Virginia Department of Health Plan for Equitable Distribution of COVID-19 Vaccine (September 2022)

Summary

The September 2022 monthly Vaccine Equity Report from the Office of Health Equity in the Virginia Department of Health, covering August 2022. It compares Virginia's equitable vaccination progress with other states in FEMA Region 3 and explores vaccine trends over time and vaccination hesitancy. The key findings state that on January 13, 2022, the average number of daily cases in Virginia peaked at 207.3 per 100,000, and that at the end of August 2022, 72.2% of Virginia's population was fully vaccinated and 82.5% had received one dose. They also discuss the BA.5 subvariant of Omicron and impacts on children.

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Virginia
Department
of Health
Plan for
Equitable
Distribution
of COVID-19
Vaccine –
September,
2022
September 2022

Office of Health Equity in the Virginia
Department of Health
Contents

Executive Summary………………………………………………….……………………………………………………………2
1. Key Equity Announcements and Critical Updates…………………………………….………………………4
2. Vaccination Equity in Virginia…………………………………….……………………………………………………7
Vaccinations for 65+…………………………………….…………………………………………………………….…….7
Vaccinations for Under 45…………………………………….………………………………………………………….8
Race and Ethnicity…………………………………….…………………………………………………………….……….8
Rural Areas…………………………………….…………………………………………………………….………………..10
Infections and Deaths Since Vaccine Availability…………………………………….……..……………...13
3. Vaccinations in FEMA Region 3………………………………………………………………………………………16
FEMA Region 3 and Race/Ethnicity………………………………………………………………………………..17
4. Trends Over Time…………………………………………………………………………………………………………..20
Racial Groups as a Share of Total Vaccinations in Virginia……………………………………………..20
Doses Administered……………………………………………………………………………………………………….21
5. Vaccine Hesitancy…………………………………………………………………………………………………………..22
Vaccination Mandates…………………………………………………………………………………………………….23
6. On the Horizon……………………………………………………………………………………………………………….24

Vaccine Equity Report | September 2022 1
Executive Summary

This monthly report is from the Office of Health Equity in the Virginia Department of Health. It
provides an overview of vaccination equity in the Commonwealth of Virginia, including key equity
accomplishments, for August 2022.

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. Additionally, this report explores vaccine trends over
time, vaccination hesitancy, and equity considerations for vaccine distribution. An overview of
recent legislative, executive, and administrative actions is also included. Key findings include:

Impact of the Omicron Variant BA.5
 In May, the new BA.5 subvariant of Omicron began to emerge in Virginia (Source).
 By the end of June, experts in the U.S. began cautioning people about the BA.5 variant, warning
that it could be the worst version of Omicron yet (Source).
 At the end of July, the BA.5 variant was responsible for over half of all cases in Virginia,
according to CDC estimates (Source).
 At the end of August, the BA.5 variant was still the dominant strain in Virginia (Source).

Trends in Average Daily Cases
 Since the end of November 2021, Virginia saw the highest number of average daily cases in the
month of January 2022 and saw a fall in cases during February and March. In the spring and
summer, cases started to increase again (Source).
 On January 13, 2022, the average number of daily cases in Virginia peaked at 207.3 per
100,000. This is compared to 17.8 per 100,000 on November 27, 2021 and 101.2 per 100,000
on February 1, 2021. By the end of March, that number had dropped even further to 8.7 cases
per 100,000 people. On April 30th, the number of daily cases had risen again to 17.6 per
100,000 people. On May 30th, it was 40.14 cases per 100,000 people and at the end of June, the
average number of daily cases was 29.9. The highest average number of daily cases in July was
on July 29th at 36.4 cases per 100,000 people (Source).
 The highest average number of daily cases in Virginia in August was on August 1st at 35.9
cases per 100,000 people (Source).

Vaccination Rates
 At the end of August 2022, 72.2% of Virginia’s population was fully vaccinated and 82.5% had
received one dose of the vaccine (Source).

Impacts on Children
 On January 26, 2022, a child younger than ten died after contracting COVID-19. The child was
the eighth Virginia child under ten to die from the virus (Source).

Vaccine Equity Report | September 2022 2
 In the Roanoke-City Alleghany Health Districts, around 11 percent of the new COVID-19 cases
were in children during the month of February (Source).
 As of August 30th, 31 individuals younger than 20 have died from COVID-19 in Virginia
(Source).
 New CDC numbers show that three out of every four kids in Virginia has had COVID-19
(Source).
 Statewide rates for Virginia show that students have fallen behind on their routine school
immunizations during the pandemic. It is yet another grim reminder of how the pandemic has
indirectly and directly impacted life for Virginians (Source).
 Ahead of the start of the 2022-2023 academic year, Governor Youngkin announced updated
guidance on quarantine recommendations for people exposed to COVID-19 in K-12 schools,
child care, and camp settings. The revised guidance was released on July 14th and states that
quarantine is no longer recommended for asymptomatic individuals who were exposed to
COVID-19-infected individuals in these settings (Source).

Vaccine Equity Report | September 2022 3
1. Key Equity Announcements and Critical Updates

This section details equity-related announcements regarding COVID-19 in the Commonwealth of
Virginia during the month. It also provides information on critical updates relevant to Virginia’s
responses to COVID-19. Equity announcements and critical updates from August include:

 August 1: In the Fairfax Health District, which includes Fairfax County and the cities of
Fairfax and Falls Church, COVID-19 cases have been on a downward trend since mid-July. In
the beginning of the summer, cases in the area had been relatively level before the
downward trend (Source).
 August 4: In Southwest Virginia, nine deaths from COVID-19 were reported in the past
week. Additionally, all cities and counties in the area, except for Wythe County, were ranked
by the CDC as having high community disease transmission levels (Source). VDH is also
offering guidance for schools as they reopen in the fall. It recommends masking, isolation
for those that test positive, and vaccinations for children (Source; Source).
 August 5: In the past week, new cases in Virginia decreased from 21,350 the week before to
20,291 (around a 5% change). The 7-day positivity rate increased from 23.0% the week
prior to 23.7% (Source).
 August 6: According to the CDC’s COVID Community Levels, universal masking is
recommended for 65 of Virginia’s localities, including Metro Richmond (Source).
 August 7: Cases started to rise again in the Dan River Region this week. The number of cases
in Danville and Pittsylvania County are at least three times higher now than they were last
year. But hospitalizations, incidents of severe illness, and deaths remain relatively low
(Source).
 August 8: The CDC put all of the Tri-City area, including Petersburg, at the “high” community
level (Source).
 August 9: The Eastern Shore Region reported five COVID-19 deaths in the past month. Four
out of five of the deaths were in individuals above the age of 80. Also, 58 people on the
Eastern Shore visited the hospital emergency department for COVID-like illness the week
ending Aug. 6, and 66 went to the emergency department for COVID-like illness the week
before (Source).
 August 10: According to VDH data, a total of 14,577,043 PCR tests have been run in Virginia
during the pandemic, with 1,987,738 positive cases (Source).
 August 12: On Thursday, the CDC announced scaled back COVID-19 guidelines. Instead of its
previous guideline of quarantining after being exposed to COVID-19, the CDC is
recommending that those exposed to someone with COVID-19 wear a mask for 10 days and
test for the virus on the fifth day. Additionally, they are dropping the recommendation for
people to stay six feet apart (Source).
 August 13: This week, Pittsylvania-Danville Health District reached the somber milestone of
500 deaths since the pandemic began. It is a grim reminder that, despite a return to normal
life, COVID-19 continues to negatively impact Virginians (Source; Source).

Vaccine Equity Report | September 2022 4
 August 15: Superintendent Jason Kamras of Richmond Public Schools (RPS) and the RPS
administration have proposed to require students and staff to wear masks. The proposal
drew mixed reactions from school board members and the community (Source).
 August 16: According to VDH’s COVID-19 Dashboard, the Commonwealth has reached over
2 million cases (2,002,533 cases, as of August 16). Over 21,000 Virginians have died due to
the virus (Source).
 August 16: Concerns have arisen that an already shaken trust in public health will continue
to worsen. Virginians expressed that, when it comes to mask wearing, they are receiving
two different public messages. Earlier this month, a public health official for the Richmond
and Henrico Health Districts advised that residents continue wearing masks indoors, given
the CDC still considers the two counties areas of high COVID-19 transmission. Earlier this
summer, Governor Youngkin announced that the state health department would no longer
recommend masks in schools, day cares, and summer camps (Source).
 August 18: The Virginia Beach Health Department announced that it will be holding a
COVID-19 vaccination clinic on August 20th (Source). The Richmond and Henrico health
districts announced that they will be holding free COVID-19 testing on August 18th, 23rd,
24th, and the 25th (Source).
 August 19: VDH announced that, in partnership with Celebrate Healthcare and Sixth Mount
Zion Baptist, it will be holding free COVID-19 vaccination clinics in Hampton (Source).
 August 22: A National Park Service news release announced that the Shenandoah National
Park in Virginia is reinstating masking requirements indoors. The announcement came on
the same day that VDH reported 1,561 new COVID-19 cases statewide (Source).
 August 23: At a school board meeting, Arlington Public Schools (APS) announced its COVID-
19 policies for the upcoming school year, with not much change from last year’s policies.
APS will mostly follow the same COVID-19 protocols as last year, including optional masks,
free weekly testing, and five-day quarantines. Superintendent Dr. Francisco Durán clarified
that if the area ever got to a high transmission level, they would be requiring masks
(Source).
 August 25: The Richmond and Henrico County Health Districts announced that they will be
offering COVID-19 testing on August 25th and will be offering free walk-up vaccine clinics on
August 25th, 30th, 31st, and September 1st. The clinics will offer both COVID-19 vaccines and
boosters (Source).
 August 26: Statewide rates for Virginia show that students have fallen behind on their
routine school immunizations during the pandemic. Virginia data for school-required
vaccinations among kindergartners and adolescents fell by 10 percentage points from fall
2019 to fall 2021 — to around 86 percent. Officials attributed the drop to fewer well-child
visits, months of virtual learning, fluctuations in kindergarten enrollment and other factors.
It is yet another example of how the pandemic has directly and indirectly impacted
population health in an adverse way (Source).
 August 28: New CDC numbers show that three out of every four kids in Virginia has already
had COVID-19, whether they were symptomatic or asymptomatic. “The study confirms that
at a population level, many children have been exposed to COVID and they’ve had some
Vaccine Equity Report | September 2022 5
degree of an infection, and that could be either asymptomatic or symptomatic,” said Lisa
Thanjan with the Virginia Department of Health. “It does not necessarily show if people
have enough antibodies to protect them against a reinfection,” Thanjan said. “If an
individual was to have a reinfection, having a previous infection does not necessarily
guarantee that they won’t have severe outcomes.” (Source)
 August 30: Virginia Beach County Public Schools (VBCPS) shared some of its plans for the
upcoming school year regarding COVID-19 protocol. Officials said they're keeping up with
sanitation and air filtration. Masks will stay optional. They are recommending them when
community levels get in the medium or high categories. Right now, they're low in Virginia
Beach, according to the CDC (Source).

Vaccine Equity Report | September 2022 6
2. Vaccination Equity in Virginia

At the end of August, over 16.5 million COVID-19 vaccine doses have been administered in Virginia
(Source). With 72.2% of the population fully vaccinated, Virginia ranks 11th in the country for the
percentage of the population that has been fully vaccinated against COVID-19 (Source; Source). At
present, 82.5% of all Virginians have received at least one dose of a vaccine (Source), which is
above the 79.1% national total vaccination rate receiving at least one dose (Source). 72.2% of
Virginians are fully vaccinated, which is above the 67.4% national total fully vaccinated rate
(Source). On average, Virginia is administering approximately 3,402 vaccinations per day (up from
3,048 vaccinations per day in June) (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). At the
end of August, 96.0% of those ages 65+ were vaccinated (Source).

Vaccine Equity Report | September 2022 7
Vaccinations for Under 45

The reported age ranges in Virginia are: 0-4, 5-11, 12-15, 16-17, 18-24, 25-34, and 35-44. As seen
on VDH’s COVID-19 dashboard, 60.6% of those aged 5-17 years have been vaccinated with at least
one dose, up by 0.7% from last month. 87.1% of individuals older than 5, up by 0.3% since last
month, have been vaccinated with at least one dose. Furthermore, 92.5% of the population over the
age of 18 have been vaccinated with at least one dose, up by 0.2% from last month. Data are also
reported by each age group for percentages of the population vaccinated with at least one dose:
9.0% of 0-4 year olds (up from 6.3%), 46.1% of 5-11 year olds (up from 45.2% last month), 76.3%
of 12-15 year olds (up from 75.8%), 78.4% of 16-17 year olds (up from 78.1%), 78.8% of 18-24
year olds (up from 78.4%), 79.2% of 25-34 year olds (up from 78.9%), and 84.9% of 35-44 year
olds (up from 84.7%) (Source).

Race and Ethnicity

Figure 2: Vaccination Count and Percent of Population Vaccinated by Race and Ethnicity
(One Dose)

Source

Note: The percentage of Native Americans that are vaccinated can be above 100% for two reasons.
1. There are small numbers of vaccinations and small population estimates for Native Americans
at the city/county level in Virginia. VDH gets population estimates from the National Center
for Health Statistics (NCHS). For example, there were 3 Native American vaccinations in a
county. Population estimates say there were only 2 people who identify as Native American in
that same county. This means that the data would say there were 3 vaccinations over 2 people
in the population. This would equal 150%, or a percentage over 100%.

Vaccine Equity Report | September 2022 8
2. Some people may identify that they are Native American and multi-race when they are getting
their vaccine. They will be categorized as Native American only in the data system. This is
because population estimates from NCHS do not include multi-race as an option. If there was a
multi-race option, a person who identified as Native American and multi-race would be in the
multi-race population estimates.

As shown above in Figure 2, as of August 30th, the key race and ethnicity breakdowns for those
receiving at least one dose are as follows (with little change since last month):
 First, Blacks have received 17.4% of all vaccinations and 65.6% have been vaccinated with
at least one dose.
 Second, Latinos have received 10.8% of all vaccinations and 84.1% have been vaccinated
with at least one dose.
 Third, Asians or Pacific Islanders have received 9.4% of all vaccinations and 93.3% have
been vaccinated with at least one dose.
 Fourth, Whites have received 56.5% of all vaccinations and 67.6% have been vaccinated
with at least one dose (Source).

Figure 3: Cases by Race and Ethnicity

Source

As shown in Figure 3, case counts are lower now than what they were during the winter but
continue to occur amongst Virginia’s population, making it more important to focus efforts on
vaccination. Moving forward, continuing to collect data on race and ethnicity will be crucial to
making more progress on vaccine equity in Virginia. This is especially true given the known
increased and disproportional risks faced by historically marginalized populations in experiencing
the worst effects and outcomes of COVID-19, including death. Likely explanations for the unequal
burden of disease on these populations include social vulnerability, social determinants of health,
and a pattern of historical disparity.

Vaccine Equity Report | September 2022 9
Rural Areas
Figure 4 below displays the rural (non-metropolitan) areas in Virginia as defined by the Office of
Management and Budget (OMB) (Source). Areas in pink are rural localities while areas in beige
are considered non-rural (as defined by the OMB).

Figure 4: Rural and Non-Rural Areas in Virginia

Source

Another way to examine rural and urban disparities is to examine rural, urban, suburban and
exurban areas. The Isserman Classification system (shown in Table 1 below) uses a combination of
urban area population and population density to identify counties as urban, rural, or mixed.

Table 1: Percent Population Vaccinated by Urban and Rural Jurisdictions (by Age Groups)

Source

Rural areas, especially in south-central and southwest Virginia, continue to have lower vaccination
rates as compared to other areas of the state, although there are have been some improvements,
primarily concentrated in the north-central and northern regions (Figure 5). Vaccination hesitancy
continues to be an issue throughout the Commonwealth. As seen in Figure 6, Virginia continues to
experience some highly elevated risk levels across the Commonwealth. Risk levels have roughly
stayed at the same level this month than what they were in July. Most counties are experiencing
highly elevated risk levels, with almost the entire Commonwealth in red. (Source).

Vaccine Equity Report | September 2022 10
Figure 5: Vaccinations by Locality – Rate per 100,000 Population

Source

Figure 6: COVID-19 Risk Levels by Locality in August

Source

Third, as shown in Figures 7 and 8, some urban and rural disparities remain in terms of cases as
measured by rates per 100,000 people, which were especially exacerbated this last winter when the
Omicron variant led to a massive rise in risk. Since then, some rural counties continue to show
slightly higher rates of cases throughout the Commonwealth. By the end of August, death rates
occurred throughout the Commonwealth but were low relative to the number of cases.

Vaccine Equity Report | September 2022 11
Figure 7: Cases of COVID-19 Over the Last 13 Weeks in Virginia: Urban and Rural

Source

Figure 8: Deaths from COVID-19 Over the Last 13 Weeks in Virginia: Urban and Rural

Source

Vaccine Equity Report | September 2022 12
Infections and Deaths Since Vaccine Availability

VDH’s data reveal that vaccinations have saved lives (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. As shown in Table 2,
disparities detailed in previous vaccine equity reports remain. Whites represent 61% of the
population, 56% of cases, and 67% of deaths. Blacks represent only 19% of the population yet 23%
of cases and 23% of deaths. Further, Hispanics make up 10% of the population yet 14% of cases
and 6% of deaths. When comparing the percentages in the population, both Blacks and Hispanics
still disproportionately contract COVID-19, and Blacks disproportionately die from it.

Table 2: Comparisons of COVID-19 Cases, Deaths, and Population
% of Cases % of Deaths % of Total Population

White 56% 67% 61%

Black 23% 23% 19%

Hispanic 14% 6% 10%

Asian 4% 3% 7%

Other 3% 1% 3%
Source

Secondly, as shown below in Figures 9 and 10, patterns concerning cases and deaths by age and sex
remain similar in August as they were in previous months. Concerning cases and age, those aged
between 30-39 continue to comprise the segment of the population with the single largest number
of cases. Regarding cases and sex, those identifying as females tend to represent more COVID-19
cases. Concerning deaths and age, 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. Regarding deaths and sex, those identifying as male tend to die at a slightly higher rate
than those identifying as female.

Vaccine Equity Report | September 2022 13
Figure 9: Cases of COVID-19 in Virginia: Demographics

Source

Vaccine Equity Report | September 2022 14
Figure 10: Deaths by COVID-19 in Virginia: Demographics

Source

Vaccine Equity Report | September 2022 15
3. Vaccinations in FEMA Region 3

Virginia is a part of FEMA Region 3, which includes Delaware, the District of Columbia, Maryland,
Pennsylvania, and West Virginia. In August, Virginia ranked second in the region in terms of COVID-
19 vaccine doses administered per 100 people (Source).

Regarding COVID-19 risk levels in August (Figure 11), all of Region 3 continues to see elevated risk
levels. The risk levels for Virginia in August were close to what they were in July. At present, West
Virginia is the most at-risk in FEMA Region 3. Virginia has 2,682.9 new daily cases, a seven-day
moving average of 31.4 new cases per 100,000 people (last month, Virginia saw 3,127.6 new daily
cases with a seven-day moving average of 36.6 new cases per 100,000 people). These numbers
place Virginia second out of sixth in FEMA Region 3 in terms of COVID-19 risk level, meaning that
this month was worse for Virginia’s rankings than last month when Virginia came in third. To
compare, in the month of January, Virginia had 9,194.0 new daily cases with a seven-day moving
average of 107.7 new cases per 100,000 people.

Figure 11: COVID-19 Risk Levels in August by County across FEMA Region 3

Source

Further, as seen in Figure 12 below, updated FEMA data are available concerning linkages
between vaccination coverage (low to high) and rankings on the social vulnerability index (SVI).
As shown below, Virginia particularly faces issues of high SVI and low vaccination coverage. In
Virginia, these issues especially affect the south-central and southwest parts of the state.

Vaccine Equity Report | September 2022 16
Figure 12: Percent of Population Fully Vaccinated by Social Vulnerability Index, FEMA
Region 3

Source

FEMA Region 3 and Race/Ethnicity
All areas in FEMA Region 3 continue to show racial disparities in the percentages of vaccines
administered. Both Blacks and Hispanics/Latinos continue to see some improvements in
vaccination percentages, but Blacks are still behind in vaccinations. According to Kaiser Family
Foundation Data for Virginia, the vaccination disparity for the Latino population reversed as of July
11, 2022, with 82% of Latinos vaccinated compared to 68% of Whites (Source). Virginia remains a
leader in working to close gaps between the percentage of cases and the percentage of vaccinations
for Blacks, Hispanics/Latinos, and Asians. Still, comparing state vaccination rates by race and
ethnicity is challenging because of reporting inconsistency and missing data on race and ethnicity
(Source). Kaiser Family Foundation data shown below are current as of April 4, 2022.

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

Source
Vaccine Equity Report | September 2022 17
Source

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

Source

Vaccine Equity Report | September 2022 18
Figure 15: Asians as a Share of COVID-19 Trends, FEMA Region 3

Source

Figure 16: Whites as a Share of COVID-19 Trends, FEMA Region 3

Source

Vaccine Equity Report | September 2022 19
Source

Notes:
1. Data does not include Philadelphia County due to differences in reporting data. As of 6/21, PA
total population data was updated to exclude Philadelphia; data should not be compared to
earlier periods due to these data changes or corrections.
2. Data prior to 4/12 will not reflect people receiving the single dose of the Janssen vaccine
because the data reflects people receiving the first dose of two-dose vaccinations.

4. Trends Over Time
A little over two years into the COVID-19 pandemic, there are still inequities in overall vaccination
rates. However, these inequities have declined over time in Virginia. Overall, minorities have
consistently had less access to vaccinations, and lower overall vaccination rates, than Whites.
Recently, those gaps have begun to narrow and VDH is working to further reduce disparities. As
part of its efforts to address inequities, VDH is transitioning their community testing centers to a
mobile clinic model in order to be able to reach areas that have low access to testing. Moving
forward, particular attention should be given to the Black population as they still suffer the worse
vaccination disparity out of all other racial and ethnic groups. These items are discussed further,
with a focus on racial equity, in the sections that follow.

Racial Groups as a Share of Total Vaccinations in Virginia
In Virginia, Whites make up 61% of the total population and 56.5% of the population with reported
race and ethnicity that have been vaccinated with at least one dose (down from 56.6% last month).
Blacks make up 19% of Virginia’s total population and 17.4% of the one-dose vaccinated population
(no change since last month). 10% of Virginia’s population is Hispanic and 10.8% of the vaccinated
population in Virginia is reported to be Latino (an increase of 0.1% since July). Asians make up 7%
of Virginia’s total population while Asian and Pacific Islanders make up 9.4% of the vaccinated
population in the Commonwealth (no change since last month) (Source; Source). While some
progress has been made in closing the disparity gap for vaccinations amongst racial groups, the
Black population is notably behind other minority groups in Virginia when it comes to vaccination
percentages.

Vaccine Equity Report | September 2022 20
Furthermore, Blacks especially carry an unequal burden of disease in Virginia when compared to
Whites and Asians, as shown in Figure 17. Looking at vaccination coverage data since the start of
the vaccine rollout, vaccinations occurred amongst Blacks at only 0.9 times the rate of Whites
(Source). Cases and deaths occurred amongst Blacks at 1.2 and 1.5 times the rate of Whites,
respectively, when looking at cumulative data across the entire pandemic. Amongst Latinos, when
analyzing data from the start of the vaccine rollout, vaccinations occurred at 1.1 times the rate of
Whites while cases and deaths each occurred at 1.3 times the rate of Whites. VDH has been working
throughout the pandemic to address these health disparities. Fortunately, some notable progress
occurred in the last three months. As shown in Figure 17, rate ratios from the last three months
reveal that, when compared to the cumulative rate ratios discussed above, the disparity gaps in
vaccination status amongst Blacks and amongst Latinos have disappeared. While Blacks continued
to experience a disproportionately higher burden of cases, deaths, and hospitalizations in the last
three months when compared to Whites, the rate ratio gaps are still smaller than what they were,
indicating some recent progress in health equity (Source).

Figure 17: Racial and Ethnic Distribution of Burden of Disease in Virginia Over the Last
Three Months (according to vaccinations, cases, deaths, and hospitalizations)

Source

Doses Administered
Between October 2021 and March 2022, Virginia saw a spike in the 7-day average of doses
administered. In general, the number of vaccines administered decreased as the winter Omicron
surge subsided. For each month since January 2022, the peak number of vaccines administered
were: 29,857 doses on January 11th, 8,780 doses on February 1st, 2,856 doses on March 4th, 3,006
doses on April 6th, 1,807 doses on May 1st, 1,235 doses on June 6th, and 3,202 doses on July 23rd
(Source). As of August 31st, the peak average number of vaccines administered in August occurred
on August 1st, with 2,443 doses (Source). By the end of August, the 7-day average of doses
administered was 3,402. These trends in Virginia generally match that of the United States as a
Vaccine Equity Report | September 2022 21
whole, which saw an increase in demand for vaccines during the winter months when the first
Omicron variant was spreading, then a general decrease in demand from the second half of January
onward, and a slight uptake in vaccinations again as the BA.5 subvariant began to spread (Source;
Source).

Figure 18: Daily Number of Administered COVID-19 Vaccine Doses and 7-Day Average in the
United States

(Blue bars represent daily numbers and red line shows 7-day average) Source

5. Vaccine Hesitancy
With close to 17 million vaccination doses administered, and a little over 7 million people (82.5%)
vaccinated with at least one dose, Virginia’s vaccination rates surpass the national rate of 79.1%
(Source; Source). This percentage includes those who have received at least one dose as well as
those who are fully vaccinated (67.4% of the U.S. population is fully vaccinated while 72.4% of
Virginia’s population is fully vaccinated). However, there is still nearly 30% of Virginia’s population
who has not been fully vaccinated (Source). Working to vaccinate a larger percentage of the
population and reducing vaccine hesitancy are important factors in combating the pandemic,
especially with the start of the school year across Virginia (Source).

Looking at nationwide trends from Kaiser Family Foundation polling, there has been some change
over time between December 2020 and July 2022 when it comes to individuals who say that they
will “definitely not” get vaccinated. Data indicate that, while 14% said that they would not get
vaccinated in January 2022, 19% said the same in the latest poll from July 2022 (Source).
Throughout 2021, there were some changes in attitudes in Virginia as well. A May 2021 poll
conducted by the Research Institute for Social Equity (RISE) at VCU’s Wilder School found that 32%

Vaccine Equity Report | September 2022 22
of those not vaccinated (n = 84/259) said that they were “not at all likely” to get vaccinated. In June
2021, the same poll found that 47% of those not vaccinated (n = 91/183) were “not at all likely” to
get vaccinated (Source). Between these polls, both the percentage and the total number of those
who were not at all likely to get vaccinated increased. More recent polls by RISE regarding attitudes
towards vaccination have either not been conducted yet or the results have not yet been released.

According to a statewide survey conducted by Mason-Dixon Polling & Strategy, 87% of
unvaccinated adults in Virginia say they do not plan on getting vaccinated for COVID-19 (Source).
Their reasons for not getting vaccinated included:
 Concerns that the vaccine could cause other health problems (28% of respondents)
 Doubts about the health threat posed by COVID-19 (22%)
 Doubts about vaccines in general
 Feeling that the vaccine is unnecessary for individuals who have already contracted
coronavirus (17%)
 Skepticism about the federal government’s role in vaccine development (13%). (Source)
In order to combat vaccine hesitancy, VDH is working to communicate the benefits of vaccination to
the public. The VDH coronavirus dashboard used to display COVID-19 rates by vaccination status,
showing that the majority of those getting infected and those getting hospitalized have not yet been
vaccinated. On May 19th, the “Cases by Vaccination Status” dashboard was retired (Source).

More recent polling from the Kaiser Family Foundation indicates who remains unvaccinated. The
most recent poll is from July 2022. Of those adults who have not gotten a vaccine:
 58% are individuals between the ages of 18-49
 28% are between the ages of 30-49
 31% have a high school education or less
 31% identify as Republican
 32% have annual incomes less than $40k
 21% reside in suburban areas and 33% reside in rural areas (Source)

Vaccination Mandates
On September 9, 2021, President Biden unveiled an action plan to mandate vaccines for employers
with 100 or more personnel, federal workers, and healthcare providers (Source). In January 2022,
the Biden Administration withdrew its mandate following the Supreme Court’s decision to block it.
On January 15, 2022, the Governor of Virginia issued Executive Director Number Two (2022),
rescinding Executive Directive Number 18 (2021), and with it the vaccine mandate for state
employees (Source). On January 26, 2022, Virginia’s Attorney General issued an advisory opinion
concluding that Virginia colleges and universities did not have the authority to require COVID-19
vaccinations as a condition of enrollment or in-person attendance, superseding a prior opinion
(Source). These actions effectively ended vaccine mandates in Virginia.

On January 20, 2022, the Governor of Virginia announced the COVID-19 Action Plan with three key
activities: (1) COVID-19 Vaccine Marshall Plan for Virginia, (2) Expanded Healthcare Flexibility &
Vaccine Equity Report | September 2022 23
Support, and (3) Prioritized Testing Guidelines (Source). His plan was updated on February 21,
2022 to include Treatment in activity (2) and to replace activity (3) with Charting a Path to
Normalcy. The White House released its March 2022 National COVID-19 Preparedness Plan with
an outline of its four key goals: (1) Protect against and treat COVID-19, (2) Prepare for new
variants, (3) Prevent economic and educational shutdowns, and (4) Continue to lead the effort to
vaccinate the world and save lives (Source). These plans signaled a new phase in the pandemic
response for Virginia and the nation. On July 14th, Governor Youngkin announced updated
guidance on quarantine recommendations for people exposed to COVID-19 in K-12 schools, child
care, and camp settings. The revised guidance states that quarantine is no longer recommended
for asymptomatic individuals who were exposed to COVID-19-infected individuals in these
settings (Source).

6. On the Horizon
COVID-19 cases surged in January, began to fall in February, and continued to decline in March.
Hospitalizations had been steadily increasing since the end of summer 2021 and started to fall at
the end of January after hitting two peaks during the winter. The number of deaths was lower in
March and in February than it was in January 2022. In the spring and summer of 2022, the number
of cases began to increase again. Hospitalizations remain relatively low, although they notably
increased from the second half of May onwards. Risks of reinfection and experiencing more severe
symptoms seem to be higher with the BA.5 variant.

Virginia’s vaccination rates are better than rates in many other states. However, nearly 30% of
Virginia’s population has not been fully vaccinated. Vaccination hesitancy remains of great
concern. Recent reports show that those who were unwilling to be vaccinated in late 2020 were
still unwilling to be vaccinated in the fall of 2021. Vaccinations in children under the age of 18
(including now infants) and frequent testing are essential to keeping children and staff healthy in
schools, daycares, and summer camps. These protocol will be especially critical as Virginia gets
ready to start the 2022-2023 school year. Continued efforts to encourage vaccination, including
booster shots when eligible, and reducing vaccine hesitancy are important factors to ensure
Virginia remains on the path to normalcy. Therapeutics, testing, prevention, outbreak control, and
public health information are also important factors.

Despite much progress, a continued focus on vaccine equity remains critical. Fears of virus spread
and breakthrough infections require the critical need to bolster vaccination efforts across the
Commonwealth and center equity in policy and procedures. Given ongoing issues of inequities
concerning who gets infected, as well as who dies from COVID-19, equity remains an important
factor in controlling COVID-19 and maintaining the path to normalcy. Racial and ethnic disparities,
as well as disparities between urban and rural areas, remain a challenge.

Vaccine Equity Report | September 2022 24
Appendix
Charging Statutes

2022 Appropriation Act Item 291 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, 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 https://budget.lis.virginia.gov/item/2022/2/HB30/Chapter/1/291/

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