Shelby County and counties across the nation are charged with making sure the COVID-19 vaccine is distributed equitably. Early numbers suggest the process is flawed, or at best, the basic reporting system needs work.

Nearly a month after immunizations started in Tennessee, only 3.8% of the shots (9,349 doses) statewide have been given to Black people while 37.2% of the doses (91,641) have been given to white people. More than 17% of the state’s population is Black.

But the largest amount so far, more than 44.75% of doses (110,219), has gone to people whose race is unknown.

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For reporting purposes, including equity, experts say the ratio and the missing data are equally problematic. 

“If the people who are disproportionately affected aren’t able to or willing to be vaccinated, then we will continue to see a rising number of cases in that demographic. It’s extremely concerning,” says Dr. LaTonya Washington, an African-American physician in Memphis and president of the Bluff City Medical Society.

The reasons African Americans are receiving the vaccine in low number involves a number of issues, she says, including an earned distrust of medical science due to a history of unethical experimentation. But there are also social factors at play, including that much of the signup so far as been online. 

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In Shelby County, the numbers look better along the Black/white divide, but troubling among people of Hispanic backgrounds.

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Through Jan. 7, 1.6% (142 doses) of the vaccine had been given to people who reported being Hispanic, according to Shelby County Health Department data. White people had received 51.9% of the vaccine (5,417 doses); Black people had received 24.4% (2,548 doses).

Black people in Shelby County represent 52% of the population; Hispanics, widely believed to be undercounted, are thought to represent 6%-10% of the county’s residents. White people represent about 40%.

Some of the blame falls on early missteps in getting the vaccine out. In Shelby County, the first appointments for eligible members of the public were made through an online portal, which assumes internet access.

While the Health Department did have a way to make appointments by phone, it was listed in Health Department releases that went to media as beginning Monday morning, more than two days after the online portal was active.

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Going forward, the local Health Department has said it will reserve about half of its appointments for call-in respondents and will soon host clinics in sites across the city, including in South Memphis and Whitehaven.

But outside the people it is vaccinating in nursing homes, the Shelby County Health Department has been vaccinating people 75 and older in drive-thru sites.

“If the people who are disproportionately affected aren’t able to or willing to be vaccinated, then we will continue to see a rising number of cases in that demographic. It’s extremely concerning.”

Dr. LaTonya Washington
Bluff City Medical Society

That alone, Washington says, means “persons without automobiles are unable to access vaccines.”

The Tennessee Department of Health did not respond to numerous requests for interviews Wednesday, Jan. 13, on the data, including why it has no racial data for nearly 45% of vaccine recipients.

Joan Carr, spokeswoman for the local health department, says people are asked to report their race in the paperwork they fill out before they get their shots.

If it is left blank, data entry people in Nashville likely categorize it as other or unknown, she said.

People cannot be forced to disclose their race for a vaccine, and many African Americans choose not to check the race box in general, says Charisse Madlock-Brown, assistant professor in Health Informatics and Information Management at the University of Tennessee Health Science Center in Memphis.

“But with that much missing information (44%), it’s hard to draw conclusions on the different rates of vaccination,” Madlock-Brown said.

It matters because communities with low vaccination rates will continue to have high transmission rates, she says.

“There still are a lot of access issues, specifically to minority communities,” she said.

Since May, Madlock-Brown has been working with the National COVID Cohort Collaborative, a project of the National Institutes of Health, to collect data on some 2.6 million U.S. residents who have been tested for COVID-19 to see what else the data say about their lives, including how access to health care, transportation, even the air quality in their region may affect their vulnerability to the virus.

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The work has shown her how much COVID data is missing, including that 22% of COVID deaths reported by the Centers for Disease Control do not include the race of the decedent.

“Data quality is a big issue. If it is not a high enough quality, you can’t draw conclusions from it,” Madlock-Brown said.

If race is not being collected systematically at all testing centers, it will be a problem for COVID researchers for years to come, she says.

Dr. Stephen Threlkeld, director of infectious disease at Baptist Memorial Hospital-Memphis, says every shred of data about COVID is critical.

“Anything we don’t know yet about who is getting the vaccine, how they are responding, what happened — all that is potentially important. And we don’t know yet what is important and what’s not going to be important,” he said.

“It surprises me if we don’t have more data on who’s gotten the vaccine, including race.”

Baptist-Memphis captures the race of all employees getting the vaccine by cross-referencing the shot paperwork with data in the employee’s file.

Methodist Le Bonheur Healthcare did not immediately respond to the question about how or whether it captures race for employees getting the vaccine.

When Baptist was developing the campaign to get word out about monoclonal antibodies, an advance treatment for people who likely would develop severe COVID disease, Threlkeld said it worked assiduously with partner clinics to make sure information is distributed with regard for the people who need to receive it. 

“We need to make sure these therapies and these vaccines are given to people who need it,” Threlkeld said, “and that needs to be according to age; it needs to be according to underlying medical problems; it needs to be according to health care workers; and we don’t need to have any divide in who gets access to these vaccines based on any other factors than that.

“If that’s happening, that’s an important thing to fix as quickly as we can. … And if we don’t know whether it’s happening or not, that is its own problem, and we certainly need to remedy it.”

The story is similar in other states. In Mississippi, as of Jan. 12, 64% of vaccinations had gone to white people and 16% to Black people, according to the Mississippi Department of Health website.

Washington’s mother lives in Mississippi. The state does not have county residency requirements for getting a vaccine. Tennessee does.

“My mother has to go three hours away to get her vaccine next week because there is no availability in her county,” Washington said. “I have heard similar things from people living in other states like Pennsylvania.”

In Pennsylvania, more than 119,000 white people had received one dose by Jan. 8, compared to about 3,947 Black people, according to its Health Department site. The second-largest category behind whites were those of unknown race, some 57,701 people.