Virginia Department of Health Plan for Equitable Distribution of COVID-19 Vaccine (January 2023)

Summary

The January 2023 Vaccine Equity Report, titled Virginia Department of Health Plan for Equitable Distribution of COVID-19 Vaccine, from the Office of Health Equity in the Virginia Department of Health (VDH). This monthly report gives an overview of vaccination equity in the Commonwealth of Virginia and compares Virginia with Delaware, the District of Columbia, Maryland, Pennsylvania and West Virginia in the Federal Emergency Management Agency (FEMA) region. Its key findings state that 73.6% of Virginia's population, or 6,319,894 people, was fully vaccinated at the end of December 2022, and that the highest average number of daily cases for the month was 23.03 cases per 100,000 people on December 21st. It includes sections on vaccine hesitancy and vaccination mandates.

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Full text

Virginia
Department
of Health
Plan for
Equitable
Distribution
of COVID-19
Vaccine –
January,
2023
January 2023

Office of Health Equity in the Virginia
Department of Health
Contents

Executive Summary………………………………………………….……………………………………………………………2
1. Key Equity Announcements and Critical Updates…………………………………….………………………3
2. Vaccination Equity in Virginia…………………………………….……………………………………………………6
Vaccinations for 65+…………………………………….…………………………………………………………….…….6
Vaccinations for Under 45…………………………………….………………………………………………………….6
Race and Ethnicity…………………………………….…………………………………………………………….……….7
Rural Areas…………………………………….…………………………………………………………….………………….9
Infections and Deaths Since Vaccine Availability…………………………………….……..……………...12
3. Vaccinations in FEMA Region 3………………………………………………………………………………………15
FEMA Region 3 and Race/Ethnicity………………………………………………………………………………..16
4. Trends Over Time…………………………………………………………………………………………………………..19
Racial Groups as a Share of Total Vaccinations in Virginia……………………………………………..20
Doses Administered……………………………………………………………………………………………………….20
5. Vaccine Hesitancy…………………………………………………………………………………………………………..21
Vaccination Mandates…………………………………………………………………………………………………….22
6. On the Horizon……………………………………………………………………………………………………………….23

Vaccine Equity Report | January 2023 1
Executive Summary

This monthly report is from the Office of Health Equity in the Virginia Department of Health (VDH).
It provides an overview of vaccination equity in the Commonwealth of Virginia, including key
equity accomplishments, for January 2023.

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
 At the end of July and August, the BA.5 variant was responsible for over half of all cases in
Virginia, according to CDC estimates (Source; Source).
 In early December, the BQ.1 and BQ.1.1 Omicron variants were responsible for nearly 70% of
new COVID-19 cases in the U.S. and public health experts are concerned about a deadly COVID-
19 surge in China that could lead to new subvariants (Source; Source).

Trends in Average Daily Cases
 As of December 21st, 2022, the highest average number of daily cases in Virginia for the month
was 23.03 cases per 100,000 people on December 21st (Source).

Vaccination Rates
 At the end of December 2022, 73.6% of Virginia’s population was fully vaccinated, or
6,319,894 people (Source).

Impacts on Children
 As of December 22nd, 2022, 105 individuals younger than 20 have died from COVID-19 in
Virginia (Source).
 CDC data shows 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).
 On July 14th, 2022, 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).
 This winter, students are facing a wave of flu-like symptoms, causing many absences in schools
across the Commonwealth (Source; Source).

Vaccine Equity Report | January 2023 2
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 December include:

 December 1: According to a graph from the VDH depicting percent of medical visits for
influenza-like illness, the 2022-2023 flu season peaked weeks earlier than usual in Virginia.
INOVA says the high number of cases are due to the flu, Respiratory Syncytial Virus (RSV),
and COVID-19 (Source).
 December 2: Data from the Virginia Hospital & Healthcare Association (VHHA) shows that
COVID-19 hospitalizations have increased in the last two weeks. Also, over 880 additional
COVID-19 patients were discharged from Virginia hospitals over the past week (Source).
 December 2: The Piedmont Health District (PHD) recently released a survey for its
residents. The survey seeks to answer how residents approach COVID-19, what they do to
protect themselves, and how they handle vaccines. The survey also assesses what people
think about booster shots, COVID-19 testing, wearing masks, and other pandemic-related
issues. Questions include whether residents consider the pandemic to be over (Source).
 December 4: Virginia health officials are saying that vaccine uptake for the latest COVID-19
booster is slower than with previous boosters. To address this, VDH is working with
localities to text and call people 50 and older who are eligible to get the booster but likely
have not (Source).
 December 5: Dr. Brooke Rossheim of VDH indicated that RSV cases have decreased in
Virginia after reaching a peak. Therefore, it is possible that there won’t be a big risk of a
“tripledemic” this winter. COVID-19 and influenza remain causes for concern as cases have
not declined recently (Source).
 December 6: Following the Thanksgiving weekend, the Fairfax Health District experienced
an increase in COVID-19 cases. For most of the fall, cases had plateaued. This is the first time
the weekly average exceeded 200 cases since Sept. 15th. This rise comes along with the
closure of mass vaccine clinics and mobile testing sites (Source).
 December 7: VDH received a multi-million dollar grant to assist nursing homes and long-
term care facilities in Virginia with ongoing COVID-19 response (Source).
 December 9: Tazewell County Public Schools announced that it will switch to virtual
learning for two days due to a “large increase in the amount of confirmed cases of flu, strep
throat, COVID, and general respiratory inflammation” and described how this has impacted
the school population (Source).
 December 10: According to Friday’s report for the University of Virginia’s Biocomplexity
Institute, the Pittsylvania-Danville Health District is in another COVID-19 surge right now.
The report stated that the area is “experiencing sustained rapid growth and exceeds recent
infection points.” Source

Vaccine Equity Report | January 2023 3
 December 12: In just the past seven days, Virginia has averaged 1,577 newly reported cases
of COVID-19 each day. Jerry Tucker with the Chesapeake Health Department said, “We've
been kind of expecting this, and we may see the numbers get a little worse as time goes on."
Hospitals around the Commonwealth are reporting more and more patients showing
symptoms of COVID-19 and are concerned about exceeding capacity as the days go on
(Source).
 December 13: The Military Circle Mall COVID-19 Vaccination Clinic is closing after being
open for nearly two years and administering over 155,000 vaccines. VDH leaders have
decided to close the facility and are reevaluating how to approach COVID-19 in the
community after its closing. Paul Brumund, the chief operations officer of Norfolk and
Virginia Beach Health Districts, said the long-term goal is to vaccinate more vulnerable
communities. He said the department is using limited funding to have pharmacies help
them reach vulnerable areas. “So, we’re working with faith-based organizations, health
departments, and other organizations that want to have a focused effort on vaccinating
populations they work with,” Brumund said (Source).
 December 14: On Wednesday, VDH announced that free bivalent pediatric COVID-19
vaccines are available for children ages six months and older. This decision comes after the
Centers for Disease Control and Prevention (CDC) recommended vaccines for ages six
months and older on Dec. 9th (Source).
 December 15: Amidst several announcements of closings of vaccine clinics and mobile
testing services, VDH announced that it will start shipping free COVID-19 test kits through
USPS starting December 19th. There is a limit of four antigen tests per household. Virginians
can order the tests online or by calling the number provided (Source).
 December 16: Fairfax County Health Department announced that its last vaccination clinic
to be open will close this weekend. The health department had previously announced its
two remaining COVID-19 vaccine clinics will close in December. After the closing, the health
department will provide vaccine appointments for children ages 6 months to 4 years at
district offices. Residents should call the Fairfax County Health Department's call center at
703-324-7404 to make an appointment. Alternatively, families can use www.vaccines.gov to
find other options or talk to their healthcare provider (Source).
 December 17: According to this week’s update from the CDC, masking is recommended for
eight localities in Virginia. Most of Metro Richmond remains in the medium level while most
of Virginia is in the low level (Source).
 December 19: Dr. Colin Greene, Virginia’s State Health Commissioner, wrote an op-ed that
was published in Winchester Star on December 19th. In it, Dr. Greene encourages Virginians
to get their flu vaccines ahead of the holidays. “According to CDC estimates, during the
2019-2020 flu season pre-COVID-19, flu was responsible for 16 million medical visits,
390,000 hospitalizations and 25,000 deaths,” Dr. Greene writes. “Last flu season, with
COVID-19 precautions in place, flu caused just a fraction of that illness.” Experts like Dr.
Greene are attributing the higher-than-normal flu cases this winter to the fewer COVID-19-
related precautions this year (Source).

Vaccine Equity Report | January 2023 4
 December 20: Local pharmacies are feeling the pinch of heightened demand for children’s
pain-relief medication amongst an increase in RSV, COVID-19, and flu cases. Some big
pharmacy chains are limiting the amount of children's medicines shoppers can buy. But
James Mitchell, a registered pharmacist who owns and operates Southeast Community
Pharmacy in Newport News, said that he has been having trouble restocking brand name
and generic varieties of children's Tylenol and Motrin (Source).
 December 21: Fredericksburg-area libraries announced that they will continue to offer free
at-home rapid COVID-19 test kits in partnership with VDH (Source).

Vaccine Equity Report | January 2023 5
1. Vaccination Equity in Virginia

At the end of December, over 18 million COVID-19 vaccine doses have been administered in
Virginia (Source). With 73.6% 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). Virginia’s fully vaccinated rate, 73.6%, is higher than the 68.9% national total fully
vaccinated rate (Source; Source). On average, Virginia is administering approximately 7,816
vaccination doses per day (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 December, 95.2% of those ages 65+ were vaccinated (Source).

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, 61.2% of those aged 5-17 years have been vaccinated with at least
one dose, up by 0.2% from last month. 87.3% of individuals older than 5, up by 0.1% since last
month, have been vaccinated with at least one dose. Furthermore, 92.6% of the population over the
age of 18 have been vaccinated with at least one dose, up by 0.1% from last month. Data are also
reported by each age group for percentages of the population vaccinated with at least one dose:

Vaccine Equity Report | January 2023 6
13.5% of 0-4 year olds (up from 12.8% last month), 47.1% of 5-11 year olds (up from 47.0%),
76.4% of 12-15 year olds (up from 76.3%), 78.5% of 16-17 year olds (no change), 79.2% of 18-24
year olds (up from 79.1%), 79.7% of 25-34 year olds (up from 79.6%), and 84.9% of 35-44 year
olds (no change) (Source).

Race and Ethnicity

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

Source

*This data source does not include population estimates for the Other Race category. No population
estimates are available for out-of-state individuals or those without a reported locality. More
information about population estimates can be found at this link:
http://www.cdc.gov/nchs/nvss/bridged_race.htm

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%.
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.

Vaccine Equity Report | January 2023 7
Table 1: Vaccination Distribution by Race and Ethnicity

Race and ethnicity Percent of people with at least one dose with
reported race and ethnicity
Black 17.4%
Latino 10.8%
Asian or Pacific Islander 9.5%
White 56.4%
Source

According to Figure 2 and Table 1, as of December 20th, 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 65.9% of Blacks have been
vaccinated with at least one dose.
 Second, Latinos have received 10.8% of all vaccinations and 84.3% of Latinos have been
vaccinated with at least one dose.
 Third, Asians or Pacific Islanders have received 9.5% of all vaccinations and 93.3% of Asians
or Pacific Islanders have been vaccinated with at least one dose.
 Fourth, Whites have received 56.4% of all vaccinations and 67.5% of Whites have been
vaccinated with at least one dose (Source).

Figure 3: Cases by Race and Ethnicity

Source
^For more information on how VDH is presenting data on race and ethnicity, visit:
https://www.vdh.virginia.gov/coronavirus/2020/06/16/race-and-ethnicity-reporting-update/

Case counts have risen since last month and 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
Vaccine Equity Report | January 2023 8
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. It will be crucial to
pay attention to these disparities as the holiday season continues, possibly bringing another wave
of COVID-19 cases.

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 2 below) uses a combination of
urban area population and population density to identify counties as urban, rural, or mixed.

Table 2: Percent Population Vaccinated by Urban and Rural Jurisdictions (by Age Groups)

Source

Rural areas, especially in southwest Virginia, continue to have lower vaccination percentages as
compared to other areas of the state. There have been some improvements, primarily concentrated
in the northern, central, and southeastern regions (Figure 5). Vaccination hesitancy continues to be
an issue throughout the Commonwealth. As seen in Figure 6, counties across Virginia are
experiencing a combination of risk levels. Fortunately, risk levels this month remain relatively low.
Risk levels have also improved this month in comparison to August when almost the entire

Vaccine Equity Report | January 2023 9
Commonwealth was experiencing highly elevated risk levels (Source). As the winter and holiday
season continues, increasing vaccination rates will be crucial to maintaining lower risk levels.

Figure 5: Vaccinations by Locality – Percent of Total Population – As of December 20th, 2022

Source

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

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. Some rural counties continue to show slightly higher rates
of cases throughout the Commonwealth. Southwest Virginia particularly has a higher case rate than
the rest of the state. Death rates per 100,000 remain relatively low in Virginia, with more deaths
occurring in southern Virginia, as shown in Figure 8.

Vaccine Equity Report | January 2023 10
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 | January 2023 11
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. Disparities detailed in
previous vaccine equity reports remain. As shown in Table 3, 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 3: 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

Figures 9 and 10 show patterns concerning cases and deaths by age, race and ethnicity, and sex for
the last 13 weeks. Regarding cases and age, those aged between 50-59 and 60-69 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
aged 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 | January 2023 12
Figure 9: Cases of COVID-19 in Virginia: Demographics

Source

^For more information on how VDH is presenting data on race and ethnicity, visit:
https://www.vdh.virginia.gov/coronavirus/2020/06/16/race-and-ethnicity-reporting-update/

Vaccine Equity Report | January 2023 13
Figure 10: Deaths by COVID-19 in Virginia: Demographics

Source

^For more information on how VDH is presenting data on race and ethnicity, visit:
https://www.vdh.virginia.gov/coronavirus/2020/06/16/race-and-ethnicity-reporting-update/

Vaccine Equity Report | January 2023 14
2. Vaccinations in FEMA Region 3

Regarding COVID-19 risk levels in December (Figure 11), most of Region 3 is currently
experiencing low or medium risk levels. At present, Virginia is the most at-risk in FEMA Region 3
when it comes to number of new cases. Virginia has 152.2 weekly new cases per 100,000, placing
Virginia first out of sixth in FEMA Region 3 in terms of new weekly COVID-19 cases per 100,000.
This means that Virginia is currently the most at-risk in the region. In terms of infection rate,
Virginia and West Virginia have the highest rate (1.11) in FEMA Region 3. On the other hand,
Virginia has one of the lowest weekly COVID-19 hospital admissions per 100,000 in the region, at
10.1 per 100,000 (Source).

Figure 11: COVID-19 Risk Levels in December 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 | January 2023 15
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. 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).

Vaccine Equity Report | January 2023 16
Figure 13: Blacks as a Share of COVID-19 Trends, FEMA Region 3

Source

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

Source

Vaccine Equity Report | January 2023 17
Source

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

Source

Vaccine Equity Report | January 2023 18
Figure 16: Whites as a Share of COVID-19 Trends, FEMA Region 3

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.

3. Trends Over Time
Nearly three 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 dispel disparities. In
addition, the 7-day average number of cases increased last winter due to the Omicron variant,
declined significantly during the spring, and started to climb again in late spring and summer. As
part of its efforts to address inequities, VDH has transitioned its community testing centers to a

Vaccine Equity Report | January 2023 19
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 56.4% of the population with reported
race and ethnicity that have been vaccinated with at least one dose. Blacks make up 19% of
Virginia’s total population and 17.4% of the one-dose vaccinated population. 10% of Virginia’s
population is Hispanic and 10.8% of the vaccinated population in Virginia is reported to be Latino.
Asians make up 7% of Virginia’s total population while Asian and Pacific Islanders make up 9.5% of
the vaccinated population in the Commonwealth (Source; Source).

Doses Administered
Between October 2021 and January 2022, Virginia saw a spike in the 7-day average of doses
administered. In general, the number of vaccines administered decreased as the winter 2021-2022
Omicron surge subsided. As of December 21st, 2022 the peak average number of vaccines
administered in Virginia in December occurred on December 13th, with 8,243 doses (Source). These
trends in Virginia generally match that of the United States as a 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 2022 onward, and a slight uptake in
vaccinations again as the BA.5 subvariant began to spread (Source; Source). Statewide and
nationally, the daily number of vaccines administered gradually decreased over the month of
November and started to slightly increase again in December (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

Vaccine Equity Report | January 2023 20
4. Vaccine Hesitancy
With a little over 18 million vaccination doses administered, and around 6.3 million people (73.6%
of the population) fully vaccinated, Virginia’s vaccination rates surpass the national rate of 68.9%
(Source; Source). 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 mounting
concerns about a “tripledemic” this winter and multiple spikes in school absences due to sickness
(Source; Source; Source; 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 a poll from July 2022 (Source). In September of
2022, 53% of parents said they will “definitely not” get their children vaccinated against COVID-19
(Source). In December 2022, nearly half of parents of children under the age of 5 said they will
“definitely not” get the COVID-19 vaccine for their child (Source).

More recent polling from the Kaiser Family Foundation indicates who is more likely to remain
unvaccinated. The most recent poll is from December 2022. Democrats, seniors, college-educated
adults, and those with higher incomes remain most likely to be vaccinated and have received their
COVID-19 booster dose. On the other hand, of those adults who have not gotten a vaccine:
 28% are individuals between the ages of 18-29
 29% are between the ages of 30-49
 31% are without a college degree
 35% identify as Republican
 30% have annual incomes less than $40k
 24% reside in suburban areas and 41% reside in rural areas (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%
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
Virginians’ attitudes towards vaccination have either not been conducted yet or the results have not
yet been released. According to a February 2022 poll by the Wason Center at Christopher Newport
University, over half of Virginia voters support vaccine mandates for first responders, teachers, and
medical providers, while opposing mandates for elementary and middle school students. 56% said
that health data should be used to determine mask requirements (Source).

Vaccine Equity Report | January 2023 21
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. VDH experts regularly communicate with local media to answer questions and offer
information about COVID-19 vaccines in Virginia (for example, here and here). VDH has also started
mobile texting to communicate with older adults who are eligible for the booster but have likely not
received it (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 &
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, 2022, 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). Following a recent vote in October 2022 by a CDC advisory committee to
approve adding COVID-19 vaccines to the recommended schedule of immunizations for both

Vaccine Equity Report | January 2023 22
children and adults, Governor Youngkin emphasized his stance that Virginia will not mandate the
COVID-19 vaccine (Source).

5. On the Horizon
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 and daycares. These protocol will be especially critical since the school year has begun
and as the winter continues. Unprecedented and elevated levels of influenza and RSV this fall and
winter are already putting a strain on hospitals and health care providers, making it more
important to mitigate the spread of COVID-19. Risks of reinfection and experiencing more severe
symptoms seem to be higher with the BA.5 variant. 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 | January 2023 23
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.

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