One-quarter of the global population has received at least one dose of a COVID-19 vaccine, including more than 188 million people in the United States as of July 25. But the average number of people getting a first or single dose has plummeted more than 50 percent since April, according to the Centers for Disease Control and Prevention (CDC). As of mid-July, 60 percent of eligible U.S. adults are fully vaccinated, and 69 percent are partially vaccinated with at least one dose of a COVID vaccine.
Meanwhile, the Delta variant—a highly infectious coronavirus strain that originated in India—has been detected in all 50 states. Also called B.1.617.2, Delta is at least twice as infectious as initial COVID strains. Some evidence also suggests Delta is more dangerous. The Delta variant is so infectious that the U.S. will need to vaccinate a higher percentage of people in order to achieve herd immunity, according to former CDC director, Tom Frieden, MD, MPH.
At greatest risk: unvaccinated people.
Complicating matters, pockets of unvaccinated people across the United States and around world are providing opportunities for the virus to continue mutating, possibly rendering existing vaccines less effective against it.
So, who are the roughly 30 percent of eligible Americans who have not yet been immunized—and why have they not gotten even one shot? Sharecare’s Community Well-Being Index (CWBI) 2020 State Rankings Report and Vaccine Hesitancy Snapshot provide some valuable insight into vaccine uptake in the United States.
Americans Who Wanted a Vaccine Likely Got One
In a March-April 2021, the CWBI vaccine hesitancy snapshot found that 71 percent of respondents said they will get the COVID-19 vaccine, while 20 percent said they would not. Of those who said they would refuse the vaccine, 47 percent said it was because they don’t trust vaccines in general. Meanwhile, 30 percent said they would not be vaccinated due to concerns about safety or effectiveness.
Disparities in vaccination rates could be attributed to personal views and distrust in medical providers.
The March-April CWBI Snapshot also revealed that more Black or African Americans said that they would not get vaccinated than white or Hispanic respondents.
Research has shown that safety concerns as well as religious beliefs may serve as a barrier to immunizations. A 2012 paper published in Human Vaccines & Immunotherapeutics describes how personal views and other social determinants of health, such as lack of education, transportation or access to healthcare and concerns about civil liberties violations could all help shape individual views about vaccination.
Ethnic minorities and communities of color tend to have higher rates of infection and lower vaccination rates. Individuals in the United States undocumented who are often the target of strict immigration laws may be wary of disclosing private information to health officials. African Americans show high rates of vaccine hesitancy that are linked to the history of inequitable healthcare in the United States.
“This distrust is deeply rooted and based on injustices and unethical treatment that many Black Americans have experienced in our medical institutions,” said California Surgeon General, Nadine Burke Harris, MD, MPH, FAAP. “It is imperative that we engage with communities to address their concerns so that all of our communities can feel confident that these vaccines are safe and that they are our key to defeating this virus.”
President Biden’s “Shots at the Shop” initiative revolves around engaging Black owned barbershops and beauty salons to aid in vaccination education and outreach. The enterprise is aimed to support businesses in some of the hardest-hit communities experiencing low vaccination rates.
Community Well-Being Tied to Vaccination Rates, COVID Case Counts
In March, President Biden set a U.S. goal to get 70 percent of adults vaccinated with at least one dose by July 4th. But by July 25, the Delta variant became the dominant COVID strain in the United States and only 20 states, Washington D.C. and Puerto Rico reached Biden’s milestone.
The Delta variant now represents 83 percent of new COVID-19 cases in the United States, according to CDC director, Rochelle Walensky, MD, MPH.
“This is a dramatic increase, up from 50 percent for the week of July 3,” Dr. Walensky said in a July 20 Senate committee hearing. “In some parts of the country the percentage is even higher, particularly in areas of low vaccination rates.”
Sharecare’s Community Well-Being Index is a comprehensive measure comprised of 10 sub-domains that identify individual health risk and opportunity and risk tied to an individual’s surroundings and environment.
Notably, 8 out of the 10 states within the top quintile of the 2020 Report—leading the nation in 10 dimensions of well-being across individual health factors and social determinants of health—are among the states that have passed the 70 percent mark for adult vaccinations among adults between 18 and 64-years old.
Leading the nation, 83 percent of Hawaii residents in that age group have received at least one dose of a COVID vaccine. Hawaii ranked second in Sharecare’s 2020 State Rankings for its top position across all individual health factors, including physical, purpose, financial, social, and community.
Top 10 CWBI states represent, on average, 20 ranking positions better than the bottom 10 CWBI states across economic security and healthcare access, and on average more than 30 ranks better for physical, financial, and social well-being.
The CWBI 2020 State Rankings Report also found that states in the top 10 for the Index represented lower on average COVID-19 incidence rates than states, which fell in the bottom 10. For example, Hawaii, Maryland, Washington, and Colorado—which each have vaccination rates greater than 70 percent—all landed in the bottom quintile for COVID-19 cases per 100,000 population.
Of the lowest 10 ranked states for Sharecare’s 2020 Index, six—Mississippi (#50), Arkansas (#49), West Virginia (#47), Alabama (#44), Louisiana (#43), and Tennessee (#42)—have the lowest percentage of residents given at least one COVID shot (less than or equal to only 50 percent), in the 18 to 64 age group. At the bottom spot of the 2020 Index, Mississippi has the farthest to go to achieve Biden’s 70 percent goal, with only 40 percent of their residents having received at least one COVID vaccine.
Moreover, when looking at the 10 states with the lowest CWBI rankings, two (Tennessee and Oklahoma) are in the top 10 for COVID-19 case counts, and 6 of 10 are in the top half of case counts overall. As of July 14, 43.2 percent of eligible Tennessee residents have gotten at least one COVID vaccine. In Oklahoma, 46.3 percent of the population has received at least one dose.
Trends tied to the Index and COVID-19 case counts, death rates and vaccination rates, underscore the inherent connection between population health and people’s willingness and ability to receive a COVID-19 vaccine.
Sharecare’s 2020 Community Well-Being Index findings reveal that states with the most unvaccinated people have broadly lower levels of individual well-being and social determinants of health. States ranked at the bottom of Sharecare’s Index, which are more physically and financially vulnerable, tend to have weaker social networks, less access to healthcare resources, and worse economic circumstances.
“States with higher social determinant issues, such as limited access to healthy foods, transportation, safe housing, access to healthcare, and more, have been disproportionately affected by COVID-19,” says Elizabeth Colyer, SVP, Community Well-Being Index at Sharecare. “Identifying and supporting areas with lower vaccination rates and enhanced COVID-19 risk requires communities to invest in community tools and resources that mitigate against the growing divide between health outcomes among residents of the top-and-bottom ranked states.”
Other Factors Affecting the COVID Vaccine Rollout
Myths and misinformation circulating online is another key factor that could affect vaccination rates, the study suggests. The 2012 paper pointed out that many people have trouble navigating vast amounts of unfiltered information from Internet sources that are not credible.
On the flip side, lack of Internet access may also serve as a barrier to COVID immunization as many vaccination sites required online registration and appointment scheduling. Older people, homeless individuals and those living in rural or low-income communities may have been disproportionately affected.
“…I think that’s a big issue right now is if you’re not already plugged into the health care system, and if you’re not also registered into a patient portal or something like that, you don’t know how to sign up,” said Lisa Cooper, director of the Johns Hopkins Center for Equity.
“Tens of millions of Americans do not have access to or cannot afford quality internet service. The United States has an internet access problem, especially in rural areas,” according to a May 2020 report from The Brookings Institution. “The existing program to extend broadband has become a corporate entitlement for incumbent telephone companies. At the same time, the United States has an internet affordability problem. Too many low-income Americans cannot afford broadband internet access.
Additionally, political affiliation and age are indicators that influence a person’s decision to receive the shot.
An April 2021 study by Monmouth University found that 43 percent of Republicans, 22 percent of Independents, and 5 percent of Democrats are hesitant to receive the COVID-19 vaccine. Similarly, Sharecare’s March-April snapshot found that seniors are less likely to display vaccine hesitancy compared to adults under the age of 65-years old (14 percent for those 65+ versus 18 percent for those 45-64, 21 percent for those 30-44, and 20 percent for those aged 18-29).
Understanding and Overcoming Vaccine Hesitancy
Sharecare’s CWBI findings shed light on Americans’ social determinants of health—the properties of the places in which they work and live, their access to healthy food, green spaces, quality education, healthcare or safe and affordable housing as well as their financial security. Understanding these factors, which play a significant role in people’s physical health and overall well-being, can help explain why the certain pockets of the United States may be affected differently by the pandemic and ongoing vaccination efforts.
“As we transition to our next normal, alignment across sectors and stakeholders on the risks that determine the health and well-being within our communities, as well as understanding the relationships between those risks will be critical to building resilience and maintaining it long-term,” Colyer says.
“Trends from Sharecare’s Community Well-Being Index and COVID-19 measures across states, highlight the importance of preventative measures across people and places that focus on care advocacy for people, connected platforms for communities, and research-backed protocols for places,” says Michael Rickles, VP, Research Strategy at Sharecare.
Medically reviewed in July 2021.
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