In our research project, we conducted an in-depth examination of the intersection between COVID-19 vaccination and mortality rates, both nationwide and within California. We explored how existing social inequalities influence health outcomes for various racial groups. Our aim was to uncover the nuanced relationship between these rates to highlight the broader implications of systemic inequalities on healthcare outcomes across racial groups. Using data from Our World in Data and the CDC, we identified significant disparities between communities. For example, early in the pandemic, access to vaccines was limited, especially for marginalized groups. Despite overall improvements in vaccination rates, this gap persisted. Our analysis further revealed a persistent contrast in mortality rates; while Non-Hispanic whites constituted a majority of the deaths, Hispanic and African-American communities experienced higher mortality rates relative to their population sizes. This suggests that these communities face greater challenges in accessing healthcare and have a higher prevalence of underlying health conditions.

Primary Research Question: How do the discrepancies between vaccination and mortality rates across different races reveal structural inequalities, particularly in the healthcare system?

Hypothesis: Structural inequalities, reflected in racial and socioeconomic disparities, result in lower vaccination rates and higher mortality rates in marginalized communities.

To provide a deeper understanding of these disparities, we employ the lens of structuralist theory, as introduced by Ferdinand de Saussure and further developed by scholars such as Claude Levi-Strauss. According to structuralism, signs and their meanings are understood through their differences and relationships within a system, rather than in isolation. Structuralism helps us understand how systemic structures and societal codes shape health outcomes. In the context of our study, racial and socioeconomic disparities can be seen as part of a larger structural system. Thus, applying structuralism may help us connect the specific experience of COVID-19 to broader forms of discrimination that may spike in potential urgent situations similar to the pandemic.  

Marxist theory provides another critical lens for examining these disparities. From a Marxist perspective, the primary human motivation is to acquire material goods, and all social structures like governments are fundamentally underpinned by, and cannot be understood without the economy. In other words, in Marx's framework, the "base" of society—consisting of the economic relations and means of production—determines the "superstructure," which includes culture, politics, and ideology.

Applying Marxist theory to our study potentially reveals how profit incentives of vaccine and healthcare companies may have led to such disparities Marginalized communities, often representing the proletariat in Marxist terms, face systemic barriers to healthcare due to their lower socioeconomic status.These barriers are maintained and perpetuated by the dominant capitalist system to the benefit of the bourgeoise, or the economically privileged classes.

Our project thus serves as a call to action, underscoring the need for systemic changes to mitigate these disparities and improve health outcomes for all, particularly those in marginalized

communities who are most vulnerable. We convey our study results in an understandable and captivating manner by using data visualizations, which opens up access to complicated material for a larger audience. 

Figure 1: Covid-19 Vaccine Uptake by Racial and Ethnic Groups in California 

The first subquestion we wanted to address in our project was the correlation between the death and vaccination rate as a total in California. COVID-19 as a whole has disproportionately affected many races due to a combination of systemic inequalities, preexisting health disparities, etc. After selecting and composing data from both Our World in Data and the CDC, it revealed a sharp contrast in vaccination and mortality rates among various demographic groups. For instance, as of February 2021, it showed that only 1.69% of the population there was fully vaccinated (receiving the first and second doses) and this increased as the months went on. Despite the increase, marginalized communities continued to face barriers in accessing vaccines. Hispanic and Non-Hispanic (African American) populations had lower vaccination rates compared to Non-Hispanic (Whites). The mortality data further highlights these disparities. Non-Hispanic (Whites) accounted for 66.2% of the deaths while only representing 59.7% of the population at the time. In contrast, Non-Hispanic (African American), who made up 12.6% of the population, accounted for 13.7% of deaths. Similarly, the Hispanic community, which is composed of 18.6% of the population, represented 15% of the deaths. 

The data represented in the bar graph(showcasing the total numbers in 2022) further illustrates the vaccination uptake among the different communities. It was made using the current data displayed by the CDC on their dataset website in correlation to the booster uptake among various racial groups in America. The completion of the two doses and the uptake of the booster doses were compared to Alaska Native (AIAN), Asian, Black, Hispanic, and White. The completion rate as follows: AIAN (77%), Asians (97%), Black (84-85%), Hispanic (84-85%) White (84-85%). While this may indicate that nearly all of the population in these different communities have taken at least one or two doses of the vaccine, the booster dose shows a different trend.

The bar plot was created using ggplot2 packaged in Rstudio, and the methodology of extracting the data and cleaning it up was mainly manual, having to sum up the week-to-week data and converting it into month-by-month data. This approach allows us to not only get a clear comparative view but also supports the argument that some of the factors that have either led to or contributed to these disparities could be systemic inequalities, access barriers, or preexisting health conditions. Systemic inequalities have always found its way into the history of America and have never left after finding a place to settle down. This creates barriers for marginalized groups and communities to gain access to critical needs such as insurance, facilities, etc. Often leading to a divide that forces them to choose to pay higher out-of-pocket costs or forfeit the right to take medicine at all.

Figure 2: Covid-19 Deaths per 100,000 Population by Race and Ethnicity 

We got the mortality data from the CDC website, then we looked at the death count per race in California and then divided it by the population of that race respectively to analyze different disproportionalities. Our findings were as follows:

Of the total reported fatalities in California, 44.3% of those reported were from the Latino Community, 25.7% belonged to the White community, 10.5% belonged to the Asian community, and 5.5% belonged to the black community. These numbers indicate that although the Latino Community only makes up about 39% of the population in California, they make up the most deaths during the COVID Period.

Figure 3: Vaccination Rate Among Ethnic Groups Nationally

Figure 5: Percentage of Cumulative COVID Vaccinations Administered by Ethnicity over Time

These two (Figure 4 and 5)  visualizations expose the disproportionate effectiveness of vaccines between different ethnicities by exposing the interethnic disparities in COVID-19 deaths rates and vaccine rates. A time frame from December 2021 to May 2023 was selected to capture the time when vaccinations entered circulation nationwide, and for the purposes of the analysis, entries with missing ethnicity responses were excluded.

The first visualization (top graph Figure 4)) shows the percentage of total cumulative COVID-19 deaths by ethnicity over time. The ethnic distribution of deaths in the United States remained nearly constant throughout the recorded time frame, with a slight increase in the percentage of Non-Hispanic White deaths towards the end. The second visualization (bottom graph) displays the percentage of COVID-19 vaccinations administered by ethnicity over time. This plot reveals a more variable pattern compared to the death visualization. Notably, the White population at first had a significantly higher vaccination rate than minority groups. Then, only once the White population’s vaccination rate decreased did the Hispanic population’s rate increase. This pattern resurfaces in July 2021, March 2022, and August 2022, in which Hispanic vaccination rates seem to give way for the White population, perhaps indicating the release of updated vaccines and booster shots. Given the widespread anticipation for COVID-19 vaccinations at a time of urgency, the established order of White before Hispanic (or any other minority group) reveals the priorities of social institutions like healthcare at a time in which limited resources must be distributed to those who seem more deserving of them.

Comparing the two visualizations, we observe that the percentage makeup of COVID-19 deaths remains relatively consistent over time, whereas the percentage makeup of vaccinations fluctuates significantly, particularly for Hispanic and White populations. Despite this oscillation mentioned earlier, the Hispanic population has had a higher vaccination rate than other minority groups, yet they do not have a significantly lower death rate relative to their population compared to these other groups, specifically with the Black population. The discrepancy between a relatively high rate of vaccination and high death rates may point to differential effects of the vaccine itself. Through a structuralist perspective, the biases that went into constructing the COVID-19 vaccine, such as who the vaccine was tested on, may have resurfaced through vaccines being more effective on over-represented populations like the White population. In other words, the way the vaccine interacts with different racial groups stems from the same societal codes favoring White populations that may have been present in the testing scheme when developing the COVID-19 vaccine.

More broadly, health disparities among ethnic groups in the United States have deep historical roots, and they have been influenced by discrimination and differences in quality healthcare access. Furthermore, the COVID-19 pandemic has highlighted these longstanding disparities as shown by the data visualizations above. Historically, minority communities, particularly Black, Hispanic, and Native American populations, have experienced higher rates of chronic conditions such as diabetes and obesity, which increase the risk of severe COVID-19 outcomes. Additionally, vaccination efforts have historically varied in effectiveness across different demographics. For example, the rollout of the polio vaccine in the 1950s saw disparities in access between different socioeconomic groups. Similarly, the visualizations show a disparity in effectiveness of COVID-19 vaccines between White and Hispanic populations. The higher vaccination rates among Hispanic individuals, despite their unchanging death rates, suggest that there may have been issues with their effectiveness on Hispanic populations in specific, aligning with the historical trend of racial inequities in healthcare. 

Our research highlights significant disparities in COVID-19 vaccination and mortality rates across different racial and ethnic groups, both nationwide and within California. These disparities are indicative of broader systemic inequalities that permeate the healthcare system, affecting marginalized communities more severely. By applying structuralist and Marxist theories, we were able to understand how these inequalities are embedded in social structures and economic systems. Structuralist theory revealed how societal codes and systemic structures contribute to health disparities, while Marxist theory highlighted the economic motivations that perpetuate these inequalities. Our visualizations underscored the persistent gaps in vaccination rates and the disproportionate mortality rates among Hispanic and African-American communities. These findings call for urgent systemic changes to address and mitigate these disparities. The broader implication is clear: we must address the underlying social and economic structures that drive these disparities to achieve equitable health outcomes. This research serves as a call to action for policymakers, healthcare providers, and society at large to work towards a more inclusive and equitable healthcare system that serves all communities effectively.