State releases race data for vaccinations, but nearly half of it is missing

Well, we now know a bit more about the racial disparity in Michigan’s vaccination rollout so far. But not much.

And that’s frustrating, because if the CDC’s numbers are any indicator, the same communities that were disproportionately impacted by COVID-19 (especially Black communities) are getting short shrift so far when it comes to receiving the vaccines. 

On Tuesday, the Michigan Department of Health and Human Services finally released the racial data it’s been collecting about the 1.2 million people who’ve received at least one dose of the vaccine so far. (Most states have already released at least some information about race.)

But turns out, more than half a million of those Michiganders “do not have race information recorded,” according to a state press release.

Here’s what we know:

• 43.7% are unknown.
• 41.7% are white.
• 9.5% are listed as other.
• 3.7% are Black.
• 1.1% are Asian or Pacific Islander.
• 0.3% are American Indian/Alaskan Native race

Wait, we don’t know the race/ethnicity of 43% of those vaccinated?

Obviously, that’s a pretty big chunk of missing data, and the explanation for why it’s missing is complicated and murky. (TLDR: the state’s tracking vaccinations with an old system that wasn’t built for this, and they’re having technical issues that are hopefully getting ironed out now.)

That system is called the Michigan Care Improvement Registry system, or MCIR (say “MICK-er.”) It’s been around since 1998, and it was originally a way to track kids’ vaccination records, so a school or a doctor could see your whole immunization history in one place. It was later changed to include adults, too.

So the good news is, hospitals are used to it, and the electronic medical records your doctor uses are built to play nicely with it. And it makes sense that when we’re rolling out a mass public vaccination campaign of unprecedented magnitude, we’d use a system that both the state officials and the health systems know: our old friend, MCIR. 

But before the COVID vaccine rollout, MCIR wasn’t tracking race and ethnicity information. There literally wasn’t a data field to enter it into. So in preparation for the COVID vaccines, MCIR was “expanded to include race and ethnicity from clinical medical records,” MDHHS spokesperson Lynn Sutfin said in an email Tuesday.

(We’ll come back to the medical records part, because that’s important.)

Hospital systems and health departments were supposed to change their systems, too, to “include race data for upload to the MCIR,” Sutfin said. And if your doctor didn’t have that information in their electronic medical records, the state has a few other cards up its sleeve to complete the picture.

“Data from birth certificates are also included in MCIR for people born after 1987,” Sutfin said. “For records missing information, MCIR is also linked with the MDHHS Master Person Index to pull data on race from Medicaid, Bridges, and other systems.”

So what’s the problem?

So, this part, the electronic medical records, appears to be going ok. The state says 85% of the race and ethnicity information it does have for vaccinations, comes from those electronic medical records (or EMRs, but the last thing we need right now is another abbreviation.)

But a lot of places, like county health departments, have been doing mass vaccination clinics, trying to get shots into as many arms as possible. (In some clinics, you literally drive your car into a big warehouse at your appointment time. A staff member comes up and takes your information, gives you a shot, waits to make sure you don’t have a bad reaction, and you drive back out once you’re done.)

And most of these mass clinics weren’t using electronic medical records, Sutfin said. Instead, they were just typing the data they’d collect from you, directly into MCIR. And apparently you literally could not enter race/ethnicity info into MCIR by hand. Sutfin said they just fixed that.

“MDHHS development team recently added a hand entry field for race and ethnicity data into the MCIR,” she said. “This will make it possible for local health and other providers who are entering data directly into MCIR to include missing race and ethnicity in the record...Now that they can do so, we have asked local health departments to begin backfilling race information. We expect this number to begin improving.”

State officials are also reminding anyone who does get a vaccine, to fill out the forms that ask them for their race and ethnicity.

“We urge Michiganders to fill out race data questions on forms when they get their vaccine,” said Dr. Joneigh Khaldun, the state’s chief medical executive. “Knowing this information helps guide the state’s strategy and allows us to address any gaps as we move forward getting Michiganders protected from the virus.”

Can we glean anything from the 56% of people whose race/ethnicity we do know?

Yes, and it’s not good. Just over 3% of those who’ve received at least one dose of the vaccine are identified as Black. It’s not an apples to apples comparison until we have more data, but for perspective, 14% of the state’s population is Black.

Some of this could also be a reflection of the demographics of those eligible to get the vaccine: nationally, about 60% of health care workers are white. But again, it’s hard to know without more data.

“The cumulative COVID-19 case rate has been 40% higher for Black Michiganders than white residents and the death rate for Black residents has been over three times the rate in white residents,” state officials said in Tuesday’s release. “The percent of vaccinated people who are Black has more than tripled between the first three weeks and the last week of vaccination (0.5% to 3.7%), but the proportion of vaccinated adults 16 and older who are Black is far lower than the proportion of Black residents in Michigan.”

So getting better at tracking the race of who's getting vaccinated will be critical to evaluating whether the national and state equity programs are working. And lack of data isn't just a Michigan problem: the CDC only has race data for about 54% of those vaccinated nationally, too (it's not clear whether Michigan's numbers are included yet). How's this for a disclaimer:

If you want to look at all states that are reporting vaccinations by race, and compare it to their demographics and COVID cases, check out this analysis by KFF (previously the Kaiser Family Foundation.)