VDH Plan for Equitable Distribution of COVID-19 Vaccine (December 2021)
Summary
The December 2021 Vaccine Equity Report, headed VDH Plan for Equitable Distribution of COVID-19 Vaccine, from the Office of Health Equity in the Virginia Department of Health and marked as a draft. It covers vaccination equity in Virginia for November 2021 and compares Virginia with other states in Region 3 of the Federal Emergency Management Agency. The report states that over 12.7 million COVID-19 vaccine doses had been administered in Virginia by the end of November and that 74.4% of all Virginians had received at least one dose as of November 30. A table as of 11/30/21 gives vaccination rates of 58.4% for Blacks and 62.8% for Whites, and the report states that over two-thirds (70%) of booster shots in Virginia have gone to White populations. Its appendix quotes 2020 Appropriation Act Item 299 on a vaccine equity workgroup.
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VDH Plan for
Equitable
Distribution
of COVID-19
Vaccine
DECEMBER 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
Vaccine Equity Report | December 2021 (Draft) Page 0
Contents
Executive Summary ..................................................................................................................2
1. Major Equity Milestones .......................................................................................................4
2. Vaccination Equity in Virginia ..............................................................................................7
Vaccinations for 65+.............................................................................................................7
Vaccinations for Under 45 ...................................................................................................7
Race and Ethnicity ...............................................................................................................8
Vaccinations by Race .........................................................................................................10
Booster Shots: Race and Ethnicity ...................................................................................10
Rural Areas .........................................................................................................................11
3. Vaccinations in FEMA Region 3 .........................................................................................14
FEMA Region 3 and Race/Ethnicity...................................................................................16
Under 40 Vaccinations .......................................................................................................17
4. Vaccine Hesitancy...............................................................................................................17
5. Policy and Administrative Updates....................................................................................18
Legislative Updates ............................................................................................................18
Executive Updates..............................................................................................................18
Agency Updates .................................................................................................................19
Court Updates.....................................................................................................................19
6. On the Horizon ....................................................................................................................19
Charging Statutes...............................................................................................................21
Vaccine Equity Report | December 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 November 2021.
This report compares Virginia's equitable vaccination progress with other states in Region 3 of
the Federal Emergency Management Agency (FEMA) including, Delaware, the District of
Columbia, Maryland, Pennsylvania, and West Virginia. This report includes equity
considerations for vaccine distribution, vaccine trends over time, and vaccination hesitancy. An
overview of recent legislative, executive, and administrative actions is also included.
Key findings include:
→ New Variant of Concern – Vital Equity Work Remains
• At the end of November, the World Health Organization (WHO) designated the
COVID-19 Omicron variant (B.1.1.529) a variant of concern, based on the evidence
that Omicron has several mutations that may impact how easily it spreads or the severity
of illness it causes (Source). Since Blacks and Hispanics still disproportionately contract
COVID-19, the emergence of the Omicron variant suggests these racial disparities will
increase.
• The State of New York declared a state of emergency in response to growing
cases of COVID-19 and concerns surrounding the Omicron variant (Source).
Additional U.S. states issued statements highlighting fears surrounding the new variant
(Source).
→ Vaccinations for Young Children, Ages 5 to 11
• Pediatric COVID-19 vaccinations were approved for children ages 5 to 11 years old
by the Centers for Disease Control and Prevention (CDC) in early November (Source).
VDH is not reporting race/ethnicity or gender information on children's vaccinations at
this time. This has important implications for equity.
→ Booster Shots
• In early November, the CDC expanded eligibility for COVID-19 booster shots to all
adults ages 18 years and older who received a Pfizer-BioNTech or Moderna vaccine at
least six months after their second dose (Source). Adults who received the Johnson &
Johnson/Janssen vaccine should get a booster two months after the initial vaccine
(Source).
• President Biden urged Americans to strengthen their protection against COVID-19
and the Omicron variant by getting a booster shot before the holiday season
(Source). Biden also urged those individuals who are unvaccinated to get vaccinated,
including children and adults.
• Racial disparities are evident in booster shots. Over two-thirds (70%) of COVID-19
booster shots in Virginia have gone to White populations, while Blacks and Latinos
Vaccine Equity Report | December 2021 Page 2
have received less than their share in the population (Source). Nearly 1.25 million
Virginians have received a booster dose (Source).
→ Disproportionate Impacts
• Blacks and Hispanics still disproportionately contract COVID-19, and Blacks
disproportionately die from it. However, racial gaps in vaccinations rates appear
to have closed for Hispanics and Asians relative to Whites. As Table 1 displays,
Whites in Virginia continue to have the highest overall numbers and percentages of
cases and deaths close to their proportion of the Virginia population. Blacks and
Hispanics experience a higher percentage of cases than their percentages in the
population. Whites and Blacks experience a higher percentage of deaths than their
percentages in the population. Blacks still are vaccinated less (58.4%) than Whites
(62.8%), although this gap is narrowing.
Table 1: Race, COVID-19 Cases, Deaths, and Vaccinations in Virginia, as of 11/30/21
% of
% of people
% Total % with % of
with at least % of % of
Points Vaccinati at Least Total
one dose of Cases Deaths
from ons One Popula
reported Race/ ** **
White* Received Dose** tion
Ethnicity*
by Race*
White 61% N/A 52.3% 62.8% 55.3% 65.7% 61%
Black 59% -3% 15.5% 58.4% 22.1% 24.5% 19%
Hispanic 68% +6% 9.1% 73.3% 13.6% 5.7% 10%
Asian 87% +25% 8.5% 84.7% 4.1% 3.3% 7%
Sources: *Kaiser Family Foundation and **VDH Data portals
→ Equity Milestones
• Racial gaps in vaccinations rates appear to have closed for some populations. The
percentage of Hispanics (73.3%) and Asians (84.7%) continue to be vaccinated at a
higher percentage than Whites (Source).
• This month, Latinos became the most-vaccinated group in Richmond and Henrico
after 18 months of enduring loss (Source).
• To enhance equity analysis, VDH recently enhanced its COVID-19 dashboards and
reporting to provide clearer comparisons, especially among local health districts and
to track data over time, of cases, hospitalizations, deaths, and vaccination rate (Source;
Source).
→ The Unvaccinated
• Republicans increasingly constitute a larger share of those who remain unvaccinated
against COVID-19 (Source)
• More than 25% of Virginia's eligible population is unvaccinated (Source).
Vaccine Equity Report | December 2021 Page 3
1. Major Equity Milestones
This section details the equity-related achievements regarding COVID-19 in the
Commonwealth during November. These accomplishments include:
● November: Schools across the Commonwealth host COVID-19 vaccination clinics for
children ages 5-11 (Source; Source; Source; Source).
● November 2: The Centers for Disease Control and Prevention (CDC) recommended
pediatric COVID-19 vaccinations for children ages 5 to 11 years old (Source).
● November 3: The Virginia Department of Health (VDH) partnered with Dollar General to
provide COVID-19 vaccinations at no cost at select store locations across the
Commonwealth throughout November (Source).
● November 4: Virginia officials announced plans to roll out vaccines against COVID-19 for
children ages 5 to 11 (Source).
● November 4: COVID-19 vaccinations for 723,000 Virginians ages 5 to 11 began
statewide on this date following recommendations from federal regulators and extensive
safety data showing a high success rate in preventing infections among kids (Source).
● November 4: The Biden administration announced it would require health care facilities
that participate in Medicare and Medicaid programs to have staff members vaccinated
by January 4 (Source).
● November 5: Pfizer announces a potentially new COVID-19 treatment pill, which
reduces the risk of hospitalization or death by nearly 90% for those who test positive for
COVID-19. The treatment is not a substitute for a vaccine (Source; Source).
● November 5: Richmond City and the County of Henrico open vaccine clinics for children
ages 5 to 11 in schools near the least-vaccinated neighborhoods. The locations include
Martin Luther King Middle School and George Wythe High School, both of which have
student populations that are more than 96% Black or Latino (Source).
● November 5: COVID-19 cases in Virginia are declining as vaccinations are made
available to more people, including younger Virginians (Source).
● November 6: In southwest Virginia, COVID-19 cases and hospitalizations decline 13%
over the previous week (Source).
● November 6: On this date, Latinos became the most-vaccinated group in Richmond and
Henrico after 18 months of enduring loss (Source).
● November 8: Community leaders, clinicians, and officials coordinate grassroots efforts to
ensure children of color have equal access to COVID-19 vaccines (Source).
Vaccine Equity Report | December 2021 Page 4
● November 10: On this date, about 900,000 elementary school-age children in the United
States have received their first doses of the Pfizer-BioNTech COVID-19 vaccine
(Source).
● November 10: VDH has added data for children ages 5-11 to its coronavirus vaccine
demographic dashboard (Source).
● November 12: More than 35,000 children were vaccinated in the first week of Virginia's
pediatric COVID-19 vaccination rollout (Source).
● November 12: Governor Ralph Northam announced that more than 83% of adults in
Virginia had received at least one dose of the COVID-19 vaccine, and 75% of adults are
fully vaccinated against COVID-19. Nearly 12 million doses have been administered
(Source).
● November 15: The Governor's Executive Leadership Team on Immigrant Integration
(ELTII) met for the fourth time. The final report was presented to the Governor, members
of the Leadership Team, and members of the Office of the New Americans Advisory
Board on November 30, 2021. The number one finding was that language access
remains a barrier to those individuals with limited English Proficiency (LEP) for
accessing state services, information, and resources, such as COVID vaccines,
coronavirus testing, and other pandemic relief resources. A copy of the ELTII report will
be included in the required language access audit conducted by the Governor's Office of
Diversity, Equity, and Inclusion. HB 1800 Item 42 #2h of the 2021 Virginia Appropriations
Act (the Act) requires the Governor's Office of Diversity, Equity, and Inclusion (the ODEI)
to develop recommendations to implement a state government language access policy
that ensures equitable access to state services for people with Limited English
Proficiency (LEP). The language access report will be delivered to the Governor and the
General Assembly on December 1, 2021.
● November 16: The VDH Health Equity Dashboard provides a clear look at COVID-19
equity at the local level. This enhancement to the dashboards is part of VDH's efforts to
provide timely and accurate information to the public about COVID-19's impact on
different communities. It should be noted that this VDH dashboard is separate and apart
from the Governor's Office of Diversity, Equity, and Inclusion's Equity in Action and
Equity at a Glance Dashboards that celebrate state resources provided and synthesize
various social determinants of health outlined in HJR 537, which declares racism as a
public health crisis. A permanent plan for the Equity in Action and Equity at a Glance
dashboards is currently are being discussed (Source).
● November 16: VDH announced its partnership with 18 libraries and library systems
across the Commonwealth to distribute COVID-19 rapid antigen at-home test kits at no
cost. The pilot program begins this week and will run through the end of December.
Additional libraries may opt into the program at a later date (Source).
Vaccine Equity Report | December 2021 Page 5
● November 19: The Food and Drug Administration (FDA) amended the emergency use
authorizations for both the Moderna and Pfizer-BioNTech COVID-19 vaccines
authorizing use of a single booster dose for all individuals 18 years of age and older after
completion of primary vaccination with any FDA-authorized or approved COVID-19
vaccine (Source).
● November 19: The Centers for Disease Control and Prevention (CDC) announced that
all adults 18 years of age and older are now eligible to get a booster shot. This follows
the U.S. Food and Drug Administration (FDA) authorization of boosters for all adults who
completed a two-dose initial vaccine series of either Moderna or Pfizer-BioNTech and
the one-dose Janssen COVID-19 Vaccine (Source).
● November 19: New cases of COVID-19 rose 41% across Southwest Virginia during the
previous week after weeks of steady declines (Source).
● November 22: The FDA authorized three over-the-counter COVID-19 antigen diagnostic
tests for people age 14 years or older with a self-collected nasal swab sample or people
age two years or older when an adult collects the nasal swab sample (Source).
● November 25: South Africa's health minister announced the discovery of the B.1.1.529
variant, Omicron, which appears to be spreading rapidly in parts of the country (Source).
● November 26: The World Health Organization (WHO) designated the COVID-19
Omicron variant (B.1.1.529) a variant of concern, based on the evidence that Omicron
has several mutations that may have an impact on how it behaves, for example, on how
easily it spreads or the severity of illness it causes (Source).
● November 29: President Biden urged Americans to strengthen their protection against
COVID-19 and the Omicron variant by getting a booster shot before the holiday season.
Biden also urged unvaccinated individuals to get vaccinated, including children and
adults (Source).
● November 29: During a press conference, Governor Northam said he has no immediate
plans to declare a new 'State of Emergency' or reinstate coronavirus restrictions in
response to the variant of concern, Omicron. Northam instead encouraged those who
are unvaccinated to become vaccinated (Source).
● November 30: As of this date, 88.1% of the adult population in Virginia (18+) have
received at least one dose, 77.1% of adults are fully vaccinated (Source).
Vaccine Equity Report | December 2021 Page 6
2. Vaccination Equity in Virginia
At the end of November, over 12.7 million COVID-19 vaccine doses have been administered in
Virginia (up from 11.52 million at the end of October), and over 14.95 million vaccines have
been received (up from 13.42 million at the end of October) (Source). Virginia ranks tenth in the
country for the percentage of distributed vaccines that have been administered (Virginia was
eighth at the end of October), and 84.03% of vaccines received have been administered
(Source). As of November 30, 74.4% of all Virginians have received at least one dose of a
vaccine (up from 70% at the end of October) (Source), which is above the 70.2% national
vaccination rate receiving at least one dose (Source). Over 5.53 million Virginians have been
fully vaccinated (up from 5.36 million at the end of October), representing 64.9% of the
population (up from 62.9% at the end of October), which is above the 59.4% national total fully
vaccinated rate (Source). During November, on average, Virginia is administering approximately
31,285 vaccinations per day (slightly down from 31,617 at the end of October) (Source)
Figure 1: Vaccinations by Age (One dose), as of 11/30/21
Source
Vaccinations for 65+
As seen in Figure 1, VDH reports the following age ranges: 65-74, 75-84, and 85+ (Source). At
the end of November, 95.1% of those ages 65+ are vaccinated, up from 91.9% at the end of
October (Source).
Vaccinations for Under 45
In November, Virginia began vaccinating children ages 5 to 11 years old (Source). Since May
2021, Virginia has been vaccinating those ages 12 and older. Reported age ranges are: 5-11,
Vaccine Equity Report | December 2021 Page 7
12-15, 16-17, 18-24, 25-34, and 35-44. Virginia continues to make strides in vaccinations for
those younger than 45 years old. As noted in the previous month's report, Virginia's increasing
vaccinations based upon age continue to be a success story. At the end of November, 44.3%
(600,151) of those ages 5 to 17 had been vaccinated with at least one dose. Over 6 million
(74.8%) Virginians ages five and older have been vaccinated with at least one dose, and 80.0%
of those 12 and older have been vaccinated with at least one dose, 81.0% of those 18 and older
have been vaccinated with at least one dose (up from 78.2% at the end of October). Data are
also reported for percentages of the population vaccinated with at least one dose: 22.2%
(160,206) of 5-11-year-olds; 68.4% (289,235) of 12-15-year-olds; 71.9% (150,710) of 16-17-
year-olds; 69.1% (551,694) of 18-24-year-olds; 70.4% (838,583) of 25-34-year-olds; and 78.8%
(876,998) of 35-44-year-olds (Source).
Race and Ethnicity
In past months, missing data was a significant limitation in assessing vaccine equity, especially
regarding race and ethnicity. Of note in July 2021, VDH instituted a statistical imputation
procedure to fill in the missing race and ethnicity data, and the missing race and ethnicity data
declined from roughly 2 million to approximately 297,000. Still, at the end of October, missing
data remains an issue. As of November, 515,374 vaccinations (up from 475,232 at the end of
October) have no race and ethnicity data reported (Source).
Further, to enhance equity analysis, VDH recently enhanced its COVID-19 dashboards and
reporting to provide clearer comparisons, especially among local health districts and to track
data over time, of cases, hospitalizations, deaths, and vaccination rate (Source; Source).
Table 1: Race, COVID-19 Cases, Deaths, and Vaccinations in Virginia, as of 11/30/21
% of people
with at
% % of Total % with
least one % of % of
Points Vaccinations at Least % of Total
dose of Cases Deaths
from Received by One Population
reported ** **
White* Race* Dose**
Race/
Ethnicity*
White 61% N/A 52.3% 62.8% 55.3% 65.7% 61%
Black 59% -3% 15.5% 58.4% 22.1% 24.5% 19%
Hispanic 68% +6% 9.1% 73.3% 13.6% 5.7% 10%
Asian 87% +25% 8.5% 84.7% 4.1% 3.3% 7%
Sources: *Kaiser Family Foundation and **VDH Data portals
As shown in Table 1 and Figure 2, as of November 30, the critical race and ethnicity
breakdowns for those receiving at least one dose are as follows and represent disparities for
communities of color, including Blacks and Hispanics:
Vaccine Equity Report | December 2021 Page 8
• 58.4% of Blacks have been vaccinated (down from 61.5% at the end of October). Blacks
are 19% of the population yet have received 15.5% of doses.
• 73.3% of Hispanics have been vaccinated (down from 79.8% at the end of October).
Hispanics are 10% of the population and have received 9.1% of doses.
• 84.7% of Asians or Pacific Islanders have been vaccinated (down from 86.2% at the end
of October). Asians or Pacific Islanders are 7% of the population and have received
8.3% of doses.
• 62.8% of Whites have been vaccinated (down from 64.2% since the end of October).
Whites are 61% of the population and have received 52.8% of doses (Source).
No significant changes have occurred in populations' percentages of cases and deaths.
However, disparities are still evident. In terms of cases, Blacks and Hispanics experience a
higher percentage of cases than their percentages in the population. In terms of deaths, Whites
and Blacks experience a higher percentage of deaths than their percentages in the population.
Finally, regarding percentages of eligible populations vaccinated with at least one dose, Blacks
still are vaccinated less (58.3%) than Whites (62.8%), although this gap is narrowing. Further,
as noted in last month's report, it was previously estimated that 61.5% of Blacks, 79.8% of
Hispanics, and 84.7% of Asians or Pacific Islanders had received at least one dose. However,
with improvements in data reporting, these numbers are shown to actually be slightly lower.
Racial gaps in vaccinations rates appear to have closed for some populations. The percentage
of Hispanics (73.3%) and Asians (84.7%) continue to be vaccinated at a higher percentage than
Whites; those rates have decreased since last month (79.8% for Hispanics and 86.2% for
Asiana at the end of October).
Figure 2: Vaccinations by Race (One dose), as of 11/30/21
Source
Vaccine Equity Report | December 2021 Page 9
Vaccinations by Race
The percent of Whites who have received at least one vaccine dose has increased since spring
2021 (Figure 3). The percentage of Blacks, Hispanics/Latinos, and Asians as a share of total
vaccinations has also increased. However, disparities persist. Whites (56%), Blacks (49%), and
Hispanics (54%) are vaccinated at rates lower than Asians (72%) in the United States (Source).
Figure 3: Percent of Total Population that Has Received at Least One COVID-19 Vaccine
Dose by Race/Ethnicity in the United States, March 1 to November 15, 2021
Source: Kaiser Family Foundation
Booster Shots: Race and Ethnicity
Booster shots appear to be outpacing first doses in adults in Virginia. As was the case last
month, disparities remain apparent in that nearly all booster shots have gone to White residents
(Source). As seen in Figure 4, disparities are already evident, particularly for Blacks and
Latinos:
• Whites comprise 61% of the population yet have received 70% (839,486) of booster
shots (down from 73.3% at the end of October), and 16.6% of this population are
vaccinated with a booster
• Blacks comprise 19% of the population yet have received 13.8% (165,784) of booster
shots (up from 12.2% at the end of October), and 10.4% of this population are
vaccinated with a booster
• Asians or Pacific Islanders comprise 7% of the total population and have received 9.0%
(108,145) of booster shots (up from 7.7% at the end of October), and 18.2% of this
population are vaccinated with a booster
Vaccine Equity Report | December 2021 Page 10
• Latinos comprise 10% of the total population yet have received 4.6% (55,533) of booster
shots (up from 3.9% at the end of October), and 7.4% of this population are vaccinated
with a booster.
Figure 4: Booster Shots by Race and Ethnicity in Virginia, as of 11/30/21
Source
Rural Areas
Figure 5 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 5: Rural and Non-Rural Areas in Virginia
Source
Vaccine Equity Report | December 2021 Page 11
There is continued progress in vaccinations when comparing rural and urban areas. Still, noted
concentrations of lower vaccinations (rate per 100,000 population) are evident in the south-
central and southwest portions of the state. Further, demand for vaccines appears to be slightly
higher at the end of November than at the end of October and September. Elevated risks levels
(Figure 7) remain for several rural localities, concentrated in Virginia's southwest, central, and
northwest regions (Source).
Figure 6: Vaccinations by Locality – Rate per 100,000 Population, as of 11/30/21
Source
Figure 7: COVID-19 Risk Levels by Locality, as of 11/30/21
Source
Vaccine Equity Report | December 2021 Page 12
As shown in Figures 8 and 9, urban and rural disparities are evident in cases as measured by
rates per 100,000 people. More rural counties continue to show disproportionate cases, with
notable concentrations in the southeast, south-central, and southwest portions of the state. As
was the case in the past month, at the end of November, rural counties disproportionately
experienced deaths related to COVID-19, other portions of the state, particularly north-central
portions, continue to show improvements in numbers of deaths (Figure 9).
Figure 8: Cases of COVID-19 in Virginia: Urban and Rural, as of 11/30/21
Source
Figure 9: Deaths from COVID-19 in Virginia: Urban and Rural, as of 11/30/21
Source
Vaccine Equity Report | December 2021 Page 13
3. Vaccinations in FEMA Region 3
Virginia is a part of FEMA Region 3, including Delaware, the District of Columbia, Maryland,
Pennsylvania, and West Virginia. Regarding risk levels in November (Figure 10), all Region 3
shows concerning trends, yet positives are also evident. By the end of November, a significant
portion of this region has relatively lower risk levels, particularly in Maryland and Virginia.
Measured as a seven-day moving average, as of 11/30/21, the Commonwealth has 1,382.1
new daily cases (down from 1,432.9 new cases at the end of October) at 16.2 new cases per
100,000 people (down from 16.8 at the end of October). Virginia ranks fourth out of six for
COVID-19 risk level in the region (Virginia also ranked fourth at the end of October and
September).
Figure 10: COVID-19 Risk Levels* by County across FEMA Region 3, as of 11/30/21
Source
Further, as shown in Figure 11 below, updated FEMA data concerning linkages between
vaccination coverage (low to high) and rankings on the social vulnerability index (SVI). As
shown below, Pennsylvania, Virginia, and West Virginia particularly face high SVI and low
vaccination coverage issues. In Virginia, these issues affect almost all areas of the state, with
particular clusters in the southwest, south-central, and central regions. The Commonwealth
should prioritize outreach, particularly for those with high SVI yet low vaccination coverage
(seen on the map in purple).
Vaccine Equity Report | December 2021 Page 14
Figure 11: Percent of Population Fully Vaccinated by Social Vulnerability Index, FEMA
Region 3, as of 11/30/21
Source
Vaccine Equity Report | December 2021 Page 15
FEMA Region 3 and Race/Ethnicity
All areas in FEMA Region 3 continue to show racial disparities in the percentages of vaccines administered. Across Region 3, both
Blacks and Hispanics/Latinos continue to see some improvements in vaccination percentages. Virginia remains a leader in closing
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 because of reporting inconsistency and missing data (Source).
Racial and ethnic disparities persist in vaccinations for some, while the gaps have closed for others. For example, across FEMA
Region 3, Blacks tend to be under-vaccinated as compared to Whites. In Virginia, Blacks are three percentage points from Whites.
Significantly, this gap has narrowed over time. In addition, the Hispanic and Asian populations in Virginia have been vaccinated at a
greater percentage than the White population. Table 2 below displays the percent of the total population that has received a
vaccination by race and ethnicity. While some positives are evident, given growing disparities evident in booster shots (Source), it is
essential to focus on promoting equity.
Table 2: Percent of Total Population that has Received a COVID-19 Vaccine Dose by Race/Ethnicity, FEMA Region 3, as of
11/15/2021
White Black Hispanic Asian
White % Pts White to % Pts White to % Pts
% % % %
to Black from Hispanic from Asian from
Vaccinated Vaccinated Vaccinated Vaccinated
Ratio White Ratio White Ratio White
Delaware 52% 46% 1.1 −6 55% 0.9 3 64% 0.8 12
District of Columbia 56% 47% 1.2 −9 63% 0.9 7 78% 0.7 22
Maryland 70% 64% 1.1 −6 69% 1.0 −1 82% 0.9 11
Pennsylvania 55% 60% 0.9 5 40% 1.4 −15 37% 1.5 −18
Virginia 61% 59% 1.0 −3 68% 0.9 6 87% 0.7 25
West Virginia 52% 53% 1.0 1 NR NR NR NR NR NR
Source: Kaiser Family Foundation
Vaccine Equity Report | December 2021 (Draft) Page 16
Under 40 Vaccinations
As shown in Table 3, Virginia continues to be far ahead of the national average for vaccinations
for those under the age of 40. Improvements from September to November for Virginia are
notable in each age category. In Virginia, for all ages, vaccination percentages rose between
September and November. This far outpaces the national average for all ages, in which
improvements were evident. Notably, the rate of vaccinations for 5-11-year-olds is over ten
percentage points higher in Virginia than in the United States.
Table 3: Virginia–U.S. Vaccination Comparisons, Ages 5-39, as of 11/30/21
Months Ages 5- Ages 12- Ages 16- Ages 18- Ages 25-
11 15 17 24 34
Virginia
(at least one November 22.2% 68.4% 71.9% 69.1% 70.4%
dose) October -- 66% 71.1% 66.8% 67.4%
September -- 63.4% 69.3% 64.5% 64.2%
Months Ages 5- Ages 12- Ages 16- Ages 18- Ages 25-
11 15 17 24 39
United
States November 8.7% 7.6% 7.6% 9.2% 20.5%
(at least one
dose) October -- 4.2% 2.4% 9% 21.2%
September -- 4.2% 2.4% 9% 21.1%
Sources: CDC estimates, VDH COVID-19 Vaccine Data Portal, and USA Facts.
4. Vaccine Hesitancy
With over 12.7 million vaccination doses administered, and as the total number of Virginians
who have received at least one dose approaches 6.4 million (74.4% of the population),
Virginia's vaccination rates continue to surpass those of many other states (Source; Source).
However, over 25% of Virginia's eligible population is unvaccinated (Source).
With the recent approval of a COVID-19 vaccine for children ages 5 through 11, child
vaccination rates are of particular interest (Source). As of November 30, 44.3% of children ages
5 to 17 are vaccinated in Virginia (Source). In July 2021, a Virginia Department of Emergency
Management COVID-19 Hesitancy Poll (Source) was conducted by the Research Institute for
Social Equity (RISE) at the L. Douglas Wilder School of Government and Public Affairs at VCU.
It examined the perceptions of parents in Virginia regarding vaccinating their children. The poll
found that 59% of parents with children ages 12 to 17 were willing to vaccinate their children (a
7-point decrease from another RISE poll conducted in May), and 53% of parents said that they
were ready to vaccinate their children ages 11 and under (a 10-point decrease from the May
poll). Additionally, 33% of parents with children ages 12 to 17 indicated that they were not at all
likely to vaccinate their children (a 10-point increase from May), and 38% of parents said that
they were not at all likely to vaccinate their children ages 11 and under (an 11-point increase
from May).
Vaccine Equity Report | December 2021 (Draft) Page 17
There were racial differences in parental willingness to vaccinate their children, with fewer White
parents saying that they are likely to vaccinate children ages 12-15 (52%) and ages 11 and
under (44%) compared to Black parents (61% and 62%, respectively).
Nationwide data also shows parental hesitancy to vaccinate children, though reluctance in
Virginia may be of less concern. As of October 28, data from the Kaiser Family Foundation
indicate that about 50% of parents said that their children in this age range have already
received the vaccine or will do so right away. In addition, 27% of parents with children ages 5 to
11 said that they would get their child vaccinated as soon as possible, while about a third said
they would wait and see how the vaccine is working before vaccinating their young child. In
comparison, 31% of parents with a child ages 12 to 17 and 30% of parents with a child ages 5
to 11 said that they would not get their child vaccinated (Source).
Primary concerns noted by parents when it comes to vaccinating their young children included
potential unknown long-term effects of the vaccine, potentially serious side effects of the
vaccine, and a potential impact of the vaccine on their child's future fertility (Source).
Some parents, especially those of lower incomes, noted barriers that they faced in vaccinating
their children. These included having to miss work to get their child vaccinated, paying out-of-
pocket costs to get their child vaccinated, the inability to have their child vaccinated at a place
they trust, and trouble traveling to a place where they could get their child vaccinated (Source).
Political partisanship continues to be increasingly crucial in predicting COVID-19 vaccination
status (Source). One-quarter of adults in the U.S. say they have not gotten vaccinated;
Republicans increasing comprise a larger share of those who remain unvaccinated (60%)
compared to unvaccinated Democrats (17%) and Independents (17%) (Source).
5. Policy and Administrative Updates
Legislative Updates
• No new updates
Executive Updates
• On November 12, Governor Ralph Northam announced that 83% of adults in Virginia
had been vaccinated, and 75% were fully vaccinated (Source).
• On November 29, President Biden ordered additional air travel restrictions from South
Africa and seven other countries in response to the Omicron variant spread through
Southern Africa (Source).
Vaccine Equity Report | December 2021 Page 18
Agency Updates
• On November 2, the Centers for Disease Control and Prevention (CDC)
recommended pediatric COVID-19 vaccinations for children ages 5 to 11 years old
(Source).
• On November 9, the CDC expanded eligibility for COVID-19 booster shots to all adults
ages 18 years and older who received a Pfizer-BioNTech or Moderna vaccine at least
six months after their second dose (Source). Adults who received the Johnson &
Johnson/Janssen vaccine should get a booster two months after the initial vaccine
(Source).
• On November 19, the Food and Drug Administration (FDA) amended the emergency
use authorizations for both the Moderna and Pfizer-BioNTech COVID-19 vaccines
authorizing the use of a single booster dose for all individuals 18 years of age and
older after completion of primary vaccination with any FDA-authorized or approved
COVID-19 vaccine (Source).
• On November 22, the FDA authorized three over-the-counter COVID-19 antigen
diagnostic tests for people age 14 years or older with a self-collected nasal swab
sample or people age two years or older when an adult collects the nasal swab
sample (Source).
Court Updates
• On November 18, the Supreme Court of Virginia extended the Thirty-first Order of
Declaration of Judicial Emergency through December 15, 2021 (Source).
6. On the Horizon
Virginia continues to make progress relative to vaccinations and vaccination equity. During
November, there were gains in vaccination rates across the Commonwealth; over one-million
COVID-19 vaccine doses were administered in Virginia during the month, and Virginia has
vaccinated individuals at a greater rate than the national average. For all eligible age groups,
vaccination percentages outpaced the national average. Notably, the rate of vaccinations for 5-
11-year-olds is over ten percentage points higher in Virginia than in the United States.
The FDA recently approved three new over-the-counter COVID-19 antigen diagnostic tests for
home use. Testing capacities in the United States have fallen behind that of other leading
countries (Source). Easy, inexpensive at-home COVID-19 tests are an essential tool to detect
new variants and stop the spread of the coronavirus (Source).
Pediatric COVID-19 vaccinations were also recently approved for children ages 5 to 11 years
old, and vaccinations rates have grown for children ages 5 to 17. Virginia vaccinated more than
35,000 children in just the first week of Virginia's pediatric COVID-19 vaccination rollout. In
addition to these efforts, VDH has partnered with school systems and libraries across the
Vaccine Equity Report | December 2021 Page 19
Commonwealth to distribute COVID-19 rapid antigen at-home test kits at no cost. The pilot
program began in mid-November and will run through the end of December.
At the end of the month, a report of a new COVID-19 variant, Omicron, caused concern across
the globe. The World Health Organization (WHO) designated the Omicron variant a ‘variant of
concern’ based on the evidence that its mutations may impact how easily it spreads or the
severity of illness it causes (Source). Further, the CDC is closely following developments
(Source). Is it unknown how well the vaccines will work against this new variant, and further
studies are needed (Source). Though the magnitude of transmissibility and severity of infection
by Omicron are still unknown, there are important equity concerns, including increasing the
disproportionate impacts of COVID hospitalizations and deaths for vulnerable communities, as
well as poorer nations. As of December 1, 2021, the Omicron variant was found in California.
Closer to home, on November 2, 2021, Virginians elected new leadership at the state level,
which resulted in a shift in political party leadership from Democratic to Republican in terms of
the Governor, Lieutenant Governor, Attorney General, and the majority of seats in the Virginia
House of Delegates. While leadership transition understandably brings a re-ordering of
priorities, issues of diversity, equity, and inclusion are core, non-partisan values of American
government. It remains critical that leaders, policymakers, and decision-makers equitably
strengthen vaccinations and access to state services, resources, and information across the
Commonwealth of Virginia and address the systemic biases and historical antecedents that
undergird the disproportionate impact of the coronavirus. Thus, it is recommended that the
Governor's Office of Diversity, Equity, and Inclusion, the Office of Health Equity at the Virginia
Department of Health, and the Equity Working Group and Task Force supervised by the
Virginia Department of Emergency Management remain an integral part of ensuring equity in
the response and recovery of the COVID-19 pandemic.
Vaccine Equity Report | December 2021 Page 20
Appendix
Charging Statutes
2020 Appropriation Act Item 299 I. The Department of Health shall convene a workgroup, 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 workgroup 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 | December 2021 Page 21
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