Author’s Response

We thank Martin et al for their insightful comment. We agree that it is imperative that we ensure equity in vaccine uptake for children by facilitating access to providers and accurate information. The Centers for Disease Control and Prevention currently stratifies vaccination rates on the basis of the SVI, which is 1 of the indices used in our study. The average vaccination rate of the population aged ≥12 years is inversely correlated with social vulnerability, with a vaccination rate of 35.8% in high social vulnerability areas compared with 46.1% in low social vulnerability areas as of July 14, 2021. With regards to race and ethnicity, Centers for Disease Control and Prevention data reveal vaccination rates of 23.7% of Black and 29.1% of Hispanic individuals, as compared with 32.6% of white individuals as of July 12, 2021.¹ Thus, socioeconomic and racial and/or ethnic inequities in rates of COVID-19 and MIS-C are similarly present in vaccination rates across the United States.

Ensuring vaccine access, as Martin et al have noted, is a key element. Programs, such as the Health Center COVID-19 Vaccine Program, provide support for vaccination in federally qualified health centers: >91% of individuals served by these health centers live at or below the Federal Poverty Guideline, and the majority are racial and/or ethnic minorities.² In our state of Massachusetts, the COVID-19 Vaccine Equity Initiative has identified 20 vulnerable communities to be prioritized for vaccine allocation.³ Such efforts should continue to be supported and expanded to ensure that we do not leave vulnerable groups behind and at risk for this disease.

Another important element is working to provide accurate information to those expressing vaccine hesitancy or, perhaps more aptly named, vaccine deliberation. It is important to note that the United States has a long history of exploitative practices against minority groups that has led to justifiable distrust of the health system. Daily injustices, such as experiencing racism and bias in health care further lead to distrust of the medical system.⁴ Moreover, the pandemic has had a more devastating effect on minority populations: Black Americans are twice as likely to personally know someone who was hospitalized or who died of COVID-19 than white Americans.⁵ As providers, we must mitigate justifiable medical distrust and reduce bias and discrimination in our medical system with an openminded and trauma-informed approach to vaccine counseling.

We appreciate this thoughtful comment on our study and share the view that vaccination efforts are a key element in eliminating the health disparities we have seen among children during this pandemic. We must support ongoing efforts to ensuring equitable access to vaccination and an empathetic approach to vaccine counseling. With these efforts, we can continue to work toward eliminating disparities in COVID-19 and MIS-C.