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How vaccination rate disparities affect employers

Health and Benefits|Wellbeing
COVID 19 Coronavirus

By Jeff Levin-Scherz, MD | June 8, 2021

Although we can be proud of our overall vaccination rate in the U.S., varying rates from community to community concern employers and health authorities.

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About our “The COVID-19 Crisis” series

“The COVID-19 Crisis” series is a weekly update by Dr. Jeff Levin-Scherz covering the latest developments related to the COVID-19 pandemic in the U.S. Explore the entire blog series.

The news in the U.S. remains excellent. Last week we had fewer than 10,000 new COVID-19 cases for the first time in over a year, and we are down to a seven-day average of about 15,000 new cases. Hospitalizations and deaths continue to trend down as well. Despite the good news, the wide variation in vaccination rates from state to state and among different communities continues to be a concern for employers and health authorities.

The seven-day moving average for June 2, 2021, was 14,349.
Daily trends in number of COVID-19 cases in the U.S. reported to the CDC

The seven-day moving average for June 2, 2021, was 14,349.
Source: CDC

Disparities in U.S. vaccination rates

We continue to give vaccines at a rate of 1.2 million a day in the U.S. — almost 300 million doses of COVID-19 vaccine have been administered here. Over 60% of all eligible people age 12 and over have received at least one dose of vaccine; it’s no wonder that we’re seeing such a dramatic drop in cases.

Although we can be proud of our overall vaccination rate in the U.S., there remain stark differences in vaccination rates from state to state and community to community. The top vaccinating states (Vermont, Hawaii and Massachusetts) have given at least one vaccine shot to 67% – 71% of their populations — an impressive feat considering that 15% of the population of the U.S. is under 12. The lowest rates of vaccination are in Alabama, Mississippi and Louisiana, which have given a first vaccine to only 34% – 36% of their populations.

Vermont has vaccinated 71% of its population, Mississippi has vaccinated 34%.
States with highest and lowest vaccination rates

Percentage of population receiving at least one vaccine dose.
Source: The NY Times

Low vaccination rates increase the risk of serious local outbreaks this fall. This is a special challenge for employers returning remote workers to the workplace; the likelihood of needing to send people back to remote work is higher where there are low vaccination rates.

Even states like Massachusetts, among the most vaccinated, have huge disparities in vaccination rates. I’ve correlated data from the state’s Department of Public Health and the U.S. Census for four communities. The wealthy, highly educated, mostly white communities (Newton and Lexington) have startlingly high vaccination rates — Lexington has fully vaccinated essentially all those 16 to 29 years of age. On the other hand, the poorer, less educated majority-minority communities have levels of vaccination much more like the rates of Alabama, Mississippi and Louisiana.

In these four communities, those with higher income and lower poverty levels have a much higher vaccination rate.
Vaccination rates for four communities in Massachusetts

Percentage of residents receiving at least one vaccine dose.
Source: Massachusetts Department of Public Health and U.S. Census.

This vaccination disparity is important to employers, who will see very different levels of risk in different categories of employees and different worksites. Even in states with high vaccination rates there remains good reason for employers to continue to aggressively communicate the importance of vaccination. Some employers can also help decrease risk by offering onsite vaccination.

Global status

The global COVID-19 situation, though, is not nearly so encouraging. Cases in India and most of Europe are declining, but the situation in much of South America remains alarming. In Uruguay, over a 10-day period, one in a hundred people are being newly infected. (The infection rate is 104 cases per 100,000 per day.) An increase in reported cases in sub-Saharan Africa is especially worrisome as there is much less medical infrastructure. The urgency of ramping up vaccination programs globally can’t be overstated. New variants spread from places with uncontrolled waves of COVID-19, so high rates of infection are a human tragedy as well as a threat to global public health.

Reports of myocarditis in young men after second mRNA vaccine

Reports from Israel suggest that inflammation of the heart (myocarditis) is appearing more commonly than expected in men ages 16 to 24 shortly after their second dose of the Pfizer vaccine. Symptoms include chest pain and shortness of breath, although it appears that the inflammation is mild and those who have it recover quickly and fully. There are reported cases in the U.S. as well. Physicians should be aware of this so they can do appropriate diagnostic tests and advice.

Should this make young men (and their parents) hesitant about getting the COVID-19 vaccination? Probably not at this point. There is a much higher risk of heart inflammation from COVID-19 infections, and the risk of COVID-19 remains high in many places. This likely vaccine side effect is transient and does not appear to cause long-lasting harm. Antibody production is high in adolescents and young adults.

In coming months we’ll see if there is less myocarditis in countries that are delaying second doses. It’s reassuring that the surveillance system is finding these relatively rare side effects. When we get the rate of COVID-19 infection close to zero, it will still benefit public health to have high vaccination rates, although the benefit to individuals will be smaller.

As we progress with caution and celebrate declining rates of COVID-19 overall, employers should remain aware of the wide variation in vaccination rates from state to state and among different communities.


Population Health Leader, Health and Benefits, North America

Jeff is a practicing physician and has led WTW’s clinical response to COVID-19. He has served in leadership roles in provider organizations and a health plan, and is an Assistant Professor at Harvard Chan School of Public Health.

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