Opinion | Who Really Gets the Vaccine

Here’s the good news: You should soon be eligible for a Covid-19 vaccine (if you aren’t already), after President Biden’s recent announcement that every adult in America should be eligible for vaccination by May. Many states are moving even faster.

Which brings us to the less-good news: Being eligible for a vaccine and getting vaccinated are two very different things. While it feels as if the course of America’s vaccine effort is about to turn a corner, vaccinating the nation is a process that will take months, even after everyone is eligible.

To understand how the next phase of the vaccination effort will play out, we can look at the vaccine rollouts in Idaho, Florida and other states to see who has been vaccinated, how quickly and why. They show why we are headed for an America marked by pockets of herd immunity (oases) and swaths of the country with low rates of vaccination (deserts).

It is taking much longer to vaccinate poorer Americans than the wealthy.

Within states and among equally eligible people, the richest areas are getting vaccines faster. This suggests that even if all poorer Americans seek out the vaccines, it will take a long time to vaccinate them at our current rates.

Consider a slice of Florida’s seniors, ages 65 to 74, who have been eligible for vaccination for four months.

Almost all seniors in the state’s wealthiest county, St. Johns, have been vaccinated. (The numbers may be inflated because of seasonal residents, or snowbirds, who aren’t necessarily counted as part of the county’s population but are still counted among people getting vaccinated there.) But the first county west of St. Johns is one of the state’s poorest: Putnam, where the median annual income is about $35,000. Only half of the county’s residents ages 65 to 74 have been vaccinated.

The pattern is echoed throughout Florida, with wealthier counties achieving much higher vaccination rates than lower-income counties.

The reasons are myriad: The state’s rollout has been deeply reliant on tech savviness and reliable transportation to secure and then get to vaccination appointments, said Dr. Frederick Anderson, who runs a community health clinic at Florida International University’s medical school. Additionally, some of the current vaccines are difficult to store and transport, which makes vaccine rollout easier in population hubs, which tend to be wealthier.

While comparable data doesn’t exist in every state, it’s a worrying sign ahead of a national rollout. If vaccination rates resemble Florida’s uptake among seniors in poor neighborhoods, the country will struggle to reach herd immunity.

When eligibility is expanded in other states, vaccinations are expected to surge among the wealthiest Americans and lag among the poorest. At the rates that Florida’s poorer counties are vaccinating people ages 65 to 74, it will take months for the rest of the state’s seniors to catch up with higher-income Floridians.

“These huge disparities will persist, but we’re hoping that they’ll start to go down with these community engagement efforts,” Dr. Anderson said. “These disparities are hundreds of years in the making. We’re not going to reverse them overnight.”

Progress has already stalled in some parts of the country.

Despite the uneven rollout in Florida, people are still seeking out the vaccines at a steady rate. That’s not the case in Idaho, where many parts of the state have settled at distressingly low vaccination rates. State officials have had to expand eligibility at an accelerated pace because of low uptake in wide swaths of Idaho.

“The rural counties are lagging slightly behind what we would expect,” said Dave Jeppesen, the director of Idaho’s health department, in a news conference Wednesday.

Data published by Idaho reveals how the current vaccination efforts are reaching a plateau in poorer parts of the state. The poorest 25 percent of ZIP codes in the state are seeing vaccination rates stalling below 70 percent for people ages 65 to 74.

Nationally, many conservatives — men in particular — have said in multiple polls that they do not wish to be vaccinated. In some of Idaho’s more conservative counties, senior vaccination rates are below 40 percent.

Some states still have a long way to go.

States will be in radically different places when they open vaccinations to all adults, in part because of differences in eligibility requirements thus far, such as whether they prioritized certain groups of essential workers alongside older residents. Their progress points to where vaccine oases and deserts may soon emerge.

Logistical hurdles and missteps could drive slower vaccination campaigns. But states may also be falling behind because of high levels of vaccine hesitancy.

If that’s the case, it will take more than just opening up eligibility to get the country to levels of vaccination that can reach herd immunity — when roughly 70 percent of people are vaccinated, making it too difficult for the virus to spread.

Counterintuitively, the states that are moving fastest to expand eligibility are more likely to have a harder time reaching that level.

In those states, the data shows that vaccine uptake is not reaching herd immunity levels in certain areas. If that trend continues as vaccine eligibility expands, we can expect to see more vaccine deserts and oases over the coming months.