Population Health

Improving vaccine equity in the U.S.

Image of a child receiving an injectionThe University of Washington Population Health Initiative led an interdisciplinary research team that undertook a mixed-methods study to better understand changes in childhood vaccination rates by race and county in the U.S.

This information helped the team produce observations and recommendations about the key factors and attributes of more resilient immunization programs that can narrow the racial gap in health and well-being that persists in the United States.

The project, which ended in February 2023, had three focus areas:

  1. Identify nine representative counties that have had the most progress, least progress and median progress in improving childhood vaccination racial equity over the past 15 years.
  2. Engage key stakeholders in each of the nine selected counties to identify which interventions or public policies have most effectively improved racial vaccination equity.
  3. Identify features of interventions, programs, procedures or policies that offer benefits that could translate to other vaccine preventable diseases.

Major findings from the study included:

  • Vaccination coverage across the U.S. remained relatively stable between 2007 and 2019, though race/ethnicity and socioeconomic status influenced coverage.
  • Study participants identified key qualities of interventions that were effective in improving vaccine equity and coverage, including data and quality improvement, developing tailored interventions to target specific populations, and leveraging and forming partnerships across sectors.
  • Participants identified data limitations as a barrier to improving vaccine coverage and equity, including challenges to assessing localized state- and county-level trends to determine impact of equitable interventions.
  • Participants also identified key challenges to tracking race and ethnicity data, such as patient privacy, discomfort asking or disclosing, and the field simply not being required.
  • These challenges contrast with the COVID-19 pandemic, which has shown that it is effective and entirely possible for states to change these policies, thus showing a roadmap for possible improvements.

We believe the project findings will support policy makers, healthcare providers and other key stakeholders to understand not only what a county’s vaccination coverage ought to be, but also offer insights into how that county or state may realistically improve racial equity in vaccination coverage.

The UW project team included faculty, students and staff from the College of Arts & Sciences, Information School, School of Medicine, School of Public Health, School of Social Work and the Population Health Initiative.

Read the Final Report

Supplementary Materials

The project team developed several supplementary documents to support the adoption of effective practices to improve childhood vaccine equity.

Funding Acknowledgement

This study was funded by a research grant from the Investigator-Initiated Studies Program of Merck Sharp & Dohme Corp (MISP Reference Number 61170). The findings and opinions expressed in the report are those of the authors and do not necessarily represent those of Merck Sharp & Dohme Corp.