Data snapshot: Higher income≈higher seasonal Covid vaccination rates.
We are back with another Data Snapshot! And just a quick reminder that this work is not free to create. We’re on the NPR model here! The more readers who upgrade, the longer we’ll be able to keep doing this, keeping most of the content free so that we can continue to spread reliable, data-driven information to you and your community. Thank you to those who have already upgraded. I appreciate your support and your partnership! —Jeremy
It seems that the CDC is settling into recommending a once-yearly updated Covid-19 vaccine for the general population, with the option of more frequent doses for immunocompromised people.
These doses are covered by medical insurance, but that does not mean that demand and access are evenly distributed across the socioeconomic spectrum.
In this week’s Inside Medicine Data Snapshot, we’re looking at vaccine status by ZIP Code in California. (We chose California because that’s the state with the best data on this right now). The animation below shows the percent of the population who are up to date on their Covid-19 vaccine (since the new formulation was released to the public in September of 2023) stratified by median household income in each ZIP Code. Each dot represents one ZIP Code. The higher the dot, the greater the percent of vaccinated people in that ZIP Code. The further to the right, the wealthier the ZIP Code.
Clearly there is an impressive correlation between the wealth of a ZIP Code and the percent of the population that has received a new and updated Covid-19 shot this season. When we look under the hood, we found that the strength of that relationship hasn’t changed much since September. In other words, it’s not just that poorer communities had an initially slower rollout of the new vaccine. Rather, the strength of the correlation has been pretty steady since the rollout began.
There are other factors at play here, and that bears mention. We know that other variables such as median age and the share of race/ethnicity groups in individual ZIP Codes can affect vaccination rates. So, while the CDC recommends a dose of the new booster for just about everyone (sidebar: the CDC no longer calls these doses “boosters”; the guidelines are now more akin to “seasonal” recommendations, like the flu shot), we expect that uptake would be higher among older people, for example. All things equal, that’s a good thing. If we had to choose, we’d prefer older people have the highest vaccination rates. As a result, some of the relationship seen in the visualization above could be an “artifact” due to age differences across the state’s ZIP Codes. It would take more a complicated analysis to tease this out, and I anticipate that controlling for age, for example, would temper at least some of the strength of the relationship you’re seeing in the dramatic images we’ve created and shared above.
Nevertheless, it makes intuitive sense that wealth and vaccine access/receipt are clearly correlated this season. Back in 2021, there were mass vaccination sites for Covid-19 shots, including many that were strategically located to reach communities that are routinely underserved by healthcare infrastructure. Today, those resources are gone. So, the relationship between wealth and percent of the population who are up to date on their Covid-19 vaccine is actually stronger now than it was back in 2020. (We’ll show that another time.)
What about pharmacies? Yes, you can get a dose of the latest vaccine at a pharmacy. But pharmacy access is not equal in all communities. “Pharmacy deserts” are a big problem, leaving at-risk communities with less access. Populations living in pharmacy deserts are precisely the ones who often most need to stay up to date on their vaccines the most. As the late-great Dr. Nancy E. Adler often reminded us, health has more to do with your ZIP Code than your genetic code. Seasonal Covid-19 vaccine uptake appears to be yet another disturbing example of that.
Questions? Comments? Insights? Ideas? I know this community has many of these. Please share them below!
Thank you to Benjy Renton for chasing down and curating this Data Snapshot and creating a great viz for us!
I’ve gone twice to get the Novavax. In my area, Upstate NY, CVS is the only one carrying it. On the CVS website it says you do not need an appointment to get Novavax yet the first time I showed up I had an appointment as I also wanted the flu and RSV vaccine. Unfortunately, they had no doses of Novavax on site. The second time I showed up, the pharmacy tech told me I had to make an appointment. I told her that the CVS site, and the sign on the door stated that was incorrect. She reiterated that without an appointment I couldn’t get the vaccine. So, I left without the vaccine. The next closest CVS in my area is 35 minutes away. I’m still am planning on getting it, it is just so frustrating that something that should be so easy is not.
Since the CDC “recommended” schedule is really a “commandment” for non-quack” MDs what does severely ” immunocompromised ” effectively mean in practice? It seems unlikely to be interpreted as applying to us seniors who comprise the overwhelming numbers of severely ill and dying from the disease. Why the hell not!! Why are those who are at almost as much - or maybe even as much as - at risk not singled out explicitly for extra doses!! Personally I believe it is a decision based on PR considerations - commonly referred to as “messaging” - which are believed by the CDC to be most likely to persuade more people to get the vaccine. And, perhaps, a lesser secondary fear of being chastised for picking an “arbitrary “ cutoff age defining “seniors”. Callous, cowardly and medically/scientifically unsubstantiated. Will you and others - who I believe know better- please call them out on this. There are millions upon millions more older people than “immunocompromised”. We are being ignored. All 30+ million of us.