As COVID-19 infections surge in the South and Midwest areas of the United States, fueled by the delta variant and a largely unvaccinated population, Delawareans appear quite well-protected from COVID-19 at first glance. As of Sept. 5, approximately 70% of the state’s 18-plus population had received at least one dose of a COVID-19 vaccine. However, on Aug. 27, the state reached its highest number of cases since early February. What is behind the surge of cases in the First State?
Although the state overall has high vaccination coverage, there are geographic and demographic pockets of Delaware where vaccine coverage remains low. These residents are at very high risk from infection with the delta variant of COVID-19.
One group where vaccination lags is young people. Of those eligible for vaccination, those aged 18-34 have the lowest rate of vaccination, with 12-17-year-olds right behind. As of Sept. 5, both groups have around 50% of their population at least partially vaccinated.
The state might consider several approaches to reach this hesitant group. In national data, fertility concerns, fueled by online misinformation, may add to hesitancy among 18-34-year-olds. The state should highlight data showing no evidence that the vaccine impacted fertility — in either men or women. Among women who have become pregnant after vaccination for COVID-19, there has been no evidence of increased risk for any pregnancy complications or birth defects. This is backed by both the American College of Obstetricians and Gynecologists and the Society for Male Reproduction and Urology.
In terms of reaching those even younger, who were most recently made eligible for vaccination when the Food and Drug Administration expanded emergency-use authorization for 12-to-15-year-olds May 10, schools may provide an opportunity to improve vaccination coverage. School nurses already play critical roles in keeping children healthy by promoting both children’s and families’ health. Their roles naturally highlight the importance of the responsibility to protect others, and schools already require a number of vaccines for students to protect population health.
Among Black Delawareans, only 42.8% have received at least one dose of a COVID-19 vaccine. Systemic mistrust in medical and scientific authorities among racial and ethnic minority groups is understandable and based on a history of abuse. Vaccine ambassadors from all Delaware communities are needed. Black medical professionals can play a central role, as can nontraditional professionals like Black barbers and beauticians, which have effectively been used to address a multitude of health disparities in the past. For example, public health programs run by African American women in churches, beauty salons and community nonprofits have increased cancer-screening rates, improved cardiovascular health outcomes and addressed racial disparities in vaccination for HPV and hepatitis.
Finally, some ZIP codes in Delaware, particularly in southern Delaware, have very low vaccination rates. This is likely due to a complex context of race, income and politics. Increasing vaccine rates in these areas with the lowest coverage can give us the most bang for the buck, since COVID-19 infections in areas with low vaccine coverage will have the highest likelihood of leading to severe disease, hospitalization and death.
With full approval of the Pfizer-BioNTech vaccine recently and the specter of delta on the horizon, even in areas like Delaware where overall vaccine coverage is high, now is the time to take action to improve vaccine coverage across the state.
Max Casciano is a senior health behavior science major at the University of Delaware. Dr. Jennifer Horney is a professor and founding director of the epidemiology program at UD.
