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

Summary

The Vaccine Equity Report for March 2023, 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). It compares Virginia's vaccination progress with Delaware, the District of Columbia, Maryland, Pennsylvania and West Virginia in Region 3 of the Federal Emergency Management Agency (FEMA). The key findings state that 73.7% of Virginia's population, or 6,334,168 people, was fully vaccinated at the end of February 2023, and that 43 individuals younger than 20 had died from COVID-19 in Virginia as of February 21st, 2023. They also cite an AARP Nursing Home COVID-19 Dashboard report that nursing home deaths nationwide spiked by 23% from late December to mid-January.

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Full text

Virginia
Department
of Health
Plan for
Equitable
Distribution
of COVID-19
Vaccine –
March,
2023
March 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…………………………………….……………………………………………………5
Vaccinations for 65+…………………………………….…………………………………………………………….…….5
Vaccinations for Under 45…………………………………….………………………………………………………….5
Race and Ethnicity…………………………………….…………………………………………………………….……….6
Rural Areas…………………………………….…………………………………………………………….………………….8
Infections and Deaths Since Vaccine Availability…………………………………….……..……………...11
3. Vaccinations in FEMA Region 3………………………………………………………………………………………14
FEMA Region 3 and Race/Ethnicity………………………………………………………………………………..15
4. Trends Over Time…………………………………………………………………………………………………………..18
Racial Groups as a Share of Total Vaccinations in Virginia……………………………………………..19
Doses Administered……………………………………………………………………………………………………….19
5. Vaccine Hesitancy…………………………………………………………………………………………………………..20
Vaccination Mandates…………………………………………………………………………………………………….21
6. On the Horizon……………………………………………………………………………………………………………….22

Vaccine Equity Report | March 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 March 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 Variants
 In early December 2022, 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 were concerned about a
deadly COVID-19 surge in China that could lead to new subvariants (Source; Source).
 According to a new report by AARP’s Nursing Home COVID-19 Dashboard, nursing home
deaths nationwide spiked by 23% from late December to mid-January. Virginia AARP Director
Jim Dau said that number increased by 160% across the Commonwealth (Source).

Trends in Average Daily Cases
 As of February 21st, 2023, the highest average number of daily cases in Virginia for the month
was 25.44 cases per 100,000 people on February 15th(Source).

Vaccination Rates
 At the end of February 2023, 73.7% of Virginia’s population was fully vaccinated, or 6,334,168
people (Source).

Impacts on Children
 As of February 21st, 2023, 43 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; Source).
 On July 14th, 2022, Governor Youngkin announced updated guidance on quarantine
recommendations for people exposed to COVID-19. The revised guidance states that
quarantine is no longer recommended for asymptomatic individuals who were exposed to
COVID-19-infected individuals in K-12 schools, child care, and camp settings (Source).
 This winter, students faced more than one wave of flu-like symptoms, causing many absences
in schools across the Commonwealth (Source; Source).

Vaccine Equity Report | March 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 February include:

 February 1: COVID-19 emergency relief will end this May, but Virginia organizations say
they are still working hard to meet the needs of struggling families. “In 2019, we were
seeing about 40 family visits per month. In 2021 and '22, we were seeing between 400 and
600 family visits per month," said William Brown, food pantry manager at Royster
Presbyterian Church in Norfolk. Staff with the Foodbank of Southeastern Virginia and the
Eastern Shore are urging Virginia’s Senate Finance Committee to support a proposal that
will allow $5 million to help local food banks and pantries keep food on the shelves
(Source).
 February 2: The Richmond and Henrico health districts will offer community COVID-19
testing on February 2nd at Southside Women, Infants and Children Office from 11 a.m. to 1
p.m. and at Fulton Neighborhood Resource Center from 3:30 to 5:30 p.m. Residents can
call the Richmond and Henrico COVID-19 Hotline at (804) 205-3501 from 8 a.m. to 5 p.m.
on Monday through Friday for more information on testing sites, or can go online at
vax.rchd.com. The Richmond and Henrico health districts said they will also offer free flu
and COVID-19 vaccine and booster shots on February 2nd, 7th, and 9th (Source).
 February 3: The Fairfax County Health Department announced that it will host a ceremony
on February 4th to honor its numerous partners in the local pandemic response, from
hospital workers and nonprofit volunteers to residences and businesses that supported
public awareness campaigns (Source).
 February 3: Between January 24th and 31st, Wise County reported 57 new COVID-19 cases.
Total deaths for the county during the pandemic are at 227 (Source).
 February 6: The Virginia Dental Association recently analyzed data from the National
Survey of Children’s Health and found that decayed teeth and cavities are up an estimated
44% among Virginia kids. Approximately 130,237 Virginia children experienced decayed
teeth or cavities from 2018-2019. However, that number jumped to 187,762 from 2020-
2021. Leaders say the dramatic spike is the result of delayed dental care during the early
part of the pandemic (Source).
 February 7: Dr. Cynthia Morrow, leader of the Roanoke City Allegheny Health Districts,
reported that the health district’s number of COVID-19 positive cases are relatively stable.
Dr. Morrow said hospitalizations did rise recently, and she continues to encourage
vaccination. “People who are not vaccinated are almost 13 times the risk of
hospitalizations compared to those who are fully up to date on their vaccines,” Dr. Morrow
said. “So just a gentle reminder COVID is still with us.” (Source)
 February 8: Virginia will suspend its COVID-19 Supplemental Nutrition Assistance
Program (SNAP) COVID-19 emergency allotments on February 16th. The decrease in
benefits comes after Congress passed the Consolidated Appropriations Act, which ended
the additional allotments. Community organizers say this will impact food security for
thousands. Enrollment increased from 330,000 state participants when the program
launched in March 2020, to 470,000 current participants, according to the U.S. Department
of Agriculture (Source).

Vaccine Equity Report | March 2023 3
 February 9: The Richmond and Henrico County health districts are offering COVID-19
testing on February 9th at the Southside Women, Infants and Children Office and at the
Fulton Neighborhood Resource Center. Free vaccines for COVID-19 and flu will be offered
on February 9th, 14th, and 15th at three different locations (Source).
 February 11: According to this week’s CDC update, masking is recommended for only four
of Virginia’s localities: Norton, Prince Edward, Scott, and Wise. The remainder of the
Commonwealth ranked as medium and low COVID-19 risk levels (Source).
 February 15: CrossOver Healthcare Ministry recently began offering a saliva-based COVID-
19 test at its Henrico and Richmond locations to clients who are low-income, uninsured,
and medically underserved. The nonprofit charitable healthcare clinic is the first
organization to offer the test in Virginia (Source).
 February 16: The Richmond and Henrico County health districts will offer COVID-19
testing on February 16th from 11 a.m. to 1 p.m. at Southside Women, Infants and Children
Office and from 3:30 to 5:30 p.m. at Fulton Neighborhood Resource Center. Free vaccine
clinics will occur on February 16th, 22nd, and 23rd (Source).
 February 20: New COVID-19 cases were down by 12% last week in Virginia and the 7-day
positivity average was 12.5% on February 14th (down from 14.6% the week prior)
(Source).

Vaccine Equity Report | March 2023 4
1. Vaccination Equity in Virginia

At the end of February, over 18 million COVID-19 vaccine doses have been administered in Virginia
(Source). With 73.7% 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, 73.7%, is higher than the 69.2% national total fully vaccinated rate
(Source; Source). On average, Virginia is administering approximately 1,841 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 February, 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, 61.4% of those aged 5-17 years have been vaccinated with at least
one dose, up by 0.1% from last month. 87.4% of individuals older than 5, up by 0.1%, 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, no change from last month. Data are also reported by each
age group for percentages of the population vaccinated with at least one dose: 14.5% of 0-4 year
olds (up from 14.1% last month), 47.4% of 5-11 year olds (up from 47.3%), 76.5% of 12-15 year
Vaccine Equity Report | March 2023 5
olds (up from 76.4%), 78.7% of 16-17 year olds (up from 78.6%), 79.3% of 18-24 year olds (no
change), 79.8% of 25-34 year olds (up from 79.7%), and 85.0% 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 | March 2023 6
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 56.3%
Source

According to Figure 2 and Table 1, as of February 15th, 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 66.0% of Blacks have been
vaccinated with at least one dose.
 Second, Latinos have received 10.8% of all vaccinations and 84.5% of Latinos have been
vaccinated with at least one dose.
 Third, Asians or Pacific Islanders have received 9.5% of all vaccinations and 93.4% of Asians
or Pacific Islanders have been vaccinated with at least one dose.
 Fourth, Whites have received 56.3% 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 begun to decline since January 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,
Vaccine Equity Report | March 2023 7
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. It will be
crucial to pay attention to these disparities as the year continues.

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. Vaccination percentages are higher 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 low
and medium risk levels. Fortunately, risk levels this month remain relatively low. Risk levels have
also improved this month in comparison to previous months this winter when a significant portion
of the Commonwealth was experiencing highly elevated risk levels (Source). As the winter
continues, increasing vaccination rates will be crucial to maintaining lower risk levels.
Vaccine Equity Report | March 2023 8
Figure 5: Vaccinations by Locality – Percent of Total Population – As of February 16th, 2022

Source

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

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 central and southern Virginia, as shown in Figure 8.

Vaccine Equity Report | March 2023 9
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 | March 2023 10
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 Virginia’s
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. Since Blacks represent only 19% of Virginia’s total population but 23% of cases
and Hispanics represent only 10% of the total population but 14% of cases, both Blacks and
Hispanics still disproportionately contract COVID-19. As for COVID-19 deaths, Blacks represent
19% of the total population but 23% of deaths and Whites make up 61% of the population but 67%
of deaths, meaning Blacks and Whites disproportionately die from COVID-19.

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, the bulk of cases are occurring between the ages of 20
and 69. 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 | March 2023 11
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 | March 2023 12
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 | March 2023 13
2. Vaccinations in FEMA Region 3

Regarding COVID-19 risk levels in February (Figure 11), almost all of Region 3 is experiencing low
or medium risk levels. At present, West Virginia is the most at-risk in FEMA Region 3 when it comes
to the number of new cases, with 105.8 new weekly cases per 100,000. Virginia has 83.4 weekly
new cases per 100,000, placing Virginia fourth out of sixth in FEMA Region 3 in terms of new
weekly COVID-19 cases per 100,000. In terms of infection rate, Delaware has the highest infection
rate (1.16) in FEMA Region 3. Virginia’s infection rate is 0.92, placing it in 5th place out of six in the
region. Virginia also has one of the lowest weekly COVID-19 hospital admissions per 100,000 in the
region, at 7.5 per 100,000 (Source).

Figure 11: COVID-19 Risk Levels in February 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 part of the state.

Vaccine Equity Report | March 2023 14
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 | March 2023 15
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 | March 2023 16
Source

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

Source

Vaccine Equity Report | March 2023 17
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 | March 2023 18
mobile clinic model 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 worst
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 56.3% 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
As of February 17th, 2023, the peak average number of vaccines administered in Virginia in
February occurred on February 1st, with 2,140 doses administered on that day (Source). These
trends in Virginia generally match that of the United States as a whole, which saw an increase in
demand for vaccines during Winter 2021-2022 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 in late 2022 (Source; Source). Statewide
and nationally, the daily number of vaccines administered gradually decreased over the month of
November 2022, started to slightly increase again in December, and then fell again in January 2023
(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 | March 2023 19
4. Vaccine Hesitancy
With a little over 18 million vaccination doses administered, and 6.3 million people (73.7% of the
population) fully vaccinated, Virginia’s vaccination rates surpass the national rate of 69.2%
(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 since regulations
and emergency funding surrounding COVID-19 are lifting in May (Source).

Looking at nationwide trends from Kaiser Family Foundation polling, there has been some change
over time between December 2020 and now 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).

A recent poll from the Kaiser Family Foundation indicates who is more likely to have received the
updated bivalent booster. The most recent poll is from January 2023. Democrats, seniors over the
age of 65, and adults who are immunocompromised are most likely to have already received their
COVID-19 booster dose. The slight uptake in the bivalent booster may be explained by people’s
fears of the “tripledemic” this winter. Data on bivalent booster uptake are available by age, political
party, and immunocompromised status:

(Source)

Vaccine Equity Report | March 2023 20
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).

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. In January of 2023,
President Biden announced to Congress that he will end the twin national emergencies for
addressing COVID-19 on May 11th, 2023 (Source).

Vaccine Equity Report | March 2023 21
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
children and adults, Governor Youngkin emphasized his stance that Virginia will not mandate the
COVID-19 vaccine (Source).

5. On the Horizon
Since President Biden has declared that the national COVID-19 emergency will end in May,
returning to normalcy in Virginia will require paying closer attention to the remaining economic
and health disparities caused by COVID-19. Many Virginia families are still grappling with the
effects of the pandemic and struggling to return to normalcy and financial stability. Targeting
these disparities will be crucial to returning Virginia to normalcy.

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 in keeping case counts and
hospitalizations down. Unprecedented and elevated levels of influenza and RSV this fall and winter
put 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 | March 2023 22
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/

Vaccine Equity Report | March 2023 23

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