Missing again: US racial and ethnic data for COVID-19 vaccination
Authors: Nancy Krieger, Pamela D Waterman, Jarvis T Chen, Christian Testa, William P Hanage
Journal: The Lancet (2021)

In the USA, Feb 2 is Groundhog Day, when the famous Punxsutawney, PA, groundhog's sighting or absence of sighting of its shadow predicts how long winter will last. The phrase also now evokes thoughts of an endless time loop, following a 1993 comic film, in which an egotistical cynical weather reporter who is assigned to film the groundhog gets stuck in a time glitch, endlessly repeating the day. He escapes only by learning the errors of his ways, redeemed by self-reflection leading to self-improvement and finally authentic love for another person.1White D Groundhog Day 2021: what did Punxsutawney Phil predict and what does it mean?.https://www.thesun.co.uk/news/13913352/groundhog-day-2021-what-punxsutawney-phil-predictDate: Feb 2, 2021Date accessed: February 4, 2021Google Scholar On Feb 2, 2021, readers of the US Centers for Disease Control morbidity and mortality report2Painter EM Ussery EN Patel A et al.Demographic characteristics of persons vaccinated during the first month of the COVID-19 vaccination program—United States, December 14, 2020–January 14, 2021.MMWR Morb Mortal Wkly Rep. 2021; 70: 174-177Crossref PubMed Google Scholar could be forgiven for thinking that we, likewise, had entered a repeating time loop. Among the 12 928 749 people who initiated vaccination against COVID-19 (ie, received at least one dose of vaccine) during the first month of the US vaccine roll-out (Dec 14, 2020, to Jan 14, 2021), data for race and ethnicity were missing for 48·13% (6 222 052) of people, despite the reporting form prominently indicating that data for race and ethnicity are required (appendix). By contrast, data for age were missing for only 0·04% (4633) of people and data for sex were missing for 3·02% (390 908) of people.2Painter EM Ussery EN Patel A et al.Demographic characteristics of persons vaccinated during the first month of the COVID-19 vaccination program—United States, December 14, 2020–January 14, 2021.MMWR Morb Mortal Wkly Rep. 2021; 70: 174-177Crossref PubMed Google Scholar These data are essential to ensure that the vaccine roll-out meets stated standards and maintains equity in vaccine access and vaccine confidence. Similarly, in early April, 2020, US journalists, advocates, and scientists raised alarm at gross gaps in data for race and ethnicity for COVID-19 cases and deaths, impeding the ability to document health inequities and guide interventions.3Krieger N Gonsalves G Bassett MT Hanage W Krumholz HM The fierce urgency of now: closing glaring gaps in US surveillance data on COVID-19.https://www.healthaffairs.org/do/10.1377/hblog20200414.238084/fullDate: April 14, 2020Date accessed: February 4, 2021Google Scholar Although the proportion of records for COVID-19 deaths that are missing racial and ethnic data is now low (<1%), the proportion of records of cases that are missing these data has not decreased: despite reporting mandates, these data were missing for 43·00% (181 484 of 422 057) of COVID-19 cases that were reported between Aug 28 and Sept 16, 2020,4Krieger N Testa C Hanage WP Chen JT US racial and ethnic data for COVID-19 cases: still missing in action.Lancet. 2020; 396: e81Summary Full Text Full Text PDF PubMed Scopus (35) Google Scholar and for 33·00% (4 083 477 of 12 374 172) of COVID-19 cases that were reported between Dec 2, 2020, and Feb 3, 2021. Journalists, advocates, and scientists are again decrying the extensive missing data for race and ethnicity for vaccination records; meanwhile large numbers of affluent white people with good computer access to book appointments are attending vaccination sites that were set up to serve communities of colour that were hard hit by COVID-19.5Pan D Freyer FJ At Roxbury vaccination site meant to expand access, few people of color line up for shots.https://www.bostonglobe.com/2021/02/03/nation/vaccination-site-roxbury-whomDate: Feb 2, 2021Date accessed: February 4, 2021Google Scholar At a time of heightened awareness about racial injustice and white supremacy, it is astonishing that racial and ethnic data for vaccination are missing. The first month of vaccination occurred in the final month of the Trump administration. To get out of this pernicious time loop, self-reflection, learning from past errors, and a commitment to equity are essential. The new Biden–Harris administration should ensure that these required data are reported. We declare no competing interests. Download .pdf (.17 MB) Help with pdf files Supplementary appendix Racism in the USA: ensuring Asian American health equityRacist anti-Asian incidents and rhetoric in the USA have been on the rise during the COVID-19 pandemic, by some accounts increasing as much as 150% . The horrific mass shooting on March 15, 2021, in which six of eight people killed in three spas in Atlanta, Georgia, were Asian women, has prompted urgent conversations about prejudice against Asian Americans. Organisations including the American Medical Association were swift to underscore that racism, in addition to gun violence, is a public health crisis. Full-Text PDF