southern u.s. includes some of the nation’s best and worst COVID-19 vaccination rates: here’s why

by KATHERINE SYPHER | May 18, 2021

Editor’s note: This article is part of a collaboration between APM Research Lab and the Ten Across initiative, housed at Arizona State University.

Since distribution of the COVID-19 vaccines began in December 2020, states have persistently worked to vaccinate as many of their residents as possible. But in the past few weeks, vaccination progress in the United States has slowed, putting into question the country’s ability to reach herd immunity.

The states in the Ten Across region—California, Arizona, New Mexico, Texas, Louisiana, Mississippi, Alabama, and Florida—have reported some of the highest and lowest vaccination rates in the country. In New Mexico, 54.3% of the population has received at least one vaccine dose, while in Mississippi, 32.5% of the population has received a shot—ranking last in the nation.

The discrepancies between states have broad implications for the health of their residents now and for future health disasters. Why do states in the Ten Across region—particularly the extremes of Mississippi and Alabama on the one hand and New Mexico on the other—have such drastically different vaccination rates? And what could be learned from their public health responses for future disasters?

On May 4, President Biden set a new goal: for 70% of U.S. adults to have received at least one COVID-19 vaccine by the Fourth of July. With less than two months to go, many states are still far from reaching that goal. Though experts disagree as to whether reaching herd immunity is attainable in the United States at all, most agree that vaccinating as many people as possible is the quickest way to return life to normal.

New Mexico and California stand out among the Ten Across states as having the region’s highest vaccination rates. As of May 16, New Mexico had given over 54% of its residents as least one COVID-19 vaccine shot, leading the Ten Across region and ranking tenth in the nation. California had vaccinated over 53% of its residents and ranks 13th. Both had among the lowest cumulative COVID-19 case rates in the region.

All of the gulf states but Florida and Texas have COVID-19 vaccination rates below 40%, with Mississippi, Louisiana, and Alabama ranking first, second, and third lowest in the nation, respectively.

Despite the differences in vaccination rates, it is notable that weekly case rates have fallen dramatically throughout the region. As shown in the graph below, case rates dropped from between 263 (New Mexico) and 681 (Arizona) per 100,000 in late January to 145 per 100,000 or lower for all Ten Across states just six weeks later. Interestingly, as of early May, weekly case rates in Mississippi, Alabama, and Louisiana were relatively similar to the rate in New Mexico, where the vaccination rate was much higher.

When broken down by race and ethnicity, the vaccination rate for populations in the Ten Across region is generally very similar to that of the country. The major exception is among the region’s Indigenous populations—across the country, over 31% of Indigenous populations have received at least one COVID-19 shot, while only about 27% have done so in the Ten Across region.

Like the rest of the country, Black and Latino Americans have the lowest vaccination rates in the Ten Across region. As of our most recent analysis, Florida has the 3rd lowest vaccination rate among the 34 states reporting comparable data for Black Americans, and Alabama has the 2nd lowest rate reported for Latinos.

In the Ten Across region, and in the country, Asian Americans are the most likely to be vaccinated. Nationally, over 50% of Asian Americans have received at least one dose. In the Ten Across region, nearly 52% of Asian Americans have gotten the shot.

White Americans have the next highest vaccination rate in the country and the Ten Across region—approximately 39% to 40% of White Americans in both are vaccinated.

Whether Indigenous Americans received a vaccine varies drastically by state. Only about 10% of Indigenous people in Mississippi have received a dose, even though that state also has the nation’s highest COVID-19 death rate among Indigenous Americans. Indigenous populations in New Mexico and California are much more likely to have received a shot—over 40% of Indigenous people in both states have received at least one dose.

Alabama consistently reported some of the lowest vaccination rates for each racial and ethnic group, while New Mexico reported some of the highest.

“Unfortunate timing is what really held us back in Alabama.” - Dr. Sarah Nafziger

New Mexico—despite having fewer hospital beds per capita than most states, a higher incidence of poverty, an aging population, a remote geography inhabited by a small number of residents, and a significant population of residents living with underlying medical conditions—surged ahead early in its COVID-19 vaccinations and has consistently had one of the highest vaccination rates in the country.

Dr. Meghan Brett, an epidemiologist at the University of New Mexico Hospital, said she was impressed by how the state was able to move forward and have a coordinated COVID-19 vaccine response, relative to many other states.

“I see that time and time again … banding together in order to make it functional when the odds are stacked against you,” she said.

Public health experts attribute at least part of the state’s success to the efforts of and cooperation among state and local officials, as well as the state’s centralized online vaccine portal, as reported by the New York Times. In a statement in April, New Mexico Governor Michelle Lujan Grisham said she believes the state can be the first to reach herd immunity.

It may also be possible that the state’s high rate of COVID-19 vaccinations may be partly due to the fast and efficient rollout of vaccines by the Indian Health Service. According to the Navajo Times, as of May 7 nearly 93% of people living on the Navajo Nation­­­—which extends into New Mexico—had received at least one vaccine dose.

In New Mexico, 40.2% of Indigenous residents have received at least one COVID vaccination, the second highest rate in the region and sixth highest in the country. New Mexico also ranked first or second in the Ten Across region for vaccinating its Asian, Black, Latino, and White residents.

Alabama, conversely, is among the Ten Across states that have lagged in COVID-19 vaccinations. On May 16, the state ranked 49th in the country in immunizing its population against the virus.

Among the issues the state faced during the pandemic, according to Dr. Sarah Nafziger, the vice president of Clinical Support Services at the University of Alabama at Birmingham, were a diminished public health budget and a lack of adequate supplies.

“[Public health officials have] done, really, I feel like the best job they could have possibly done under the circumstances and I genuinely mean that,” she said. “But they’ve had to do the work of a department that should have been scaled a lot larger.”

Nafziger also said that when the vaccine became available, hospitals had to scramble to meet the federal vaccine requirements and allocate doses to the right people in an efficient and equitable way. At the same time, the state and country were in the midst of another huge case surge.

“Unfortunate timing is what really held us back in Alabama,” she said.

Public health officials in Mississippi—currently, the state with the lowest vaccination rate in the U.S.—reported similar issues. In an interview with Mississippi Today, State Health Officer Dr. Thomas Dobbs said the federal government’s method for allocating vaccines as well as problems in the state’s pharmacy partnership program were partly to blame for that state’s low vaccination rates.

Though Alabama has worked to catch up, vaccination rates are now slowing. Nafziger said that the University of Alabama at Birmingham is planning to close some vaccination sites because of decreasing demand, a phenomenon also happening in other states. In May, the federal government also announced that unused vaccine supplies would be reallocated from areas with low demand to those with high demand, a move that could impact Alabama. As of May 16, Alabama had administered 66% of its vaccine doses, the lowest rate of any state in the country.

A March NPR/Marist poll found that 30% of U.S. adults won’t or are unsure if they will get the COVID-19 vaccine. The Centers for Disease Control and Prevention estimate that some of the most hesitant people living in the Ten Across region live in Louisiana, Mississippi, and parts of Arizona, New Mexico, and Florida.

“There still is ongoing transmission, there’s still people that are getting hospitalized. From that perspective… to me, it does not feel like it’s over.” - Dr. Meghan Brett

Reasons for not wanting to receive the shot vary from skepticism of Pfizer and Moderna’s new mRNA vaccine technology to misinformation to longstanding distrust of medicine and medical institutions.

Politics also appear to be at least partly to blame—residents of states that President Biden won last fall are generally more likely to have received at least one COVID-19 vaccine than those living in states won by former President Trump. Trump won Alabama, Louisiana, and Mississippi by over a 10% margin—the same states with the lowest vaccination rates in the Ten Across region and the country.

READ MORE ABOUT HOW BLUE STATES MAY REACH HERD IMMUNITY SOONER THAN RED STATES

While the COVID-19 pandemic has not entirely run its course, progress on vaccinations has helped to mitigate its impacts. Along with the rest of the country, vaccination rates have slowed recently in the Ten Across region—our latest scenario projects that three gulf states may not vaccinate 70% of their residents until 2022.

Despite New Mexico’s success relative to other states, Brett cautions that there are still many variables at play, including variants of the virus, vaccine hesitancy, and whether reaching herd immunity is a meaningful or attainable goal.

“There still is ongoing transmission, there’s still people that are getting hospitalized. From that perspective… to me, it does not feel like it’s over,” Brett said.

It may be, however, that recent changes like the expansion of vaccine eligibility for 12- to 15-year-old adolescents and the CDC’s relaxed masking requirements for fully vaccinated individuals will reinvigorate vaccination efforts.

Nafziger said she still is optimistic that more people in Alabama will choose to get vaccinated as time goes on, though she does worry about another potential wave of infections hitting the state in the fall.

“Our vaccine administration is slowed—it hasn’t stopped,” she said. “We are still getting shots in arms every day, even if it’s not as many as we need.”