations per day (up from 12,350 at the end of July)
(Source)

Figure 1: Vaccinations by Age (One dose)

Source

Vaccinations for 65+
As seen in Figure 1, VDH reports the following age ranges: 65-74, 75-84, and 85+ (Source).
Those ages 65+ represent roughly 23.6% (1.13 million) of the number of people who have
received at least one dose, and 83.4% of people in this group are vaccinated (Source).

Vaccinations for Under 45
Since May, Virginia has been vaccinating those ages 12 and older. Reported age ranges are:
12-15, 16-17, 18-24, 25-34, and 35-44. Virginia continues to make strides in vaccinations for

Vaccine Equity Report | September 2021 Page 12
those younger than 45 years old. As seen in Figure 1, 56.9% (359,781) of those younger than
18 have been vaccinated with at least one dose, and 66.5% (4.43 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: 53.9% (227,686) of 12-15-year-olds; 63%
(132,095) of 16-17-year-olds; 54.3% (433,805) of 18-24-year-olds; 52.9% (629,787) of 25-34-
year-olds; and 62% (689,437) of 35-44-year-olds (Source).

Race and Ethnicity
In past months, missing data constituted a significant limitation in assessing vaccine equity,
especially relative to race and ethnicity. In July, VDH instituted a statistical imputation procedure
to fill in missing race and ethnicity data, and the missing race and ethnicity data declined from
roughly 2 million to roughly 297,000. Still, missing data remains an issue. As of August 31,
327,282 vaccinations have no race and ethnicity data reported (Source).

Table 2: Race, COVID Cases and Deaths, and Vaccinations in Virginia, as of 08/31/2021
% of % with at least % of % of % of Total
Vaccinations one dose Cases Deaths Population
White 59% 56.3% 51% 64% 61%
Black 16.6% 51.8% 22% 25% 19%
Hispanic 10% 67.5% 19% 7% 10%
Asian 9% 76.3% 4% 4% 7%
Sources: Kaiser Family Foundation and VDH Data portals

As shown below in Table 2 and Figure 2, as of August 31, the key race and ethnicity
breakdowns for those receiving at least one dose are as follows and represent some
improvements for Blacks and Hispanics. First, Blacks have received 16.6% of all vaccinations
(up from 16% at the end of July), and 51.8% (745,535) have been vaccinated (up from 47.8% at
the end of July). Second, Hispanics have received 10% of all vaccinations (up from 9% at the
end of July), and 67.5% (438,251) have been vaccinated (up from 61.7% at the end of July).
Third, Asians or Pacific Islanders have received 9% of all vaccinations (down from 10% in July),
and 76.3% (411,288) have been vaccinated (up from 75% at the end of July). Fourth, Whites
have received 59% of all vaccinations (no change from July), and 56.3% (2.62 million) have
been vaccinated (up from 53.8% at the end of July) (Source). No major changes have occurred
in populations’ percentages of cases and deaths. While these figures represent some positive
developments, vaccine equity must remain a priority in Virginia, especially given the rapidly
rising risks associated with the Delta variant as well as the known increased and disproportional
risks faced by historically marginalized populations in experiencing the worst effects and
outcomes of COVID-19, including death.

Vaccine Equity Report | September 2021 Page 13
Figure 2: Vaccinations by Race (One Dose)

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. The demand for vaccines has risen slightly as compared to the end of July,
and VDH’s data dashboards in tandem with press releases mentioned above clearly showcase
linkages between higher vaccination rates and significantly reduced cases of COVID-19
(Source; Source). In August and as seen in Figure 5, Virginia saw a noted rise in highly elevated
risk levels across the Commonwealth, with most being “high risk” (Source).

Vaccine Equity Report | September 2021 Page 14
Figure 4: Vaccinations by Locality – Rate per 100,000 Population

Source

Figure 5: COVID-19 Risk Levels by Locality

Source
Infections and Deaths Since Vaccine Availability
VDH continues to note how the data clearly reveal that vaccinations have saved lives, with very
few “breakthrough” cases occurring amongst vaccinated individuals (Source; Source). Despite
some progress in recent months, disparities remain in infections and deaths since the
availability of vaccines, especially concerning: 1) race; 2) age and sex; and 3) urban-rural
divides.

Vaccine Equity Report | September 2021 Page 15
First, as a reminder from above, there have been no major changes in reported percentages of
cases and deaths for Asians, Blacks, Hispanics, and Whites. As shown in Table 3, disparities
remain. 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% 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 Total
% of Cases % of Deaths
Population
White 51% 64% 61%
Black 22% 25% 19%
Hispanic 19% 7% 10%
Asian 4% 4% 7%
Source: Kaiser Family Foundation

Second, patterns concerning cases and deaths by age and sex remain similar in August as they
were in July. Concerning cases and age, those ages 20-29 continue to comprise the group with
the single largest number of cases. Concerning cases and sex, those identifying as females
tend to represent slightly more COVID-19 cases. Concerning deaths and age, 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.
Concerning deaths and sex, those identifying as male tend to die at a higher rate than those
identifying as female.

Vaccine Equity Report | September 2021 Page 16
Figure 6: Cases of COVID-19 in Virginia: Demographics

Source

Vaccine Equity Report | September 2021 Page 17
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, which appear exacerbated as the Delta
variant has led to a massive rise in risk. More rural counties continue to show disproportionate
cases, although no area of Virginia has been immune to the rapid rise in risk levels. As was the
case in past month, at the end of August, rural counties disproportionately experienced deaths
related to COVID-19.

Vaccine Equity Report | September 2021 Page 18
Figure 8: Cases of COVID-19 in Virginia, Urban and Rural

Source

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

Source

4. 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 August, Virginia ranked third in the region in
terms of COVID-19 vaccine doses administered per 100 people, which was the same as for July
(Source). Regarding risk levels in August (Figure 10), all of Region 3 is seeing highly concerning
trends. The Commonwealth has 3,178.3 new cases (seven day rolling average, up from 886
cases in July and 253.6 cases in June) at 37.2 cases per 100,000 people (up from 10.4 cases in
July and 3 cases in June). This places Virginia third out of six in terms of COVID-19 risk level
(down from second in July’s ranking).

Vaccine Equity Report | September 2021 Page 19
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, both Virginia and West Virginia particularly face issues of high SVI and low
vaccination coverage. In Virginia, these issues affect almost all areas of the state, with particular
clusters in the south-west, south-central, central, and south-east portions of the state.

Vaccine Equity Report | September 2021 Page 20
Figure 11: Percent of Population Fully Vaccinated by Social Vulnerability Index, FEMA
Region 3

Source

FEMA Region 3 and Race/Ethnicity
As was the case in July, all areas in FEMA Region 3 continue to show racial disparities in the
percentages of vaccines administered in August. As noted earlier, across Region 3, both Blacks
and Hispanics/Latinos have seen some improvements in vaccination percentages. Virginia still
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 August 16, 2021.

Vaccine Equity Report | September 2021 Page 21
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
FEMA Region 3 and 65+ Vaccinations
In August, 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 1-2 (Table 4). In most cases, those ages 65+ who have at
least one dose are near or over 90% of the given populations.

Vaccine Equity Report | September 2021 Page 22
Table 4: Comparison of Population and Vaccination Demographics, 65+, FEMA Region 3

Virginia Delaware District of Maryland Pennsylvania West
Columbia Virginia

% of population
65+ with at 92% 96% 89% 95% ~100% 79%
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
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, often rising
between 2-4% for each age group. Nationally, however, vaccinations for those under 40 only
rose by less than 1% or so between July and August for each age group.

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)
54% 63.2% 54.5% 53%

United States Ages 12-15 Ages 16-17 Ages 18-24 Ages 25-39
(at least one dose) 4% 2.3% 8.7% 20.7%
Sources: CDC estimates, VDH COVID-19 Vaccine Data Portal, and USA Facts.

5. Trends Over Time
As healthcare professionals and policymakers work to increase vaccination rates across Virginia
and the United States, the wide availability of vaccines has not fully reduced barriers to access,
especially among already marginalized groups. In addition, vaccine availability does not
guarantee that the public will take a vaccine. In July, the 7-day average vaccination rate in
Virginia had been on the decline (due to the fact that many had already received it as well as to
vaccine hesitancy), though it has increased in August. This section further examines progress
and disparities, including: COVID-19 infection and death rates; racial groups as a share of total
vaccinations in Virginia; and the 7-day average in Virginia.

Vaccine Equity Report | September 2021 Page 23
COVID-19 Infections and Death Rates
Since vaccines became available, rates of infections, and deaths from COVID-19 have
significantly dropped among those who have been vaccine. However, some populations still
experience higher rates of infections and deaths than others. In some cases, this is due to
hesitancy or refusal to get vaccinated; in other cases, it is due to a lack of access. Nationwide,
Blacks and Hispanics/Latinos have received smaller shares of vaccinations than have Whites
and, therefore, are still seeing higher rates of infections and deaths. Conversely, the percent of
vaccinations among Whites and Asians is higher than their percentage 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
(though it has remained relatively steady for the past four months), while the percentage of
Blacks and Hispanics/Latinos remains lower. Blacks have seen a slight increase from 12% to
16% since February 2021, though this figure has remained stable in recent months. The
percentage for Hispanics/Latinos trended upward between February and June, although there
was a large decrease between June and July. However, in August, the figure increased slightly
from 9% to 10% (Source).

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

100%

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

40%

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

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

Source
Doses Administered
In Virginia, the 7-day average of doses administered had been on the decline until August.
However, an increase in demand between the beginning of July and the middle of August was
evident. Although demand is again trending slightly downward, it remains higher than it had
been at the end of June and beginning of July (Source). This trend matches that of the United

Vaccine Equity Report | September 2021 Page 24
States as a whole, which experienced a decrease in demand between April and early July and
is now experiencing an increase in the 7-day average (Source).

Figure 17: 7-day Doses Administered Average in Virginia
80000

70000

60000

50000

40000

30000

20000

10000

Source

6. Education Equity in Virginia
This section explores current equity concerns around elementary through secondary school and
higher education in Virginia.

Pre-Kindergarten – Secondary Schools
Public school divisions in Virginia are associated with one or more counties, cities, and
incorporated towns and are locally governed by elected school board officials and
superintendents (Source). Virginia is home to over 200 individual school districts among its eight
regional districts. This decentralized governance structure allows for localities to form policies
and provisions in accordance with the specific needs of their community. However, a lack of
statewide policies and procedures has been a significant hurdle for individual districts with
regard to health and safety related to COVID-19 (Source; Source; Source).

On August 12, Governor Northam released a Public Health Emergency Order mandating
universal indoor masking for all students, teachers, and staff in K-12 schools (Source; Source).
Pre-K programs located at K-12 schools are also be required to adhere to the Order. The
mandate supports current bipartisan Virginia legislation (SB 1303) requiring Virginia schools to
implement CDC recommended prevention strategies to the greatest degree possible, including
universal masking (Source). The Order does not apply to outdoor spaces, though the Virginia
Department of Health continues to recommend that unvaccinated individuals maintain masking
in densely populated outdoor environments (Source).

At the end of August, seven school districts in Virginia have mandated COVID-19 vaccinations
for adults in schools. Table 6 below details these localities, free and reduced eligibility, and
detail of vaccination verification.

Vaccine Equity Report | September 2021 Page 25
Table 6: Vaccination Mandates by Locality and Free and Reduced Eligibility

% Free and
Vaccine
Locality Reduced Notes
Verification Due
Eligibility

Alexandria City Vaccines or regular testing
50.61% TBA
Public Schools mandatory for staff (Source)

Arlington County Vaccines mandatory for employees
22.96% August 30
Public Schools (Source)

Vaccines or regular testing
Late October
mandatory for staff (Source)
Fairfax County
25.65%
Public Schools Vaccines required of high school
November 8 athletes participating in Winter and
Spring sports (Source)

Harrisonburg Vaccines mandatory for employees.
County Schools Medical and religious exemptions
66.57% TBA
(Rockingham may apply, pending weekly COVID-
County) 19 testing (Source)

1st dose: Vaccines mandatory for all staff.
10/1/2021; Fully After Oct. 1st, those who have not
Vaccinated: documented partial vaccination must
Loudoun County 11/1/2021 submit to weekly testing (Source)
14.95%
Schools
Vaccines mandatory for student
November 8 athletes participating in winter and
spring sports (Source)

Prince George Vaccines or regular testing
84.10% Not listed
County mandatory for staff (Source)

Richmond City Vaccines mandatory for employees
74.16% 10/1/2021
Public Schools (Source)
Source: Media outlets and the Virginia Department of Education, 2019-2020 Free and Reduced
Eligibility Report

Many of Virginia school divisions across Virginia required families to make a decision about
enrolling their children virtually or attending classes in person in late May or early June
(Source). Now, as the Delta variant spreads across the Commonwealth, parents are rethinking
their choice to send their children to in-person school. Schools are not required to offer virtual
learning and are limited in length of school closure. Many school division virtual programs have
narrow time restrictions per Virginia law mandating in-person instruction (Source). Cases of
COVID-19 in schools have caused problems with the start of the 2021-22 academic year,
causing quarantine measures and rapid shifts back to virtual learning for some schools (Source;
Source; Source).

Vaccine Equity Report | September 2021 Page 26
VDH data show 56.3% of Virginians ages 12-17 have received at least one vaccine dose.
Approximately 53.2% of those between the ages of 12-15 received one dose, and 62.5% of 16-
17-year-olds have received one vaccine dose. However, these rates vary considerably by
locality (Source). For example, in Carroll County 19.1% of those between the ages of 12-15
received one dose, while in Loudoun County 76.1% of those between the ages of 12-15 have
received one dose. There is significant divide between the rural and non-rural areas of the state
in regards to vaccination.

In mid-August, VDH reversed their decision to halt reporting on COVID-19 in specific locales.
Given “the rapid increase in transmission of COVID-19 across the state spurred by the Delta
variant,” VDH reinstated the Outbreaks by Selected Exposure Settings on the COVID-19 Data
Insights dashboards. The dashboard includes information on outbreaks that occurred in medical
care facilities, residential or day programs licensed by VDH, Department of Social Services
(DSS) or Department of Behavioral Health and Developmental Services (DBHDS), summer
camps, K-12 schools, colleges and universities and long-term care facilities (Source; Source).

This lack of universal policies surrounding elementary and secondary schools in Virginia has
larger equity implications. One major implication is overall student learning. Virginia 2020-2021
Standard of Learning (SOL) test results reflect learning disruption experienced during the
COVID-19 pandemic. James Lane, Superintendent of Public Instruction reported that the SOL
data also reflect, “inequities between student groups” (Source). Students benefit from in person
learning and the school system is responsible for providing a safe return to in-person schooling.
As children under the age of 12 are not yet eligible for vaccinations, the CDC’s “guidance
emphasizes implementing layered prevention strategies (e.g., using multiple prevention
strategies together consistently) to protect students, teachers, staff, visitors, and other members
of their households and support in-person learning” (Source). In addition, localities are
responsible for monitoring community transmission, vaccination coverage, screening testing,
and occurrence of outbreaks to guide decisions (Source).

Higher Education
Most college and universities in Virginia are requiring mandatory vaccines in some form for the
2021-2022 academic year (Source; Source). Many too are requiring universal mask wearing
inside buildings on campus (Source).

The Virginia Community College System (VCCS), which governs all of the community colleges
across the Commonwealth. has instituted mask mandates in public indoor spaces on campuses
and other VCCS facilities (Source). Glenn DuBois, chancellor of the Virginia Community College
System stated in May that community colleges lack the necessary public health resources to
manage student health and vaccination records (Source). However, Governor Northam’s state
employee vaccination order extends to community college faculty, staff, part-time employees,
and contractors who enter the workplace or have public-facing duties (Source).

Most bachelor-granting colleges and universities across the Commonwealth have mandated
COVID-19 vaccines for staff and students, but not all are enforcing their policies (Source;
Source). Other schools are using incentives to encourage vaccination. For example, Norfolk
State University opts to incentivize student and faculty, offering $500 to students and $1,000 to
faculty for showing proof of COVID-19 vaccinations by September 20 (Source). Some colleges
are not requiring proof of vaccination and at others, individuals have been granted medical or

Vaccine Equity Report | September 2021 Page 27
religious exemptions. Some colleges are granting extensions based on strongly held personal
beliefs (Source). Other universities are considering alternative penalties for students who have
not submitted verification documents for COVID-19 vaccines (Source).

Overall, colleges and universities have used their institutional policy making abilities to mandate
both mask and vaccination mandates increasing the protection of higher education students and
staff from COVID-19 infections.

7. Vaccine Hesitancy
With over 56% of the population fully vaccinated, and over 63% vaccinated with at least one
dose, Virginia’s vaccination rates (including those who are fully vaccinated and those who are
vaccinated with at least one dose) surpass those of many other states (Source; Source).
However, the Delta variant is an ongoing concern and, in rare cases, causes breakthrough
cases among the unvaccinated (Source). Ensuring that as many people as possible get
vaccinated is more important than ever. However, many are still hesitant to get vaccinated.

In a recent poll conducted by the Research Institute for Social Equity (RISE) at Virginia
Commonwealth University’s (VCU) Wilder School of Government and Public Affairs, adults in
Virginia were asked about their likeliness to get vaccinated, as well as reasons why some chose
not to get vaccinated (Source; Source). The RISE poll found that unvaccinated racial and ethnic
minorities were more likely to get vaccinated than unvaccinated Whites. Specifically,15% of
unvaccinated Blacks, 11% of unvaccinated Hispanics/Latinos, and 10% of unvaccinated Asians
expressing a willingness to vaccinate. In comparison, only 6% of unvaccinated whites said that
they were likely to get vaccinated.

When those who were not vaccinated were asked why, concerns included:

• How quickly the vaccines were tested and developed (72%)
• Vaccine side effects (67%)
• The idea that the vaccine is not needed (43%)
• How well the vaccines work (37%)

Nationwide, the percent of individuals who have received a vaccine is increasing while the
percent who say that they intend to get a vaccine is decreasing (Source). Of those who are
unvaccinated, 26% said that they were likely to get vaccinated while 25% said that they were
unlikely. Further, 46% said that they would definitely not get vaccinated. A majority (65%) of
those who said they would definitely not get vaccinated were white, while about 40% of those
who say that they are going to “wait and see” before getting the vaccine are communities of
color.

On August 23, the FDA granted full approval for the Pfizer vaccine for those 16 and older
(Source). While the FDA states that "the public can be very confident that this vaccine meets the
high standards for safety, effectiveness, and manufacturing quality the FDA requires of an
approved product," the impact that approval will have on vaccine hesitancy remains to be seen.

Some assert that approval will decrease hesitancy. On August 23, Dr. Anthony Fauci, chief
medical adviser and a member of President Biden’s COVID-19 response team stated that he

Vaccine Equity Report | September 2021 Page 28
expected about 20% of the 90 million eligible Americans who had not been vaccinated would
choose to do so due to approval (Source). Nationwide polls show a similar perspective, with a
June poll from the Kaiser Family Foundation finding that 30% of those who were not vaccinated
said that they would do so once the vaccine had been approved by the FDA. However, the
same poll also found that about 66% of adults believed that the vaccines available in the U.S.
had already received FDA approval (Source). This finding raises some concern that FDA
approval may not have a major impact on decreasing vaccine hesitancy, as many of the
hesitant already thought that the vaccines were approved and still chose to remain
unvaccinated.

8. Data Gaps Impacting Equity
As mentioned above, VDH’s 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 data, particularly concerning race and ethnicity. Updates on VDH vaccination counts by
race and ethnicity were completed using statistical imputation methods. As detailed in the June
2021 report, nearly 2 million vaccinations were missing race and ethnicity data. The cumulative
impact of missing data and data gaps incrementally impact Virginia's equitable response to
COVID-19. 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).

During the COVID-19 pandemic, collecting, coordinating, and managing state data governance
and analytics have 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 (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 a COVID-19 vaccine, the state should rely on complete data to further examine the
burden of disease on communities 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.

9. Policy and Administrative Updates
Legislative Updates

• On August 10, a special session of the Virginia General Assembly concluded. The
session concluded with a signed budget bill to allocate the American Rescue Plan
Act's Coronavirus State Fiscal Recovery Funds for Virginia (Source).

Vaccine Equity Report | September 2021 Page 29
Executive Updates

• On August 5, Governor Northam announced Virginia will require most state
employees to show proof of vaccination or subscribe to weekly COVID testing. This
policy will impact approximately 122,000 employees (Source; Source).
• On August 12, Governor Northam announced a Public Health Emergency Order
requiring universal masking in all indoor settings in Virginia’s K-12 schools. This order
reinforces current state law, which requires Virginia schools adhere to mitigation
strategies outlined by the CDC (Source; Source).

Agency Updates

• On August 23, the FDA granted full licensure to the Pfizer-BioNTech COVID-19
vaccine for persons ages 16 years and older (Source).
• On August 23, the U.S. Department of Defense announced it will require service
members to receive the COVID-19 vaccine now that the Pfizer vaccine has received
full approval (Source).

Court Updates

• On August 25, the Supreme Court of Virginia extended the Twenty-Seventh Order of
Declaration of Judicial Emergency through September 22, 2021 (Source).
• On August 26, the U.S. Supreme Court struck down the Biden administration's
temporary federal moratorium on evictions (Source).

10. On the Horizon
Government agencies will need to continue to pay particular attention to the high rates of
infection due to the Delta variant. As part of this, rigorous examinations of changes in cases,
hospitalizations, and deaths is needed.

Given ongoing issues of inequities concerning who gets infected as well as who dies from
COVID-19 in tandem with ongoing inequities in vaccine access, it is critical that equity remains
centered in all government practice. Disparities are particularly noted concerning race and
ethnicity as well as in urban and rural divides.

The potential for inequity could increase given the forthcoming ends of eviction moratoria and
the upcoming recommencement of federal student loan payments. In addition, the American
Rescue Plan provides federal unemployment benefits official expire on Labor Day (September
6) and federal benefits will end for self-employed, gig-workers, and long-term unemployed and
other typically ineligible for state benefits. The $300 additional federal weekly benefit will also
end. This lack of additional support may have impacts on individuals throughout the
commonwealth (Source).

Vaccine Equity Report | September 2021 Page 30
Currently, children under 12 are ineligible to receive vaccines, and rates of vaccinations show
57.1% of Virginians ages 12-17 have received at least one vaccine dose. Approximately 54% of
those between the ages of 12-15 received one dose, and 63.2% of 16-17-year-olds have
received one vaccine dose. Cases of COVID-19 in schools have caused problems with the start
of the 2021-22 academic year, causing quarantine measures and rapid shifts back to virtual
learning for some schools (Source; Source; Source). The state Vaccination Coordinator, Dr.
Danny Avula described how the more than 700,000 children given eligibility status could change
the conversation around schools safely returning to in person learning and boost Virginia’s
vaccination rates (Source).

Despite much progress, a continued focus on vaccine equity remains critical. Fears of virus
spread and breakthrough infections requires the critical need to bolster vaccinations efforts
across the Commonwealth and center equity in policy and procedures.

Vaccine Equity Report | September 2021 Page 31
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 | September 2021 Page 32

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