The Need to Prioritize Equity: Race and Vaccinations in Arkansas
Picture of Kesha Moore

Kesha Moore

TMI Senior Researcher

The Need to Prioritize Equity: Race and Vaccinations in Arkansas

April 9, 2020

As of April 8, 2021, the State of Arkansas has only administered 67% of its received vaccines. This vaccine administration rate is 13 percentage points below the nation’s average rate (80%). In addition to Arkansas’s poor performance in vaccine administration, it has also performed poorly with respect to vaccine equity. Although all counties in Arkansas have roughly similar vaccination rates, this pattern does not produce equity in vaccine distribution nor ensure that those most at risk for serious harm by COVID-19 get priority in access to the vaccines.

Arkansas does not publish COVID-19 cases and death rates by race at the county level. However, we can still see that the pandemic disproportionately burdens Black, Latinx, and Native American persons based on national and state data. We see that the gulf is vast between the rate of contracting the illness and the outcomes for Whites and most other racial and ethnic groups. Nationally, Native Americans have shouldered the most significant disparities in COVID-19 cases, hospitalizations, and deaths relative to Whites, followed by Latinx and Black people. Asians track more closely to the rates for Whites. As of March 12, 2021, Black people were almost three times more likely to be hospitalized and almost twice as likely to die from COVID-19 than their White counterparts. In Arkansas, Black people are 15% of the population but 18% of the COVID-19 cases. In comparison, White people in Arkansas are 72% of the state’s population and 73% of the COVID-19 cases.

While Black people tend to experience more significant harms from COVID-19, White people in Arkansas (and across the nation) continue to be overrepresented in the COVID-19 vaccinations and Black people are underrepresented. As seen in Figure 1 (right), White people comprise 72% of Arkansas residents, yet they represent 84% of all vaccinations. Black people comprise 15% of the state’s population, but only 11% of those who are vaccinated.

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What accounts for this overrepresentation of White people and underrepresentation of Black people among the vaccinated? Arkansas has both failed to create an equity plan for its vaccine administration that includes race and failed to promote transparency and accountability by publishing county-level COVID-19 outcomes and vaccine related demographics, including race.

Arkansas’s failure to adopt an equity framework directly harms Black Arkansans. Because Native Americans, Latinx, and Black people, overall, represent a higher proportion of severe cases and deaths by COVID-19, government officials should do everything possible to ensure that these communities receive priority in vaccine administration. Furthermore, Arkansas’s decision not to share county-level data on COVID-19 cases, deaths, and vaccinations broken down by race and ethnicity make it difficult to assess the state’s vaccine distribution’s equity and effectiveness.

If the vaccine distribution process were equitable, then the communities with the highest levels of threat and harm from COVID-19 would have the highest vaccination rates. Arkansas’s vaccine administration process has produced comparable distribution by county across the state, even though the pandemic’s impact has not been distributed equally across the state. Figure 2 below identifies 17 counties that show substantial levels of COVID-19 transmission in the community. An equity-based vaccination process would intensify vaccination efforts in these 17 counties.

Figure 3 below reveals the vaccination rates for these 17 counties with substantial levels of community transmission. Forty one percent of these counties (7/17) have vaccination rates that are at least three percentage points higher than the state average (high), 29% of the counties (5/17) have vaccination rates one to two percentage points higher than the state average (medium), and 29% of the counties (5/17) have vaccination rates equal to or lower than the state average (low).

Arkansas’s vaccine administrators’ choice not to prioritize counties severely impacted by the pandemic exacerbates racial disparities in adverse COVID-19 outcomes. The low vaccination category counties have a larger Black population on average than those with a high vaccination rate. Fourteen percent of counties with a high vaccination rate have Black populations at or above 30% (1/7), compared to none of the medium vaccinated counties, and 60% (4/5) of the low vaccinated counties. Given that these counties all have substantial levels of COVID-19 transmission, all should be prioritized and have vaccination levels higher than the state average. Yet three of the communities facing substantial community transmission have vaccination levels at the same rate as the state average.

Moreover, two of the counties facing substantial community transmission have vaccination rates below the state average. Randolph County has a vaccination rate that is three percentage points below the state average. Hampstead County has the lowest vaccination rate of all, six percentage points below the state average. While Randolph has a small Black population (one percent), 30% of Hampstead county residents identify as Black. Both Hampstead and Randolph counties should be prioritized in vaccine distribution. If all five counties in the low vaccination group were prioritized with rates above the state average, the state’s racial inequities would decrease, and we would likely see overall improvement in the state’s COVID-19 outcomes. 

Johns Hopkins Center for Health Security explains why giving everyone equal access to the COVID-19 vaccine is a violation of the recommended principles of justice, fairness, and equity. The report states that “[b]ecause of the impact of the vaccine is different for different people [i.e., some people are at greater risk of death], the straightforward ways of treating people equally are often rejected as unfair or as an inefficient use of the vaccine (p.10).” They recommend that the most efficient and equitable process for distributing COVID-19 vaccines includes prioritizing the communities that experience more severe public health and economic impacts from the pandemic. Vaccine equity requires prioritizing those communities most harmed by COVID-19 and publishing the racial demographics at the county level of the people impacted by COVID-19 and vaccinated to facilitate public accountability.


#FairShot: Tracking COVID-19 Vaccination Equity