VDH Plan for Equitable Distribution of COVID-19 Vaccine (January 2022)
Summary
A monthly Vaccine Equity Report for December 2021 (marked Draft; cover dated January 2022) from the Office of Health Equity in the Virginia Department of Health, under the supervision of the Governor's Chief Diversity, Equity, and Inclusion Officer and the Equity Leadership Task Force. It compares Virginia's vaccination progress with other states in Region 3 of the Federal Emergency Management Agency and covers vaccine hesitancy and recent legislative, executive and administrative actions. The key findings state that Virginia broke its COVID-19 one-day case record on December 31 with 17,618 new cases, and that nearly two-thirds (66.3%) of booster shots have gone to White populations. An appendix reproduces the charging statutes from the 2020 Appropriation Act.
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VDH Plan for
Equitable
Distribution
of COVID-19
Vaccine
JANUARY 2022
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 ...................................................................................................8
Race and Ethnicity ...............................................................................................................8
Vaccinations by Race ...........................................................................................................9
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
Unvaccinated Adults ..........................................................................................................17
Children Vaccinations ........................................................................................................18
Efforts to Increase Booster Shots .....................................................................................19
5. Policy and Administrative Updates....................................................................................19
Legislative Updates ............................................................................................................19
Executive Updates..............................................................................................................19
Agency Updates .................................................................................................................19
Court Updates.....................................................................................................................20
6. On the Horizon ....................................................................................................................20
Charging Statutes...............................................................................................................22
Vaccine Equity Report | January 2022 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 December 2021. This will
be the last report under the supervision of Dr. Janice Underwood, Virginia Chief Diversity,
Equity, and Inclusion Officer.
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:
→ Omicron Variant Widespread
• Omicron was first detected in Virginia on December 9 but was the most common
variant in the United States by the end of the month (Source; Source).
• COVID-19 risk levels are high across Virginia and the United States, fueled by
recent holiday travel and the rapidly spreading Omicron variant (Source; Source;
Source).
• Virginia broke its COVID-19 one-day case record on December 31 with 17,618 new
cases (Source; Source).
• COVID-19 vaccines, especially boosters, protect against the worst outcomes of
the fast-spreading Omicron variant (Source).
→ Undercounting of Positive Cases
• The positivity rate may be larger than reported, as the number of positive cases
identified by at-home tests is unknown. Many of the results of these tests are not
reported (Source; Source).
→ Testing Accessibility
• Rapid, at-home COVID-19 test kits are sold out at many retailers (Source; Source;
Source). These tests are an essential tool to stop the spread of the coronavirus (Source;
Source). Issues of testing equity remain a core concern for communities
disproportionately impacted by the coronavirus.
• In response, localities across the Commonwealth are holding walk-up COVID-19
testing clinics on specific dates and times, and some are providing at-home antigen
tests (Source; Source; Source; Source).
→ Inequity in Booster Shots – Black and Brown Disparities
• Racial disparities are evident in booster shots. Nearly two-thirds (66.3%) of
COVID-19 booster shots in Virginia have gone to White populations, while Blacks
Vaccine Equity Report | January 2022 Page 2
and Latinos have received less than their share in the population (Source). This disparity
puts communities of color at risk amid the current surge in COVID-19 cases (Source).
→ Children Cases and Vaccinations
• Pediatric COVID-19 hospitalizations increased among children in the U.S.,
increasing concerns about how children will fare in the new case surge (Source).
• Virginia continues to outpace the national average for vaccinations for children
ages 5-17 (Source; Source). Virginia is making progress vaccinating populations ages 5-
17, with 50.1% (679,472) of this population being vaccinated (Source).
→ Disproportionate Impacts
• Blacks and Hispanics still disproportionately contract COVID-19, and Blacks and
Whites 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 have a higher proportion of cases, given their population.
Table 1: Race, COVID-19 Cases, Deaths, and Vaccinations in Virginia, as of 12/31/21
% of People % of Eligible
%
with at least Population
Points % of % of % of Total
one dose with Vaccinated
from Cases Deaths Population*
Reported with at least
White
Race/Ethnicity one dose
White 57.5% 64.7% N/A 55.3% 66.3% 61%
Black 17% 60.8% -3.9% 22.2% 24% 19%
Hispanic 10.2% 77.3% +12.6% 13.2% 5.7% 10%
Asian 9.3% 89.3% +24.6% 4.2% 3.3% 7%
Sources: VDH COVID-19 Dashboards; *U.S. Census
→ Equity Milestones
• Racial gaps in vaccinations rates appear to have closed for some populations. The
percentage of Hispanics (77.3%) and Asians (89.3%) continue to be vaccinated at a
higher percentage than Whites (Source).
→ Unvaccinated Adults and Children
• More than 22% of Virginia’s adult (18+) population have not received a vaccine dose
(Source).
• Surveyed unvaccinated adults cite distrust of the COVID-19 vaccine (42.4%) or
worry about possible side effects of the vaccine (49.6%) as primary reasons they remain
unvaccinated (Source).
Vaccine Equity Report | January 2022 Page 3
1. Major Equity Milestones
This section details the equity-related achievements regarding COVID-19 in the
Commonwealth during December 2021. These accomplishments include:
● December 2021: Local Virginia Department of Health districts across the Commonwealth
host vaccinations clinics including booster shots, free COVID-19 testing events, and
distribute at home antigen tests (Source; Source; Source; Source; Source: Source;
Source; Source).
● December 2: President Biden announced several new actions to protect Americans
against the Delta and Omicron COVID-19 variants (Source).
● December 7: The state will not mandate COVID-19 vaccines in schools for employees or
students, at least for now. The Virginia Department of Health made the decision this
week after a months-long process (Source).
● December 8: Pfizer Inc. and BioNTech SE today announced results from an initial
laboratory study demonstrating that serum antibodies induced by the Pfizer-BioNTech
COVID-19 Vaccine neutralize the SARS-CoV-2 Omicron variant after three doses
(Source).
● December 9: The Virginia Department of Health announced the first confirmed case of
the Omicron variant in Virginia (Source).
● December 9: The Centers for Disease Control and Prevention (CDC) announced that all
children 16-17 years of age are now eligible to get a Pfizer-BioNTech COVID-19 vaccine
booster shot (Source).
● December 10: Following CDC approval on December 9, VDH officials began
administering Pfizer COVID-19 booster vaccines to children ages 16-17 years old across
the Commonwealth (Source; Source; Source).
● December 16: The CDC announced its endorsement of a clinical preference for
individuals to receive an mRNA COVID-19 vaccine over Johnson & Johnson’s COVID-
19 vaccine (Source).
● December 17: The CDC released two reports highlighting the use of test-to-stay
practices used in schools to minimize absenteeism and learning loss which can occur
during traditional quarantine at home (Source).
● December 20: As of this date, the Omicron variant accounts for 73% of US COVID-19
infections based on sequencing data according to the CDC (Source).
● December 20: Since Thanksgiving, more than 55,000 Virginians have been vaccinated
or received booster doses through one of the Virginia Department of Health’s nine
community vaccination centers. Demand for COVID-19 vaccinations is up, as seen in
walk-in rates and appointments requests (Source).
Vaccine Equity Report | January 2022 Page 4
● December 21: President Biden announced additional federal vaccination and testing
sites to tackle a surge in COVID-19 driven by the Omicron variant and said 500 million
free at-home rapid tests would be available to Americans starting in January (Source).
● December 22: Studies indicate a lower risk of hospitalization with the Omicron variant
than other strains of COVID-19 (Source).
● December 22: The U.S. Food and Drug Administration (FDA) issued an emergency use
authorization (EUA) for Pfizer’s antiviral COVID-19 pill for people ages 12 and older at
risk of severe illness, the first oral and at-home treatment as well as a new tool against
the fast-spreading Omicron variant (Source).
● December 25: As of this date, 5.7 million Virginias have been fully vaccinated against
COVID-19. Of these people, 1.5% have developed COVID-19, 0.045% have been
hospitalized, and 0.0169% have died (Source).
● December 25: During the previous week in Virginia, unvaccinated people developed
COVID-19 at a rate of 11.9 times that of fully vaccinated people and 4.2 times that of
partially vaccinated people (Source).
● December 27: The Centers for Disease Control and Prevention (CDC) updated isolation
and quarantine guidance for the general public. VDH immediately adopted the CDC
guidance (Source; Source). This new guidance includes:
• Individuals who test positive for COVID-19 should isolate for five days (shortened
from 10 days) and, once symptoms reduce, they should wear a mask for an
additional five days when around others.
• Individuals who are vaccinated and have had known exposure to COVID-19 do
not need to quarantine following exposure but should wear a mask for ten days
after the exposure when they are around others.
• VDH recommends individuals with known exposure to COVID-19 be tested five
days after exposure. If symptoms develop, they should immediately quarantine
until a negative test confirms symptoms are not from COVID-19 (Source).
● December 27: In response to increasing COVID-19 cases, Hampton University will begin
the spring semester with courses held remotely for the first two weeks (Source)
● December 27: VDH added 165 COVID-19 associated deaths of Virginia residents who
died in another state in 2020 to the COVID-19 data dashboards (Source).
● December 28: Virginia Tech announced students and employees must get boosters, and
indoor mask-wearing will be required (Source).
● December 28: Norfolk State University announced it would postpone the start of its
spring semester classes by a week to mitigate the spread of COVID-19 on campus.
Booster shots will also be required (Source).
Vaccine Equity Report | January 2022 Page 5
● December 28: The seven-day-average number of daily hospitalizations for children
increased more than 58% nationwide in the past week, increasing concerns about how
children will fare in the new case surge (Source).
● December 29: Fairfax County Public Schools has been accepted into a Test to Stay pilot
program by the Virginia Department of Health. Under the test-to-stay guidance, students
deemed close contacts of other students who have tested positive for COVID-19 can
continue in-person classes if they continue to test negative. The program aims to
prevent excessive quarantine times for students deemed close contacts (Source;
Source).
● December 30: As of this date, about 47.2% of Virginians (2,005,482 people) have
received a booster COVID-19 vaccine dose (Source).
● December 30: As of this date, about 31% of Virginians 5-11 years of age have received
at least one dose of a COVID-19 vaccine (Source). The success of this rate is due to
multiple channels of vaccination, including private providers, pharmacies, public health,
and contracted vendors to do on-site school-based clinics, which helps to increase
access and equity for all children.
● December 30: Data from a real-world study indicate a booster dose of the Johnson &
Johnson COVID-19 vaccine was 84% effective at preventing hospitalization in South
African healthcare workers who became infected as the Omicron variant spread
(Source).
● December 30: Richmond and Henrico Health Districts will distribute 3,600 COVID-19
tests next week in addition to three planned testing events. The announcement comes
amid a surge in demand for tests that have been outpacing their availability (Source).
● December 31: Over 14 million COVID-19 vaccine doses have been administered in
Virginia, and 77.3% of all Virginians have received at least one dose of a vaccine
(Source).
Vaccine Equity Report | January 2022 Page 6
2. Vaccination Equity in Virginia
At the end of December, over 14 million COVID-19 vaccine doses have been administered in
Virginia (up from 12.7 million at the end of November), and over 16.2 million vaccines have
been received (up from 14.95 million at the end of November) (Source). Virginia ranks tenth in
the country for the percentage of distributed vaccines that have been administered (Virginia was
also tenth at the end of November), and 84.03% of vaccines received have been administered
(Source). As of December 31, 77.3% of all Virginians have received at least one dose of a
vaccine (up from 74.4% at the end of November) (Source), which is above the 73.3% national
vaccination rate receiving at least one dose (Source). Over 5.7 million Virginians have been fully
vaccinated (up from 5.53 million at the end of November), representing 67.6% of the population
(up from 64.9% at the end of November), which is above the 62% national total fully vaccinated
rate (Source). During December, on average, Virginia is administering approximately 28,426
vaccinations per day (down from 31,285 at the end of November) (Source).
Figure 1: Vaccinations by Age (One dose), as of 12/31/21
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 December, 96.2% of those ages 65+ are vaccinated, up from 95.1% at the end of
November (Source).
Vaccine Equity Report | January 2022 Page 7
Vaccinations for Under 45
Three reminders are critical for the under-45 population. First, in November, Virginia began
vaccinating children ages 5 to 11 years old (Source). Second, since May 2021, Virginia has
been vaccinating those ages 12 and older. Third, VDH’s reported age ranges are: 5-11, 12-15,
16-17, 18-24, 25-34, and 35-44.
As noted in past reports, in December, Virginia continued to make strides in vaccinations for
those younger than 45 years old. As noted in the previous report, Virginia’s vaccinations based
upon age continue to be a success story. As of December 31, 50.1% (679,427) of those ages 5-
17 have been vaccinated, 87.2% (6.37 million) of those ages 12+ have been vaccinated, and
88.7% (5.919 million) of those ages 18+ have been vaccinated. In all age categories except for
5-11, vaccinations for each applicable age group are between 70-75% (Source).
Race and Ethnicity
As was the case in past months and in December, missing data have been significant limitations
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,
throughout the year, missing data remains an issue. As of December 31, 896,692 vaccinations
(up from 515,374 at the end of November) have no race and ethnicity data reported (Source).
Further, to enhance equity analysis, VDH recently enhanced its COVID-19 dashboards and
reporting to provide more apparent comparisons, especially among local health districts, and to
track cases, hospitalizations, deaths, and vaccination rates over time (Source; Source).
Table 1: Race, COVID-19 Cases, Deaths, and Vaccinations in Virginia, as of 12/31/21
% of People % of Eligible
%
with at least Population
Points % of % of % of Total
one dose with Vaccinated
from Cases Deaths Population*
Reported with at least
White
Race/Ethnicity one dose
White 57.5% 64.7% N/A 55.3% 66.3% 61%
Black 17% 60.8% -3.9% 22.2% 24% 19%
Hispanic 10.2% 77.3% +12.6% 13.2% 5.7% 10%
Asian 9.3% 89.3% +24.6% 4.2% 3.3% 7%
Sources: VDH COVID-19 Dashboards; *U.S. Census
As shown in Table 1 and Figure 2, as of December 31, 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:
Vaccine Equity Report | January 2022 Page 8
• 60.8% of Blacks have been vaccinated (up from 58.4% at the end of November). Blacks
are 19% of the population yet have received 17% of doses.
• 77.3% of Hispanics have been vaccinated (up from 73.3% at the end of November).
Hispanics are 10% of the population and have received 10.2% of doses.
• 89.3% of Asians or Pacific Islanders have been vaccinated (up from 84.7% at the end of
November). Asians or Pacific Islanders are 7% of the population and have received
9.3% of doses.
• 64.7% of Whites have been vaccinated (up from 62.8% at the end of November). Whites
are 61% of the population and have received 57.5% of doses (Source).
As was the case in past months, there are no major changes in population demographics,
vaccinations, cases, and deaths. However, as reported in past months, disparities remain. For
instance, Blacks continue to be the most under-vaccinated population and continue to
disproportionately account for a higher percentage of cases, although Whites now count for a
slightly higher percentage of deaths. Numerous positives are evident for Asian and Hispanic
communities as these populations continue to see rising vaccination rates in tandem with
lowered percentages of deaths and cases per their percentages in the population.
Figure 2: Vaccinations by Race (One dose), as of 12/31/21
Source
Vaccinations by Race
As continues to be the case in December, 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 (58%), Hispanics (56%), and Blacks (51%) are vaccinated at rates
lower than Asians (77%) in the United States (Source).
Vaccine Equity Report | January 2022 Page 9
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 December 13, 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 two-thirds of 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 66.3% (1.309 million) of
booster shots (down from 70% in November), and 25.9% of this population are
vaccinated with a booster
• Blacks comprise 19% of the population yet have received 14.8% (292,172) of booster
shots (up from 13.8% in November), and 18.3% of this population are vaccinated with a
booster
• Asians or Pacific Islanders comprise 7% of the total population and have received 10.6%
(208,236) of booster shots (up from 9% at the end of November), and 35% of this
population are vaccinated with a booster
• Latinos comprise 10% of the total population yet have received 5.9% (116,102) of
booster shots (up from 4.6% at the end of November), and 15.4% of this population are
vaccinated with a booster.
Vaccine Equity Report | January 2022 Page 10
Figure 4: Booster Shots by Race and Ethnicity in Virginia, as of 12/31/21
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
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 (Figure 6). Figure 7 displays COVID-19 risk levels by
Vaccine Equity Report | January 2022 Page 11
locality. The risk levels by locality are at the highest level (red) across most of Virginia at the end
of December (Source) due to the rapidly spreading Omicron variant (Source).
Figure 6: Vaccinations by Locality – Rate per 100,000 Population, as of 12/31/21
Source
Figure 7: COVID-19 Risk Levels by Locality, as of 12/31/21
Source
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 state’s southeast, south-central, and southwest portions. As was
the case in the past months, at the end of December, rural counties disproportionately
Vaccine Equity Report | January 2022 Page 12
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 12/31/21
Source
Figure 9: Deaths from COVID-19 in Virginia: Urban and Rural, as of 12/31/21
Source
Vaccine Equity Report | January 2022 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 December (Figure 10), most of
Region 3 is under high-risk levels. Measured as a seven-day moving average, as of 12/31/21,
the Commonwealth has 8,618.6 new daily cases (up from 1382.1 new cases at the end of
November) at 101 new cases per 100,000 people (up from 16.2 at the end of November).
However, Virginia ranks fifth out of six for COVID-19 risk level/daily new cases in the region
(Virginia ranked fourth at the end of October, September, and November).
Figure 10: COVID-19 Risk Levels* by County across FEMA Region 3, as of 12/31/21
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).
Compared with past months and as shown below, Pennsylvania, Virginia, and West Virginia
face high SVI yet somewhat higher vaccination coverage. 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 | January 2022 Page 14
Figure 11: Percent of Population Fully Vaccinated by Social Vulnerability Index, FEMA
Region 3, as of 12/30/21
Source
Vaccine Equity Report | January 2022 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 vaccinations for Blacks, Hispanics/Latinos, and Asians. Still, comparing state vaccination
rates by race and ethnicity because of reporting inconsistency and missing data (Source).
For some, racial and ethnic disparities persist in vaccinations, while the gaps have closed for others. For example, across FEMA
Region 3, Blacks continue to be under-vaccinated 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
12/13/2021
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 68% 55% 1.2 −14 59% 1.2 −9 82% 0.8 14
District of Columbia 61% 49% 1.2 −12 67% 0.9 5 85% 0.7 23
Maryland 74% 67% 1.1 −7 73% 1.0 −1 88% 0.8 14
Pennsylvania 59% 64% 0.9 6 44% 1.3 −15 47% 1.3 −12
Virginia 64% 61% 1.0 −3 72% 0.9 8 92% 0.7 28
West Virginia 58% 66% 0.9 8 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 in December continued to be far ahead of the national average for
vaccinations for those under 40. Improvements from September to December for Virginia are
notable in each age category. Gains in Virginia far outpace the national average for all ages, in
which improvements were also 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 12/31/21
Months Ages 5- Ages 12- Ages 16- Ages 18- Ages 25-
11 15 17 24 34
Virginia December 31.5% 70.3% 73.7% 72.4% 73.9%
(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 17* 17* 24* 39*
United December 2.8% 6.6% -- 9% 21.2%
States
(at least one November -- 7.6% 7.6% 9.2% 20.5%
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
*Between November and December, the CDC changed the age ranges it reported, particularly
for populations younger than 18 years of age.
4. Vaccine Hesitancy
Virginia’s vaccination rates continue to surpass those of many other states (Source), with 6.59
million Virginians having received at least one dose, nearly 5.77 million having received two
doses, and about 2 million have also received a booster shot (Source). However, more than
22% of Virginia’s adult (18+) population have not received at least one vaccine dose (Source).
Unvaccinated Adults
Whites account for the largest share of unvaccinated people (63%) (Source). Republicans
increasingly constitute a larger share of those who remain unvaccinated against COVID-19
(Source). A recent KFF survey provides additional insight into what would convince the
unvaccinated to become vaccinated. Half say nothing could persuade them when asked what
might change their minds (Source). Twelve percent said more research and transparency could
convince them to get vaccinated. Six percent say they would get vaccinated if they were
required for work or if the vaccine became mandatory, 5% said if they received a large monetary
Vaccine Equity Report | December 2021 (Draft) Page 17
incentive, if their doctor recommended it (3%), or if the vaccine prevented 100% of all infections
(3%) (Source).
A recent survey by the U.S. Census Bureau, the Household Pulse Survey (HPS), reported
various reasons why some individuals were unvaccinated against COVID-19. Unvaccinated
refers to adults who have not received any COVID-19 vaccine dose. In this survey,
unvaccinated adults who responded could select more than one reason.
Figure 12: Why Adults Did Not Get a COVID-19 Vaccine (%)
Concerned about possible side effects of the vaccine 49.6%
Don’t trust the COVID-19 vaccine 42.4%
Don’t trust the government 35.4%
Don’t believe I need a COVID-19 vaccine 31.8%
Plan to wait and see if it is safe 27.9%
Don’t know if a COVID-19 vaccine will protect me 23.3%
Don’t think COVID-19 is that big a threat 22.4%
Doctor has not recommended it 8.6%
Concerned about the cost 1.7%
Hard for me to get a COVID-19 vaccine 1.7%
Source: U.S. Census, Household Pulse Survey
As Figure 12 above displays, approximately half of the unvaccinated adults reported that they
were concerned about the vaccine’s possible side effects, and about 42% reported that they
don’t trust the COVID-19 vaccine (Source).
Regarding race and ethnicity, non-Hispanic Black adults were slightly more likely to be
unvaccinated (Source).
Children Vaccinations
With the November approval of vaccines for children ages five and older, pediatric vaccinations
have been of particular interest to policymakers and the public. In Virginia, 26.8% of the ages 5-
11 population has been vaccinated with at least done dose, compared to 69.2% of those ages
12-15 and 72.5% of those ages 16-17 (Source). Virginia’s percentage of 5-11 year-olds who
have been vaccinated is notably higher than the national average of 16.7%. It is one of only
eight states with a vaccination rate of more than 25% for this age group (Source). The
nationwide percent may continue to remain relatively low, as vaccinations in this age group
dropped sharply after Thanksgiving (and continue to stay down) despite initial enthusiasm
(Source). While concerns about supply and access dominated conversations of young child
vaccination in early November, the conversation is now shifting to addressing hesitancy and
encouraging vaccine uptake (Source).
Vaccine Equity Report | January 2022 Page 18
Reasons for parental hesitancy to vaccinate their children vary, and methods of promoting
vaccine uptake among parents will need to be tailored for different communities, perspectives,
and life experiences. As part of this effort, the White House and the U.S. Department of Health
and Human Services have planned to conduct education campaigns featuring individuals
trusted in different communities and trusted local media to encourage child vaccinations
(Source).
Efforts to Increase Booster Shots
In addition to promoting child vaccinations, the White House is also focused on promoting
booster shots for adults as part of an effort to protect against recent COVID-19 variants. This
plan includes:
• Expanding the availability of boosters at pharmacies
• Direct outreach to adults eligible for a booster shot
• Promoting equity in booster shot access by offering vaccines at convenient hours
• Launching education campaigns, with a special focus on senior citizens
• Collaborating with AARP to promote booster shots among senior citizens (e.g., town
halls, transportation to vaccine locations, events, and a hotline for seniors and AARP
members to ask questions and get more information)
• Encouraging employers to provide paid time off for employees to get a booster shot
(Source)
With winter approaching, and with the Omicron variant becoming the dominant strain in the
United States (Source), addressing vaccine hesitancy is crucial in ensuring that all citizens,
especially those most vulnerable, are as protected as possible.
5. Policy and Administrative Updates
Legislative Updates
• No new updates
Executive Updates
• On December 2, President Biden announced new actions to protect Americans against
the Delta and Omicron COVID-19 variants (Source).
Agency Updates
• On December 9, the Virginia Department of Health announced the first confirmed case
of the Omicron variant in Virginia (Source).
Vaccine Equity Report | January 2022 Page 19
Court Updates
• On December 10, the Supreme Court of Virginia extended the Thirty-second Order of
Declaration of Judicial Emergency through January 5, 2022 (Source).
6. On the Horizon
During December 2021, there were gains in vaccination rates across the Commonwealth; over
1.3 million COVID-19 vaccine doses were administered in Virginia (up from 1 million in
November). For all eligible age groups, vaccination percentages outpaced the national average.
Virginia continues to outpace the national average for pediatric COVID-19 vaccinations, children
ages 5-17.
Though the gap has narrowed, more than 22% of eligible Virginians (18 and older) remain
vaccinated. A recent survey of unvaccinated adults explains that many distrust the COVID-19
vaccine; others worry about possible side effects. To combat this hesitancy, the Commonwealth
should continue its targeted outreach efforts. Unvaccinated children are also a population for
concern. Reasons for parental hesitancy to vaccinate their children vary, and methods of
promoting vaccine uptake among parents will need to be tailored for different communities,
perspectives, and life experiences.
On December 9, Omicron was first detected in Virginia but was widespread by the end of the
month. Fueled by holiday travel and the rapidly spreading Omicron variant, Virginia broke its
COVID-19 one-day case record on the last day of 2021 with 17,618 new cases. As we begin
2022, COVID-19 risk levels remain high across the Commonwealth and the nation. However,
studies indicate that vaccines and boosters successfully protect against the worst outcomes of
COVID-19, and they remain the best defense against severe illness, hospitalizations, and
deaths.
The case positivity rate may be larger than reported, as the number of positive cases identified
by at-home COVID-19 tests is unknown. Many of the results of rapid tests are not reported to
local health departments and are not included in VDH data portals. Also on the horizon and of
great concern is the expected increased positive cases in local, state, and regional corrections
facilities. As of January 10, the following was reported to the Office of the Secretary of Public
Safety and Homeland Security and the Governor’s Office of Diversity, Equity, and Inclusion
(ODEI) from the Virginia Department of Corrections regarding positive COVID cases,
vaccination rates, and on-going challenges:
Positive COVID Cases Vaccination Rates Challenges
Staff – 717 active cases Staff Staffing remains a challenge, In-person
53% have at least 1 visitation has been suspended until
Inmates – 970 active dose; 48% are fully January 28; All correctional education
cases schools, treatment and re-entry
vaccinated; 10.7%
have received a programs, and religious services where
booster inmates/CCAP probationers attend in-
person, outside of their respective
Vaccine Equity Report | January 2022 Page 20
Inmates housing area has been suspended until
85% have at least 1 January 28, 2022. This includes all
dose; 80% are fully academic, career and technical
vaccinated; 24.1% education (CTE) programs, college
have received a classes, and libraries.
booster.
Though Virginia has administered over 2 million booster doses, approximately two-thirds of
COVID-19 boosters have gone to White populations. Blacks and Hispanics still
disproportionately contract COVID-19, and Blacks and Whites disproportionately die from it.
Virginia should continue targeting vaccination efforts to communities the coronavirus has
disproportionately impacted. In addition, state leaders should prioritize outreach to communities
with low vaccination coverage and high social vulnerability.
In November, the FDA approved three new at-home COVID-19 antigen diagnostic tests.
However, by the end of the month, many retailers had sold out of rapid, at-home COVID-19 test
kits. Easy, inexpensive at-home COVID-19 tests are an essential tool to detect new variants and
stop the spread of the coronavirus. Administrators should continue to hold walk-up COVID-19
testing clinics and distribute rapid, at-home tests to vulnerable communities to combat testing
inequities.
On January 15, Virginia’s new statewide leadership will take office, which will include a new
Health and Human Resources Secretary, State Health Commissioner, and several other cabinet
members. While leadership transition understandably brings a re-ordering of priorities, issues of
diversity, equity, and inclusion remain core, non-partisan values of American government. At the
time of this report, the future of the Governor’s Office of Diversity, Equity, and Inclusion remain
unclear. January 14, 2022, will be the last day for all members of the ODEI. However, as it has
been stated in several previous reports, it is critical that leaders, policymakers, and decision-
makers equitably strengthen the systems and state agencies that provide access to information,
state services, vaccinations, and resources across the Commonwealth of Virginia and address
the systemic biases and historical antecedents that undergird the disproportionate impact of the
coronavirus. Thus, in the absence of a Virginia Chief Diversity Officer, this monthly equity report
to the Virginia General Assembly will shift to the equity leaders in the Virginia Department of
Emergency Management and the Virginia Department of Health.
Vaccine Equity Report | January 2022 Page 21
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, and
iii. Make recommendations for any statutory, regulatory, or budgetary actions necessary to
implement such plan. The Department shall make an initial report on its activities and
any findings to the Chairs of the House Committee on Health, Welfare and Institutions
and the Senate Committee on Education and Health by December 1, 2020, and shall
report monthly thereafter.
Vaccine Equity Report | January 2022 Page 22
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