All Hands On Deck: Closing the COVID-19 Racial and Ethnic Gap in Maryland
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Kesha Moore

TMI Senior Researcher

All Hands on Deck: Closing the COVID-19 Racial and Ethnic Gap in Maryland

April 23, 2021

On March 1, 2021, Governor Larry Hogan announced Maryland’s plan to improve equity in vaccine distribution. This equity plan included a public-private partnership between Maryland’s health department, the University of Maryland Medical System, and Johns Hopkins Medicine to focus on vaccinating the most vulnerable communities in Baltimore.  The state’s Vaccine Equity Task Force (VETF), led by Maryland National Guard Brigadier General Janeen Birckhead, implements the state’s equity plan to expand COVID-19 vaccine access to “underserved, vulnerable, and hard to reach areas.” Through VETF, the state has established vaccine clinics in vulnerable communities and hosted several community outreach events to increase the public’s knowledge of and confidence in the COVID-19 vaccines.

Although the state’s equity efforts have increased the portion of Black and Latinx Marylanders receiving the COVID-19 vaccine, it has not reduced racial disparities in its vaccination rates. As Figure 1 below shows, the racial disparities in vaccinations has increased since the creation of VETF. On March 1, 2021, Black residents had a vaccination rate of 8%, which was eight percentage points below the vaccination rate for White residents of 16%. By April 12, 2021, the gap between the percentage of Black residents who were vaccinated (28%) and White residents who were vaccinated (42%) had grown to 14 percentage points. Likewise, the gap in the vaccination rate between White and Latinx communities doubled between March and April. On March 1, 2021, the Latinx vaccination rate (5%) was 11 percentage points below the rate for Whites (16%). By April 12, 2021, the gap between the vaccination rate for the Latinx population (20%) and the White population (42%) had increased to 22 percentage points.

The VETF identified seven “hard-hit” Maryland zip codes (20785, 20904, 21217, 21224, 21801, 21804, 21853) where the task force is partnering with local community leaders to hold vaccine clinics in order to increase vaccination rates. One of these targeted zip codes is in Prince George’s County, two are in Baltimore City, one is in Montgomery County, two are in the Eastern Shore community of Wicomico County, and one is in the Eastern Shore community of Somerset County.

Although the state’s equity plan promises to deploy resources to communities with high rates of COVID-19 cases, sizable populations of racial and ethnic minority residents, and populations with an annual income below $49,000, it is unclear how VETF selected these seven zip codes to target as “hard-hit” areas. Among the two targeted communities in Baltimore City, zip code 21217 fits the VETF profile with 85% Black residents and a median household income of $29,196. Yet, the other Baltimore City zip code – 21224 — has a Black population of 15% and a household income of $73,750, and is not consistent with the target profile. Moreover, there are three zip codes in Baltimore City with a total COVID-19 case rate larger than zip code 21224 and 11 additional zip codes within the City of Baltimore with a total COVID-19 case rate above that of zip code 21217.

Figure 2 below shows the COVID-19 case and death rate for the jurisdictions containing the zip codes targeted by VETF. Prince George’s County has the highest COVID-19 case rate, accounting for 19% of all COVID-19 cases in Maryland. Prince George’s County, Montgomery County, and Baltimore County have equally high rates of deaths from COVID-19, with each county having 17% of the state total. Baltimore City has slightly lower COVID-19 outcomes, comprising 11% of the COVID-19 cases and 12% of the COVID-19 deaths in the state. The other two counties targeted by VETF, Somerset and Wicomico, account for a small percentage of the state’s COVID-19 cases and deaths.

Although Montgomery County and Baltimore County have vaccination rates at or above their respective COVID-19 case rate, Prince George’s County and Baltimore City have vaccination rates much lower than their rates of COVID-19 cases and deaths. Prince George’s County has 19% of the COVID-19 cases and 17% of the COVID-19 deaths in Maryland but comprises only 12% of its first doses of COVID-19 vaccines. Likewise, Baltimore City has 11% of Maryland’s COVID-19 cases and 12% of its COVID-19 deaths, but only 8% of the state’s COVID-19 first dose vaccinations. Maryland can significantly improve its COVID-19 equity outcomes by increasing vaccination efforts in underrepresented jurisdictions of Prince George’s County and Baltimore City, which are also majority-Black. However, increasing COVID-19 vaccine distribution to these jurisdictions alone will not completely close the state’s racial and ethnic gap in COVID-19 vaccinations.

Even within majority-Black jursisdictions in Maryland, Black and Latinx residents remain underrepresented in COVID-19 vaccinations, and White residents are overrepresented. In Baltimore City, Black people are 1.3 times more likely to die from COVID-19 than White residents. Figure 3 shows the death rate of Baltimore City’s Black residents from the coronavirus (73%), is 31 percentage points above their vaccination rate (42%), while the death rate of Baltimore City’s White residents (23%) is 17 percentage points below their vaccination rate of 40%. Latinx residents in Baltimore City are 1.4 times more likely than White residents to get COVID-19. Still, the Latinx vaccination rate (4%) is six percentage points below their COVID-19 case rates (10%).

Although Montgomery County and Baltimore County have vaccination rates at or above their respective COVID-19 case rate, Prince George’s County and Baltimore City have vaccination rates much lower than their rates of COVID-19 cases and deaths. Prince George’s County has 19% of the COVID-19 cases and 17% of the COVID-19 deaths in Maryland but comprises only 12% of its first doses of COVID-19 vaccines. Likewise, Baltimore City has 11% of Maryland’s COVID-19 cases and 12% of its COVID-19 deaths, but only 8% of the state’s COVID-19 first dose vaccinations. Maryland can significantly improve its COVID-19 equity outcomes by increasing vaccination efforts in underrepresented jurisdictions of Prince George’s County and Baltimore City, which are also majority-Black. However, increasing COVID-19 vaccine distribution to these jurisdictions alone will not completely close the state’s racial and ethnic gap in COVID-19 vaccinations.

Even within majority-Black jursisdictions in Maryland, Black and Latinx residents remain underrepresented in COVID-19 vaccinations, and White residents are overrepresented. In Baltimore City, Black people are 1.3 times more likely to die from COVID-19 than White residents. Figure 3 shows the death rate of Baltimore City’s Black residents from the coronavirus (73%), is 31 percentage points above their vaccination rate (42%), while the death rate of Baltimore City’s White residents (23%) is 17 percentage points below their vaccination rate of 40%. Latinx residents in Baltimore City are 1.4 times more likely than White residents to get COVID-19. Still, the Latinx vaccination rate (4%) is six percentage points below their COVID-19 case rates (10%).

Based on data from Prince George’s County (as of April 19, 2021, see Current Status tab), Black residents in Prince George’s County are 10% more likely to die from COVID-19 than are the county’s White residents. Yet, the vaccination rate for Black residents (57%) is seven percentage points below their COVID-19 death rate (64%), while the vaccination rate of White people (16%) is four percentage points above their COVID-19 death rate (12%). Latinx residents of Prince George’s County are 2.8 times more likely to get COVID-19 than White residents. Yet, the Latinx vaccination rate (9%) is 15 percentage points below their COVID-19 case rate (24%), and White residents have a COVID-19 vaccination rate (16%) that is 11 percentage points higher than their COVID-19 case rate 5%).

VETF has thus far been decidedly unsuccessful in achieving its goal of decreasing racial and ethnic disparities in COVID-19 vaccinations across the state and targeted counties. These disparities cannot be explained by vaccine hesitancy in the Black community. In a survey of Black residents in Baltimore City, 74% of the residents surveyed stated that they want to get the vaccine when available. Yet, 58% of the Black residents reported they did not know where to get vaccinated, and 46% stated that they did not believe the COVID-19 vaccines were fairly distributed.   

Also, we cannot attribute the racial disparities in vaccinations in Maryland to the priority age populations. Given that Black and Latinx communities are not equally distributed among all priority groups, states can equally vaccinate racial groups within the priority populations and still have racial disparities in vaccinations overall due to disproportionate representation within priority groups. Black people have a lower life expectancy and thus are underrepresented among Maryland’s prioritized elderly group (75 years old and up). However, this is counterbalanced by Black people’s overrepresentation in the state’s prioritized group of healthcare workers. Thus, the underrepresentation of Black and Latinx residents in Maryland’s COVID-19 vaccinations most likely results from other factors, not group-level differences in priority categories or the desirability of the vaccines. The other factors that most likely explain these disparities are the state’s practice of not prioritizing the most impacted zip codes for vaccination distribution, which are disproportionately majority Black and Latinx areas. When there is vaccine scarcity, it is also necessary to address vaccine tourism of wealthier White populations in efforts to ensure effective targeting to highly impacted communities.

The Rockefeller Foundation has partnered with Open Society Institute-Baltimore (OSI-Baltimore) in its Equity-First Vaccination Initiative pilot launch. The Baltimore Equitable Vaccination Initiative is designed to provide “medically sound, culturally competent information about vaccine safety and improve distribution and delivery mechanisms to reach disconnected Baltimoreans through pop-up vaccination sites and mobile clinics across the city.” Given the racial disparities in COVID-19 vaccinations that remain in Baltimore City, across the state of Maryland, and across the United States, we need an “all hands on deck” approach to achieving this public health priority.

#FairShot: Tracking COVID-19 Vaccination Equity

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