Missing again: US racial and ethnic data for COVID-19 vaccination

In the USA, Feb 2 is Groundhog Day, when the famous Punxsutawney, PA, groundhog's sighting or absence of sighting of its shadow predicts how long winter will last. The phrase also now evokes thoughts of an endless time loop, following a 1993 comic film, in which an egotistical cynical weather reporter who is assigned to film the groundhog gets stuck in a time glitch, endlessly repeating the day. He escapes only by learning the errors of his ways, redeemed by self-reflection leading to self-improvement and finally authentic love for another person.¹

On Feb 2, 2021, readers of the US Centers for Disease Control morbidity and mortality report² could be forgiven for thinking that we, likewise, had entered a repeating time loop. Among the 12 928 749 people who initiated vaccination against COVID-19 (ie, received at least one dose of vaccine) during the first month of the US vaccine roll-out (Dec 14, 2020, to Jan 14, 2021), data for race and ethnicity were missing for 48·13% (6 222 052) of people, despite the reporting form prominently indicating that data for race and ethnicity are required (appendix). By contrast, data for age were missing for only 0·04% (4633) of people and data for sex were missing for 3·02% (390 908) of people.² These data are essential to ensure that the vaccine roll-out meets stated standards and maintains equity in vaccine access and vaccine confidence.

Similarly, in early April, 2020, US journalists, advocates, and scientists raised alarm at gross gaps in data for race and ethnicity for COVID-19 cases and deaths, impeding the ability to document health inequities and guide interventions.³ Although the proportion of records for COVID-19 deaths that are missing racial and ethnic data is now low (<1%), the proportion of records of cases that are missing these data has not decreased: despite reporting mandates, these data were missing for 43·00% (181 484 of 422 057) of COVID-19 cases that were reported between Aug 28 and Sept 16, 2020,⁴ and for 33·00% (4 083 477 of 12 374 172) of COVID-19 cases that were reported between Dec 2, 2020, and Feb 3, 2021.

Journalists, advocates, and scientists are again decrying the extensive missing data for race and ethnicity for vaccination records; meanwhile large numbers of affluent white people with good computer access to book appointments are attending vaccination sites that were set up to serve communities of colour that were hard hit by COVID-19.⁵

At a time of heightened awareness about racial injustice and white supremacy, it is astonishing that racial and ethnic data for vaccination are missing. The first month of vaccination occurred in the final month of the Trump administration. To get out of this pernicious time loop, self-reflection, learning from past errors, and a commitment to equity are essential. The new Biden–Harris administration should ensure that these required data are reported.

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