The CDC needs to change recommendations to states into requirements.
As the news that U.S. officials had paused the distribution of Johnson & Johnson’s COVID-19 vaccine rippled across headlines worldwide, safety and efficacy data points were scrutinized and debated on morning news shows and across social media. But with the FDA’s decision to resume use of the one-dose vaccine in the U.S., another fundamental data point should have been called into question: How many doses are going into arms?
The Centers for Disease Control and Prevention (CDC) has issued guidance for how states should report data to the agency. But in the absence of required standards and accountability, states are reporting different vaccination metrics in different ways, limiting our ability to track our progress against the virus. Even basic metrics, such as the number of individuals who have received one vaccine dose or who are fully vaccinated with both doses of the most prevalent two-shot vaccines, are not reported consistently across states. The mixed bag of approaches --counting doses administered versus people vaccinated -- is reminiscent of the confusing ways states report individuals tested and the number of tests performed, as we detailed last fall. The same challenge that has hampered testing efforts across the United States is now limiting our understanding of the COVID-19 vaccination rollout.
Data reported by states became even messier as the Johnson & Johnson single-dose vaccine first entered the market. Some states such as Ohio and Mississippi have been counting the single Johnson & Johnson shots under two different categories: vaccine started and fully vaccinated. That makes it nearly impossible to precisely calculate the total number of people partially and fully vaccinated. And the CDC recently changed the data it provides to the public by lumping together the number of doses administered by state and federal agencies (the Veterans Health Administration, Indian Health Services, and Bureau of Prisons). As a result, the CDC’s reported state numbers are inconsistent with the data reported by some states themselves.
To be clear, this problem did not begin with the current administration. We and our colleagues at the Johns Hopkins Coronavirus Resource Center, along with many other researchers, data scientists, and public health experts grappling with inconsistent public data have been calling for data standards for nearly as long as the pandemic has been ravaging the world. In his first 100 days in office, President Biden’s administration has been hard at work rebuilding the nation’s beleaguered public health agencies — institutions stocked full of the nation’s finest scientific talent and expertise — squandered and silenced by a Trump administration that placed optics over data and politics before science.
But without federal standards and requirements to submit certain data, our nation’s decentralized and overwhelmed public health system will continue to produce vital COVID-19 data using different metrics and reporting methods, hindering our responses and obscuring the extent of suffering the virus has been inflicting on the nation’s most vulnerable populations. Just knowing the number of doses distributed and administered is not sufficient. We must be able to answer key questions: Who is being vaccinated? Where do they live? And what proportion of those in the highest priority groups, such as health care personnel and residents of long-term care facilities, have been vaccinated? We simply do not know. And we won’t be able to know until the federal government imposes uniform standards and incentivizes state compliance.
As of this writing the CDC reports that for the 97 million people fully vaccinated, they only have demographic information for 56 million or about 58 percent. Further compounding the problem, states use different and incompatible categories for race and ethnicity, and their reported data do not allow a determination of the number of people vaccinated across race/ethnicity, age, and gender.
There is clear and convincing evidence that COVID-19 is disproportionately impacting Black and Brown Americans. We know this because roughly a year after the first COVID-19 case crossed our borders, there is now widespread reporting of the race and ethnicity of cases and deaths. Yet we still have virtually no data showing which Americans have had access to testing in this country. And now the same blind spot has been extended to which Americans are granted the privilege of vaccination.
Federal authorities have asked states to voluntarily report the race and ethnicity of vaccine recipients. But more than a year’s worth of evidence makes clear that it will take more than a request to ensure consistent standards are applied.
We have marveled at the nation’s ability to quickly develop several highly protective vaccines against COVID-19 and the Biden administration’s remarkable success so far at converting vaccine doses into vaccinations for millions. But without accurate, timely, and standardized data across states, local jurisdictions, and federal agencies, there is no way to monitor progress toward national goals and ensure equitable access to vaccines and testing. As the second year of the pandemic grinds on, the Biden Administration has the opportunity to undo one of the Trump Administration’s biggest mistakes last year by establishing such standards and a requirement to report key elements as soon as possible.
Beth Blauer is associate vice provost of Public Sector Innovation at Johns Hopkins University and co-founder of the Centers for Civic Impact; William Moss is executive director at the Johns Hopkins International Vaccine Access Center.