Top 5 Takeaways

1. Lower Vaccination Coverage in Rural Areas: COVID-19 vaccination coverage with the first dose was significantly lower in rural counties (58.5%) compared to urban counties (75.4%).
2. Increased Disparities Over Time: The disparity in vaccination coverage between urban and rural areas has more than doubled since April 2021.
3. Booster Dose Uptake: Receipt of booster or additional doses was similarly low in both rural and urban counties.
4. Demographic Variations: Vaccination coverage was lower in rural counties across all age groups and sexes, with the largest absolute difference among those aged 12–17 years.
5. Public Health Implications: Addressing barriers to vaccination in rural areas is critical for achieving vaccine equity and reducing COVID-19-related illness and death.

Original Article Author and Citation

Corresponding Author

Ryan Saelee, rsaelee@cdc.gov

Suggested Citation

Saelee R, Zell E, Murthy BP, et al. Disparities in COVID-19 Vaccination Coverage Between Urban and Rural Counties — United States, December 14, 2020–January 31, 2022. MMWR Morb Mortal Wkly Rep 2022;71:335–340. DOI: http://dx.doi.org/10.15585/mmwr.mm7109a2

Summary

This report highlights significant disparities in COVID-19 vaccination coverage between urban and rural counties in the United States from December 14, 2020, to January 31, 2022. Rural counties had lower first-dose vaccination coverage (58.5%) compared to urban counties (75.4%), and these disparities have increased over time. Despite similar low uptake of booster doses in both settings, addressing vaccination barriers in rural areas remains crucial for achieving vaccine equity and reducing COVID-19-related health impacts.

Methods

The study analyzed county-level vaccine administration data for individuals aged ≥5 years who received their first dose of a COVID-19 vaccine from December 14, 2020, to January 31, 2022. Data were reported to the CDC by jurisdictions, pharmacies, and federal entities. Counties were classified as urban or rural based on the 2013 National Center for Health Statistics Urban-Rural Classification Scheme. Vaccination coverage was calculated overall and by age group, sex, and jurisdiction.

Discussion

The analysis revealed that COVID-19 vaccination coverage was consistently lower in rural counties across all demographics. Factors contributing to these disparities include limited access to healthcare, sociocultural differences, and higher vaccine hesitancy in rural areas. Efforts to increase vaccine confidence and access in rural communities are essential to bridging the gap in vaccination coverage.

Conclusion

Addressing the barriers to COVID-19 vaccination in rural areas is critical for achieving vaccine equity and reducing disparities. Public health efforts should focus on collaborating with local healthcare providers, community organizations, and other stakeholders to improve vaccine confidence and ensure equitable access to COVID-19 vaccines in rural communities.

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