Federally Qualified Health Centers Play a Critical Role in Ensuring Equitable COVID‐19 Vaccine Access

RESEARCH OBJECTIVE: Federally Qualified Health Centers (FQHCs) play a critical role in enabling access to care for low‐income, racially diverse, medically underserved populations—populations disproportionately affected by COVID‐19 and the health inequities it has revealed. As trusted, accessible providers, FQHCs are well‐positioned to help mitigate further inequities by providing access to COVID‐19 vaccinations in their communities. This is particularly critical given early data that suggest racial/ethnic communities most affected by COVID‐19 have been the least likely to access the vaccine during the first 3 months of administration. The objectives of this study were to (1) examine COVID‐19 vaccination rates within US FQHCs by race/ethnicity and (2) examine racial/ethnic equity within states among FQHC populations. STUDY DESIGN: Our primary data source was HRSA Health Center COVID‐19 Survey data (as of March 2021), which included a response rate of 69% of all FQHCs in the US. Our secondary data source was the 2019 Uniform Data System. We first generated descriptive statistics to examine vaccination rates across FQHCs by race/ethnicity. Next, for each racial/ethnic group, we calculated “vaccination equity ratios” within each state by calculating the number of observed vaccinations within the racial/ethnic group divided by the number of expected vaccinations within the group, where the expected is based on the percent of the FQHC population that belongs to that racial/ethnic group. Observed to expected ratios less than 1.0 suggest that the racial/ethnic group has received fewer vaccinations than they should have received if vaccinations were equitably administered by race/ethnicity. POPULATION STUDIED: National sample of FQHCs across the US (N = 931), serving >20.7 million low‐income patients. PRINCIPAL FINDINGS: As of March 2021, across FQHCs, 59.1% of all initiated vaccines were with racial/ethnic minority patients; this included 31.8% with Hispanic patients, 13.2% with Black patients, 8.3% with Asian patients, 3.4% with American Indian/Alaskan Native/Pacific Islander patients, and 3.2% with patients of >1 race. When accounting for the racial/ethnic composition of the FQHC patient populations, non‐Hispanic White (equity ratio = 1.35) and Asian (equity ratio = 1.66) patients were more likely to receive the vaccine, whereas Hispanic (equity ratio = 0.76), Black (equity ratio = 0.62), and American Indian/Alaskan Native/Pacific Islander (equity ratio = 0.29) patients were less likely to receive the vaccine. Vaccination equity varied widely by state. For instance, Black patients had the most equitable access to vaccines at FQHCs in AL, CA, NC, and PA, and the least equitable access in AZ, ID, IN, KS, MI, MN, OK, OR, and TX. CONCLUSIONS: FQHCs have played a pivotal role in providing access to COVID‐19 vaccinations to racial/ethnic minority patients. However, racial/ethnic equity in FQHC vaccine administration varies widely by state, which may be driven in part by state COVID‐19 eligibility group guidelines. IMPLICATIONS FOR POLICY OR PRACTICE: States should leverage FQHCs as major vaccine administration sites in order to improve vaccination equity. In states with low vaccination equity within FQHC populations, additional resources dedicated to vaccine enrollment assistance and outreach in Hispanic, Black, and/or Native communities are essential, particularly as vaccine eligibility opens up to the general public. PRIMARY FUNDING SOURCE: Health Resources and Services Administration.