Examining the Relationship between Race, Ethnicity, and Sociodemographic Factors and Coverage of Three Vaccines: COVID-19, MMR, and HPV

Abstract

The incidence of vaccine-preventable diseases is on the rise in the United States and globally. This is due to multiple factors including a recent surge in vaccine hesitancy, which the WHO has named a top ten global health threat, and persistent barriers to accessing vaccination. These factors have led to larger numbers of unprotected individuals who are at increased risk for contracting diseases such as COVID-19, measles, and the human papillomavirus (HPV). This dissertation aimed to identify racial, ethnic, and sociodemographic disparities in vaccine coverage for, 1) measles, mumps, and rubella (MMR) and 2) HPV, and explored the reasons behind COVID-19 vaccine hesitancy among Black women. In Manuscript 1, I used qualitative methods to understand COVID-19 vaccine decision-making among a diverse set of Black women in the Minneapolis-Saint Paul metropolitan area. I identified myths and misinformation about the vaccine, some of which were specific to ethnic groups. I found that historical trauma and culturally appropriate messaging influenced vaccine decision-making. In Manuscript 2, I used data from the Minnesota Department of Health’s Minnesota Immunization Information Connection (MIIC) and birth certificate data from the Center for Health Statistics (CHS) to assess on-time MMR vaccine coverage among Minnesota-born children. Findings indicated substantial gaps by ethnicity and socioeconomic status for on-time MMR vaccination. This has implications for how measles cases and outbreaks in the state might emerge and how to target immunization access campaigns. In Manuscript 3, I used MIIC and CHS data to assess on-time HPV vaccine coverage among Minnesota-born adolescents. Findings indicated low coverage overall, gaps by ethnicity, and significant urban/rural differences. These low rates of on-time HPV vaccination could have consequences for the epidemiology of future HPV-associated cancers in Minnesota. In summary, my findings contribute to the understanding of racial, ethnic and sociodemographic inequities in the coverage of three important vaccines: COVID-19, MMR, and HPV. These findings can inform public health interventions targeted to improve vaccine coverage among marginalized groups.