Structural Racism in COVID-19 Vaccine Distribution: The Geodemography of Phase One Dose Shipments in Pennsylvania

Background: Racial disparities in COVID-19 vaccination rates in the U.S. are commonly explained by reference to survey research concerning vaccine hesitancy. We test whether these disparities might be understood by studying geographic patterns of vaccine distribution.Methods: For this observational study, we gathered the shipment addresses of 6,365,810 COVID-19 vaccine doses delivered during Phase One of Pennsylvania’s vaccine distribution program. Using the U.S. Census Bureau’s 2015-2019 American Community Survey, we associated each shipment with neighborhood-level racial and ethnic demographics for all 3,218 Pennsylvania census tracts. We used logistic and linear regressions to estimate the relationship between racial demographics and vaccine dose allocations.Findings: White people were 25% more likely than Black people to live in neighborhoods that received vaccine. For neighborhoods receiving vaccine, public-private partnerships between vaccine manufacturers and pharmacy chains shipped greater quantities in proportion to the number of White residents. In contrast, the Pennsylvania Department of Health tended to ship fewer doses to neighborhoods with more White residents.Interpretation: During the first 17 weeks in which COVID-19 vaccines were administered in Pennsylvania, White people were more likely to live in areas where doses were available. Further research and new policies should be developed to increase equity in future rollouts of vaccine for novel viruses and variants..Funding Information: This research was funded by grants from The Rockefeller Foundation and The Commonwealth Fund.Declaration of Interests: All authors declare no competing interest.