One day last month, the number of Missourians that state data showed had received the COVID-19 vaccine suddenly plummeted across every demographic group.
Weeks later, the percentage of Hispanic residents reported to have received their first dose quadrupled.
And last week, the state for the first time began allowing local public health departments to obtain registration lists for vaccination events from Missouri’s centralized system.
Nearly four months into Missouri’s distribution of the COVID-19 vaccine, the state continues to struggle with data issues — making changes designed to give a more accurate picture of vaccine distribution, but resulting in dramatic swings in its data.
Past issues have made some local public health departments wary of the state’s data and its accuracy. And problems with vaccine data are reminiscent of issues that resulted in more than 80,000 previously uncounted COVID-19 infections being added to Missouri’s tally earlier this month.
The challenges the state has had providing the public with an accurate picture of the vaccine rollout have perplexed many who have followed the situation closely, leaving some wondering why the recent improvements took months to implement.
“Throughout this entire process, I’ve just been mystified that they weren’t more prepared to do all of these logistical things,” said Chris Prener an assistant professor of sociology at Saint Louis University who has been closely tracking and compiling data on COVID cases and vaccinations in Missouri.
Changing dashboard numbers
Missouri launched its own vaccine dashboard in the wake of Centers for Disease Control and Prevention data showing Missouri ranked last in the nation for the percentage of residents with at least one dose. At the time of its launch in late January, Gov. Mike Parson had said it would provide the “most up-to-date, Missouri-specific data available” while others “tasked with reporting Missouri’s vaccine data often fail to report the complete picture.”
But the state’s own data has had gaps from the beginning.
The Department of Health and Senior Services announced Thursday it’s now using more accurate population totals for demographic groups. The same day the state also made demographic data broken down by county accessible and available to download.
The change caused some groups to see dramatic increases in their vaccination rates — with the percentage of Hispanic or Latino residents who have received their first dose instantly quadrupling, from nearly 4 percent to nearly 16 percent.
Similarly, the percentage for Asian residents increased from about 5.4 percent to 15 percent.
The rate for the 75 to 84 age group jumped by 20 percentage points from 45 percent to 65.8 percent of those residents receiving their first dose.
The percentages for other groups, like Black and white residents saw changes of just a few percentage points. But disparities in vaccination rates still persist. According to the state’s dashboard Thursday after the change was made, 9.9 percent of Black residents have received their first dose compared to 18.3 percent of white residents.
Previously, the vaccine dashboard had “relied on national population demographic percentages which were attributed to Missouri and not taking into account the differences between Missouri’s demographic landscape and national averages,” according to a news release.
Going forward, the dashboard is now using Missouri-specific demographic data from 2019 Census estimates.
Prener said it’s a section of the state’s dashboard that he has never been able to reproduce in his own analyses.
“When I dug into the dashboard, I had this moment of like, ‘Wow, this really doesn’t make a lot of sense. These numbers are not clear to me. I can’t replicate them,’” Prener said of the state’s percentages for demographic groups.
It’s not the first time changes to the dashboard have had a major impact on the data the public sees on vaccine distribution.
Last month, the number of vaccinations for demographic groups all experienced dramatic declines.
For example, on Feb. 7, the state’s dashboard showed 419,078 white residents had received at least their first dose. But a day later, that same number dropped to 323,936.
From there, the numbers continued to increase each day from the reduced level.
All other racial groups, and the remaining demographic categories of age, sex and ethnicity, also saw declines.
The reason for the decline, Cox said, was the state had been displaying all doses administered for each group. Now, the numbers reflect only the initial doses, not the booster.
Despite the changes, the state continues to over count multiracial Missourians.
As of Sunday, the state’s dashboard showed 81,041 multiracial residents had received their first dose. The would represent roughly 55 percent of the 146,653 multiracial Missourians estimated to live in the state, according to U.S. Census Bureau.
For weeks, the state has been trying to pin down why the number of multiracial Missourians showing up in the data is so high.
Adam Crumbliss, the director of DHSS’ Division of Community and Public Health, said one factor may be that some vaccinators mark residents’ race for their first dose, but not the second.
“However, if they come back a second time and they leave that column blank, that actually gets reported essentially as a separate record of race, and so it gets reported multiracial,” Crumbliss said during a meeting earlier this month of the Advisory Committee on Equitable COVID-19 Vaccine Distribution.
The state’s registration system, the Missouri Vaccine Navigator, has also undergone recent changes.
The Missouri Vaccine Navigator has had a slow adoption from vaccinators around the state. The system was launched in February — weeks after many providers had already created their own waitlists — and glitches early on caused issues for some health departments using it.
One of the upsides to the system is that it allows data to be inputted directly to the state’s immunization database, ShowMeVax, which several local health departments have said is especially useful for mass vaccination events.
But issues such as a misspelled name or incorrect birthdate must be corrected in the Vaccine Navigator data before being entered into ShowMeVax so that the info can be attributed to the correct person, said Scott Clardy, assistant director of the Columbia/Boone County Department of Public Health and Human Services.
While the data cleaning is “a reasonable and correct thing to do,” Clardy it’s also led to delays in data being transmitted.
Cox said it could take up to seven days between a vaccination clinic and getting the Vaccine Navigator data through the necessary steps to be put onto the state’s dashboard.
“It looks like that will decrease to 48 hours or less very soon with some automation that has been in progress,” Cox said.
Meanwhile, the system continues to be restrictive in other ways.
Despite over counting multiracial Missourians in its data on vaccinations, there is actually no option to select “multiracial” when registering through the Vaccine Navigator. The only options are to choose one race, “refused” or “none specified.”
When selecting which gender, in addition to male, female, prefer not to answer and other, Vaccine Navigator and the state’s consent form also simply lists “transgender.”
The Centers for Disease Control and Prevention’s guidelines recommend when collecting data on gender identity that forms include more inclusive options, such as transgender man, transgender woman, genderqueer or gender nonconforming and a fill-in-the-blank option.
Stephen Eisele, the executive director of PROMO, a statewide organization that advocates for LGBTQ equality in Missouri, said it’s emblematic of ways in which the LGBTQ community can be invisible when navigating forms and healthcare more broadly.
“For too long, it was simply male or female, and then maybe ‘other,’” Eisele said, “and just creating an environment where people are unwilling to even fill out the rest of the form, if they feel like they’re not going to get the treatment that they need.”
Eisele said it’s important to give people the ability to identify as they see themselves, and PROMO recommends when asking for gender identify that forms include the options of female, male, gender non-binary or gender nonconforming, not listed (fill in the blank) and prefer not to answer.
Data collection is just one piece, and requires targeted outreach too, Eisele said. LGBTQ people, especially those of color and who are low income, are especially vulnerable to health care and employment issues amid the pandemic, a Movement Advancement Project survey found.
A February study by the CDC also found gay, lesbian and bisexual people are at higher risk for COVID, and recommend improved data collection to help understand the scope of the disparities.
“I don’t think you can really tackle a problem,” Eisele said, “if you’re not identifying it and naming it.”