The health, judicial, and socioeconomic disparities among ethnic minorities are pervasive, and vaccination rates are key among them. The inequities among marginalized groups are largely driven by social determinants of health, education, and access to care. The United States has a well-documented history of these inadequacies, strengthened even further by the COVID-19 pandemic in 2020, leading to higher mortality and lower vaccination rates among these demographics. According to the CDC updated vaccination rates through 2023–2024, there is a continued disproportionate rate in vaccination of Non-Hispanic Black adults (8 percent) and Hispanic adults (8 percent) who received an updated COVID-19 vaccine, which is nearly half that of white adults (15 percent). These rates were even more pronounced at the pandemic’s peak due to the intersectionality between historic public health policies and cultural differences among these groups.
While the COVID-19 pandemic provides a more recent example of these inequities, the disproportionality in vaccination rates is stark, be it HPV or even influenza vaccines. Adults and children who live at or below 100 percent of the poverty level typically have lower vaccination rates than those living above the poverty line. This highlights the continued need for education in health-promoting initiatives.
Vaccination rates among children, especially minorities, have dropped since pre-pandemic times. The reasons behind this drop are multifactorial and primarily affect disadvantaged communities. The primary reason for the lack of vaccination is the lack of access to care. This issue presents itself in various forms, such as lack of health insurance, low-income families that cannot take time off for doctor appointments, and lack of care providers, especially in rural areas. Lack of health insurance often means that these families cannot afford to pay out of pocket for vaccinations and thus do not get vaccinated. Low socioeconomic status also often means these individuals cannot afford to sacrifice a workday to attend appointments. Few physicians serve in rural settings, and finding providers willing to serve these areas is often difficult. Thus, even if a patient may be willing to get vaccinated, they may lack access to it. As a result, it is essential to recognize the value of immunizations in all populations and their impact on current and future community health.
The introduction of the HPV vaccine in 2006 marked a significant advancement in public health, yet disparities in vaccination rates and awareness persist. In 2022, approximately 76 percent of U.S. children received at least one dose of the HPV vaccine, falling short of national targets. Disparities in vaccination rates are particularly concerning among different racial and ethnic groups. Human papillomavirus strains more prevalent in African American women than in white women include HPV 31, 33, 35, 45, 56, 58, 66, and 68. Conversely, HPV 16 and 18, the two main subtypes targeted by current vaccines, are less frequently detected in African American women with precancerous cervical lesions. Gender disparities also exist, with women being over three times more likely to initiate vaccination compared to men. Among adults aged 27 to 45, Non-Hispanic Black individuals are more likely to be vaccinated than their non-Hispanic white counterparts, while Hispanic adults are less likely.
Awareness of HPV and its vaccine remains alarmingly low among adults with lower educational attainment. Only 40 percent of those with less than a high school education are aware of HPV, compared to 78 percent of college graduates. Awareness also varies significantly across racial and ethnic groups, with non-Hispanic Asian individuals showing the lowest awareness levels.
As of March 13, 2025, 301 cases of measles have been confirmed in over 15 states. The resurgence of preventable diseases in the United States, such as measles, highlights the urgent need for vaccination education from trusted sources. In 2000, measles was officially eliminated from the United States. However, this public health achievement has been impacted by the spread of measles in 2019 and its resurgence in the present time. Herd immunity plays a large role in protecting unvaccinated individuals from becoming ill. To achieve herd immunity, 95 percent of a population must be vaccinated against the disease. However, a decline in MMR vaccination rates has been noted from previous school years, now reflecting a vaccination rate of 92.7 percent among kindergartners. Discussions about vaccination should not be limited to guardians of young patients but should also include adults who may be unvaccinated or eligible for booster doses. Vaccines not only help prevent the spread of preventable diseases but also decrease the financial strain on the health care system by reducing health provider costs and medical equipment expenses to manage patient care. It also boosts social productivity and economic benefits, as vaccines have been correlated with improved cognition and school attainment.
The World Health Organization (WHO) named vaccine hesitancy a top 10 global health threat in 2019. Vaccine misinformation and pseudoscience are growing concerns that directly affect vaccination rates. Medical mistrust has been and continues to contribute to vaccination hesitancy. Compared to other racial and ethnic adults, Black adults tend to have higher rates of mistrust of medical providers. This tends to stem from a history of mistreatment and racial injustices. A decrease and/or lack of knowledge about the risks and benefits of vaccinations tends to prevail within racial and ethnic minority groups. This knowledge deficit could be attributed to a lack of health literacy, ineffective communication of risks and benefits from the health care provider, language barriers, and cultural differences.
The COVID-19 pandemic also unveiled the rise of vaccination hesitancy among health care workers. This hesitancy is due to factors such as a lack of trust in government agencies, health care systems, and pharmaceutical companies. Unfortunately, health care provider vaccination hesitancy can play a dangerous role in the mass vaccination hesitancy of patients. It is important that when this is seen within health care institutions, it is addressed immediately and effectively. When combating vaccination hesitancy, the promotion of vaccinations publicly, an increase in education on the risks and benefits of vaccinations, health care worker education about vaccination importance, and increasing the availability and access to vaccinations have been recommended.
Kaitlynn Esemaya, Alexis Thompson, Beatrice Odhiambo, Annique McLune, and Anamaria Ancheta are medical students.