Native vaccination rates are higher than white rates in 28 states, including New Mexico, Arizona and Alaska, where many receive care from tribal health centers and the Indian Health Service. In states such as South Carolina and Tennessee, where IHS access is more limited and Native residents are more likely to live in urban areas, vaccination rates are far lower than for white residents.
Groups in those areas reported problems finding health care providers to administer shots. Tribal organizations compiled lists of retired nurses to tap for clinics. At one point, staffers from an Oklahoma City clinic for Native Americans offered to fly to Washington, D.C., to help vaccinate Indigenous people living around the nation's capital, Raimondi said.
"It became an issue of, 'Well, we could get you the vaccine, but we don't know who is going to administer them,'" Raimondi said.
The council and Native American Lifelines, a nonprofit providing health services, partnered with the University of Maryland-Baltimore for a vaccination site exclusively for Native Americans living in Maryland, Virginia and Washington, D.C. It launched in April.
While the vaccination rates for Native Americans surpass those of whites in some states due in part to IHS, that infrastructure does not exist for Black Americans, said Rhonda BeLue, the department chair of health management policy at Saint Louis University.
At the beginning of the pandemic, people were shocked by how much more likely Black Americans were to die from COVID, she said.
"However, the same structural inequities that caused that disproportionate mortality in COVID are the same structural inequities that predated COVID and caused disproportionate burdens of morbidity and mortality," she said. "This isn't new."
Easing fears in Hispanic communities
Some states are reporting higher vaccination rates among Hispanics than white and Black residents, which Bibbins-Domingo said fits with surveys showing high enthusiasm for vaccination among Hispanics. It also indicates that some of the reported barriers may have been addressed more effectively in those states, she said.
Paul Berry, chair of the Virginia Latino Advisory Board, partly attributes Virginia's success to targeted outreach efforts. The state and certain counties also increased Spanish-language resources to boost sign-ups.
Connecting with every community cannot be an afterthought, said Diego Abente, president and CEO of St. Louis' Casa de Salud, a health care provider focused on immigrant communities. Community buy-in, effective social media use and language programming from the start have been essential, he said. Hispanics have a higher vaccination rate than whites in Missouri.
But nationally, a dearth of transportation options, an inability to take off from work to get a vaccine, and concerns about documentation and privacy have dampened uptake among Hispanics, according to experts.
"To me it's more about access to health care," Berry said. "If you don't live close to health care, you're just going to shrug it off immediately. 'I can't get that vaccination. I'm going to miss work.'"
To reduce fear among Idaho agricultural workers that may be part of mixed-immigration status families, public health workers emphasized messaging that documentation wouldn't be required, said Monica Schoch-Spana, a senior scholar at Johns Hopkins Center for Health Security. She has helped lead its CommuniVax project seeking to boost uptake among Black, Hispanic and Indigenous communities.
It's also important to engage trusted institutions to administer vaccines, Schoch-Spana said: "Is it a familiar place, does it feel safe, and is it easy to get to?"
Federal efforts have placed sites in underserved neighborhoods. About 60% of shots at the Federal Emergency Management Agency's vaccination sites and at community health centers were given to people of color, federal health officials said this week.
Incomplete data collection
Race or ethnicity information is still missing for nearly 69 million vaccinated people—or 44%—in the CDC data, despite vows by federal officials to improve outdated systems to better inform their response.
CDC spokesperson Kate Fowlie said their efforts, including sharing strategies for capturing demographic data and reducing data gaps with state and local governments, have resulted in improvements in data collection. Officials are also planning to allow agencies to update previously submitted vaccine records. The true national rates by race or ethnicity group would each be higher with complete data.
Unlike the federal government, North Carolina made it nearly impossible for providers to submit vaccine data without recording race and ethnicity. As a result, it has the most complete demographic data of any state.
Adding that step was not an easy sell — providers and other vaccinators were initially resistant, said Kody Kinsley, chief deputy secretary for health at the North Carolina health department. But it has paid off in the state's ability to target its response to populations getting left behind, he said.
Bibbins-Domingo said the federal government and states need to make collecting this vaccination data by race mandatory, because data drives the response to the pandemic.
"The feds know how to do this. They do it every 10 years for the Census," she said. "That we somehow cannot figure it out in public health data is quite simply unacceptable."
KHN reporter Victoria Knight contributed to this report.