The United States fell short of its July 4 vaccination goals. Here’s where the biggest coverage disparities remain.

In May, President Joe Biden’s administration announced a new goal to administer at least one dose of Covid-19 vaccine to 70% of adults — and to have 160 million people fully vaccinated — in the United States by July 4. At the time, the pace of vaccinations was well on track to meet, and exceed, this goal. But vaccination rates have slowed to less than half of what they were at the time of the announcement, and the administration fell short of its goal by millions of people.

As of July 4, about two-thirds of adults in the US had received at least one dose of Covid-19 vaccine and about 157 million people were fully vaccinated, but coverage varied widely among different groups. And as vaccination progress stalls, large disparities remain between who has been vaccinated and who has been most affected by the coronavirus.

While the Biden administration’s July 4 goal focused on the number of adults who were at least partially vaccinated, the share of the total population that is fully vaccinated better represents the level of protection against Covid-19.

Here’s the share of vaccinations by race and ethnicity. At first, vaccine coverage among White people relative to their share of the US population far outpaced other groups. But that gap has started to close, as Black and especially Hispanic people have accounted for a larger share of vaccinations over the past couple of weeks.

Yet, groups that have been most affected by Covid-19 remain underrepresented among those who have been vaccinated.

White Americans make up about 50% of all US Covid-19 cases, but more than 60% of those vaccinated. The most troubling disparities are among groups who have been disproportionately affected by Covid-19 but are underrepresented in vaccinations.

Black and Hispanic communities have been particularly hard hit by the pandemic. About 29% of Covid-19 infections in the US were among Hispanic people, more than their 17% share of the total population — but Hispanic people have only received 15% of vaccinations. Similarly, more than 11% of Covid-19 cases have occurred among Black people, who make up 9% of all vaccinations.

Adults 65 and older were eligible for the vaccine earlier than others, and vaccination coverage among seniors has continued to climb. More than 78% of those 65 and older are fully vaccinated, accounting for more than a quarter of those vaccinated. But as the pace of vaccinations has slowed, disparities have grown between those being vaccinated and those falling sick.

Adults ages 18 to 29 make up the largest share of Covid-19 cases reported since the start of the pandemic, as well as in recent weeks. But they make up the smallest share of those who are vaccinated with the exception of minors, not all of whom are eligible to receive a vaccine.

This is a particular concern among health officials in the US as the Delta variant spreads rapidly across unvaccinated populations. The Biden administration specifically identified adults under 27 as the group that would miss the July 4 goal.

Geographic disparities exist, as well. Here’s the share of vaccinations by US region. The South is the most populous region in the country and has the largest share of vaccinated people. But the region recorded an even larger share of Covid-19 cases throughout the pandemic, and vaccination progress lags in many Southern states.

Covid-19 cases are surging in some under-vaccinated regions — particularly the South and Midwest — threatening progress and risking the development of new variants. The largest gap between vaccinations and cases is in the South, where several states, including Alabama and Louisiana, have vaccinated less than 40% of their population with at least one dose.

State leadership has played a critical role in the vaccination campaign. There was “a tremendous amount of planning week-by-week” as supply allocations remained in flux and distribution plans adjusted to reach the most vulnerable populations fastest, said Rebecca Weintraub, director of vaccine delivery at Ariadne Labs, a joint center for health systems innovation at Brigham and Women’s Hospital and the Harvard T.H. Chan School of Public Health.

But little direct support was offered to states that had already been “beleaguered” by resource strains throughout the pandemic, she said. “We spent billions developing vaccines, but did not invest in delivery systems and left states to create systems on their own.”

States with less restrictive prioritization groups — including Alaska and West Virginia — surged ahead with vaccination rates early on. But with everyone 12 and older in the US now eligible for vaccination, vaccine hesitancy, along with access and communication issues, have driven a widening divide.

Percent of total population that is fully vaccinated

<40%

40-45%

45-50%

50-55%

55%+

NH

WA

ME

VT

MT

ND

MN

OR

ID

NY

WI

MA

SD

WY

MI

PA

IA

NE

NV

OH

IL

IN

UT

CO

WV

VA

RI

KS

KY

MO

CA

CT

NC

TN

OK

AZ

SC

NJ

NM

AR

AL

MS

GA

DE

TX

LA

MD

FL

AK

DC

HI

Mississippi and Alabama are among the top five states with the lowest vaccination rates.

<40%

40-45%

45-50%

50-55%

55%+

NH

WA

ME

VT

MT

ND

MN

OR

ID

NY

WI

MA

SD

WY

MI

PA

IA

NE

NV

OH

IL

IN

UT

CO

WV

VA

RI

KS

KY

MO

CA

CT

NC

TN

OK

AZ

SC

NJ

NM

AR

AL

MS

GA

DE

TX

LA

MD

FL

AK

DC

HI

Mississippi and Alabama are among the top five states with the lowest vaccination rates.

<40%

40-45%

45-50%

50-55%

55%+

NH

WA

ME

VT

MT

ND

MN

OR

ID

NY

WI

MA

SD

WY

MI

PA

IA

NE

NV

OH

IL

IN

UT

CO

WV

VA

RI

KS

KY

MO

CA

CT

NC

TN

OK

AZ

SC

NJ

NM

AR

AL

MS

GA

DE

TX

LA

MD

FL

AK

DC

HI

Mississippi and Alabama are among the top five states with the lowest vaccination rates.

Source: Centers for Disease Control and Prevention

With states managing their own decentralized reporting systems, some data gaps have proven difficult to fill. Race and ethnicity is missing for about a third of vaccination records, according to the Centers for Disease Control and Prevention (CDC), while age and gender are missing for about 1 in 10 records.

“We do operate at a little bit of a disadvantage because of the lack of specificity in the data,” Dr. Lisa Cooper, co-chair of the National Institutes of Health Community Engagement Alliance Against COVID-19 Disparities steering committee, told CNN. “But a lot of other things — like knowing the demographics of particular ZIP codes — help give us a good idea of who we’re missing, and I don’t think it’s hampering what we need to do.”

What we need to do, she said, is determine which messages resonate with people to ensure that those who have not yet been vaccinated are fully equipped with the knowledge to battle misconceptions.

Demographic breakdown of states with the lowest percent of total population vaccinated:

Share of vaccinations

Share of population

Mississippi

36% of residents given at least one shot

58%

58%

38%

36%

3%

3%

2%

1%

Louisiana

39% of residents given at least one shot

62%

59%

32%

29%

7%

5%

3%

2%

Idaho

40% of residents given at least one shot

89%

83%

13%

10%

2%

0.7%

0.7%

1%

Alabama

40% of residents given at least one shot

68%

67%

27%

25%

5%

4%

3%

1%

Share of vaccinations

Share of population

Mississippi

36% of residents given at least one shot

58%

58%

38%

36%

3%

3%

2%

1%

Louisiana

39% of residents given at least one shot

62%

59%

32%

29%

7%

5%

3%

2%

Idaho

40% of residents given at least one shot

89%

83%

13%

10%

2%

0.7%

0.7%

1%

Alabama

40% of residents given at least one shot

68%

67%

27%

25%

5%

4%

3%

1%

Share of vaccinations

Share of population

Mississippi

Louisiana

36% of residents given at least one shot

39% of residents given at least one shot

62%

59%

58%

58%

38%

36%

32%

29%

7%

5%

3%

3%

3%

2%

2%

1%

Idaho

Alabama

40% of residents given at least one shot

40% of residents given at least one shot

89%

83%

68%

67%

27%

25%

13%

10%

5%

4%

2%

0.7%

0.7%

1%

3%

1%

Source: Kaiser Family Foundation. 39.9% of Wyoming residents have received at least one dose of the Covid-19 vaccine, but the state does not provide demographic vaccination data.

Some of that responsibility to communicate and build trust falls to the federal government, Cooper said. But as with actual vaccine logistics, much of the work will come down to state and local actors.

“It matters what the CDC says. It matters what President Biden says. It’s certainly their responsibility to send out clear messaging and to provide support and to be role models,” she said. “But when the rubber meets the road, it’s the local context — the door-to-door stuff — and meeting people where they are that will make the difference.”

Even with the disparities that remain, Cooper said she is “encouraged” by progress in vaccinations.

“Given the misinformation and conflicting messaging that people have gotten over the past year, it could have been a lot worse than it is. But I’m encouraged that close to 50% of the US population is (fully) vaccinated.”

Dr. Georges Benjamin, executive director of the American Public Health Association, agreed and said he doesn’t think that coming in short of the July 4 goal should be viewed as a failure.

“I believe in goals. What gets measured gets done, and (Biden’s goal) was an aspirational goal to try to move us forward to what I hope is 80 or 90% of our population at some point,” he said.