Disaggregated Data Key to Tackling Low Maternal Vaccination Rates among Boston’s Black Pregnant Population

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By: Jodian Pinkney, Infectious Diseases Physician. She is currently a Fellow in the Commonwealth Fund Fellowship in Minority Health Policy and is enrolled in the Harvard School of Public Health MPH-45 program in Health Policy with a concentration in Maternal and Child Health.

Maternal Respiratory Syncytial Virus (RSV) vaccines risk becoming the latest casualty of low vaccine uptake among Black pregnant people in Boston. Last year, the city of Boston hosted over 12,000 Infectious Disease specialists at the annual Infectious Diseases Society of America meeting, celebrating a multitude of breakthroughs in the field, notably the FDA’s approval of maternal RSV vaccines. However, achieving high RSV vaccination rates for Black pregnant people in Boston will require Open Data on the city’s maternal vaccination rates by language and nativity. To demonstrate the significance of understanding these characteristics, I will begin with a recent encounter of mine.

My pregnant coworker breathed a sigh of relief when I informed her that she no longer needed the RSV vaccine, as the RSV season ended on January 31, 2024. She also shared that she had not had a conversation with her obstetrician or primary care physician about it, despite her eligibility based on her gestational age. Like me, she was a Black immigrant living in Boston, though our roots stretched across different terrains—hers from an African nation and mine from the Caribbean. As our conversation deepened, she revealed that her intense fear of needles, otherwise known as trypanophobia, was one of the main drivers of her fear of getting the RSV vaccine.

Given the brevity of our encounter, I was unable to gather more information about the complexities of her RSV vaccine-decision making process. However, I was concerned that her health care team had not discussed this decision with her, despite the considerable benefits it offers for her infant, and healthcare provider recommendations being dubbed one of the most powerful motivators for maternal vaccination. I also pondered whether her fear of needles would have been earnestly acknowledged or quickly dismissed, as has unfortunately all too often been the case for Black pregnant individuals within the US healthcare system.  While trypanophobia as a reason for vaccine avoidance was quite familiar to me as a Caribbean immigrant, I recognized it was much rarer in the US, one of the many unexplored differences that could exist between US-born and non-US-born Black pregnant individuals. Would her health care team possess the same cultural competency to permit a meaningful discussion around her vaccine fears?

As the demographic composition of the Black pregnant population in Boston continues to evolve, recognizing and understanding the role of nativity and language in health behaviors will become crucial for public health officials and healthcare providers. For instance, in 2016, approximately 10% of Black residents in Massachusetts had limited English proficiency— a surrogate marker for national origin— indicating a staggering 300% increase from 2010. In Greater Boston alone, 37% of Black adults identified as immigrants, with Haitian Creole being the second most common language spoken following English. Alarmingly, a secondary analysis of the national Surveillance for Emerging Threats to Mothers and Babies Network (SET-NET) database revealed that between May 2021 and May 2022, only 38% of Black pregnant individuals in Massachusetts were vaccinated against COVID-19 compared with 56% of White pregnant individuals. Those with limited English proficiency, a surrogate for being non-US  born, faced even lower rates, with only 34% of Haitian Creole-speaking and 21% of Cape-Verdean-speaking pregnant individuals receiving vaccination, compared to 55% of English speakers. To date, it remains uncertain whether these disparities stemmed solely from language barriers or if cultural differences, such as trypanophobia, influenced this trend.

Open Data: A Catalyst for Change

Open Data alludes to freely available electronic data that can be accessed and analyzed by anyone, complying with relevant privacy laws to ensure individual identities are protected. Open Data played a pivotal role in drawing national attention to the gravely low maternal COVID-19 vaccination rates, particularly affecting Black pregnant individuals in August 2021. The ensuing collaborative efforts between public health agencies, healthcare providers, pharmacies, community leaders and non-profit organizations, led to a remarkable increase in maternal COVID-19 vaccination rates from 50% in late 2021 to 71% in early 2022. However, racial disparities persisted, with Black pregnant individuals having the lowest COVID-19 vaccination rate across all racial groups for that time period. The racial disparities observed for maternal COVID-19 vaccinations are not unique. Black pregnant individuals have consistently had the lowest uptake of all maternal vaccines recommended by the Advisory Committee on Immunization Practices (ACIP), including the TDAP (tetanus, diphtheria, and pertussis) and influenza vaccines. However, differences in maternal vaccination rates between US-born and non-US-born Black pregnant people remain hidden in the shadows.

Open, disaggregated data on nativity and language holds immense potential to empower health care providers and public health officials with the information they need to effectively engage patients, communities, the media, and policymakers in a manner that catalyzes the elimination of racial and ethnic disparities in maternal vaccination. Advocacy for disaggregated data, has already been championed by Asian Americans Advancing Justice for AANHPI communities. Utilizing disaggregated data, they uncovered notable differences within the Asian American population. For example, they found that the rate of poverty among Asian Americans varied from 6.8% among Filipino Americans to 39.4% among Burmese Americans. They concluded that without recognizing these differences in nativity, policymakers could not effectively address the needs of Asian Americans. Similar analyses could enhance our understanding of the vaccine decision-making process across diverse subpopulations of pregnant Black Bostonians including the relative weight of high out-of-pocket costs of RSV vaccines, language-congruent care and culturally competent care in the vaccine decision-making process in each subpopulation.

Potential sources of Open Data on maternal nativity and language include the Centers for Disease Control and Prevention (CDC) as they have already provided Open datasets including the Behavioral Risk Factor Surveillance System (BRFSS). BRFSS has been used to inform the strategic distribution of COVID-19 vaccines, by identifying preferences in locations ( for e.g., pharmacies versus healthcare providers) for groups at high risk of severe COVID-19 disease.

Achieving high vaccination rates for Black pregnant people in Boston will require the disaggregation of the city’s maternal vaccination data by nativity and language. Let’s not allow history to repeat itself. Instead, let’s get ahead of the curve for the equitable delivery and uptake of maternal RSV vaccinations. This proactive approach not only improves immediate health outcomes for mothers and their infants, but also sets the precedent for the equitable and effective delivery of all future maternal vaccines.