Racial disparities in Phase 1 COVID-19 vaccine shipments to Neighborhood sites in Pennsylvania by the Federal Retail Pharmacy Program

Early racial disparities in COVID-19 vaccination rates have been attributed primarily to personal vaccine attitudes and behavior. Little attention has been paid to the possibility that inequitable vaccine distribution may have contributed to racial disparities in vaccine uptake when supplies were most scarce. We test the hypothesis that scarce vaccines were distributed inequitably using the shipping addresses of 385,930 COVID-19 vaccine doses distributed in the first 17 weeks of Pennsylvania's Phase 1 rollout (December 14, 2020 through April 12, 2021). All shipments we analyze were allocated via the Federal Retail Pharmacy Program, a public-private partnership coordinated by the Centers for Disease Control and Prevention.Overall, White people had an average of 81.4% more retail pharmacy program doses shipped to their neighborhoods than did Black people. Regression models reveal that weekly vaccine allocations determined by pharmacy chains-rather than initial shipment and administration site decisions requiring state and federal approval-drove these effects. All findings remained consistent after controlling for neighborhood differences in income, population density, insurance coverage, number of pharmacies, and other social determinants of health.Our findings suggest that the private distribution of scarce public resources should be assessed for racial impact, regulated as public resources, and monitored continuously.