Year of Publication



Public Health

Date Available


Degree Name

Master of Public Health (M.P.H.)

Committee Chair

Sarah B. Wackerbarth, PhD

Committee Member

Kathi L. Harp, PhD

Committee Member

Elizabeth N. Riley, PhD


Objective: COVID-19 is a potentially severe respiratory disease caused by infection from the SARS-CoV-2 virus. COVID-19 was first discovered in 2019 and vaccines against the virus began development in early 2020. COVID-19 vaccines are effective at preventing severe illness, hospitalizations, and death from SARS-CoV-2 infection. Clark Memorial Health is a 236-bed community health system located in southern Indiana. As one of the first four hospitals in the state of Indiana to receive the Pfizer-BioNTech’s COVID-19 vaccine in December of 2020, this health system led the area in vaccine administration. Prior to the emergency use authorization (EUA) of the COVID-19 vaccines, there were fears that vaccine confidence lacked in certain demographics of patients, including those of non-white race and those of reproductive age. The purpose of this study was to determine disparities in uptake of the COVID-19 vaccine during Indiana’s primary vaccine series rollout.

Methods: This retrospective cohort study analyzed patients vaccinated at the Clark Memoria Health vaccine clinic between December 2020 and May 2021. Data were collected from the Children and Hoosier Immunization Registry Program (CHIRP) and stratified by vaccine administration site, date of vaccination, race/ethnicity, and date of birth (age). Only those vaccinated at the Clark Memorial Health vaccine clinic during this time frame were included for analysis in this study. Those younger than 18 years old were excluded as well as those missing information on race or date of birth. The primary objective of this study was to determine if there was lower-than-expected vaccine uptake in those of non-white races during the primary vaccine series rollout. A goodness of fit chi-square analysis was run comparing the population vaccinated at the Clark Memorial Health vaccine clinic to the complete surrounding population of Clark County, Indiana. A goodness of fit chi-square analysis was run using the same comparison population to determine a secondary objective of this study. The secondary objective attempted to generate a hypothesis on vaccine confidence and uptake in female reproductive-age and same-aged males.

Results: There were 20,488 patients that met criteria for inclusion in this study. Of this population, 7.05% were of non-white races compared to 17.6% in the Clark County, Indiana, population. The vaccinated population had a lower frequency of non-white races than expected as shown by a significant difference in the racial distribution of the two populations (chi-square 1,572.9, p <0.0001). The vaccinated population consisted of 38.1% reproductive-age females and same-aged males compared to 35.1% in the Clark County, Indiana, population. Results of this chi-square goodness of fit also showed a significant difference between the vaccinated population and the comparison population (chi-square 84.3, p <0.0001). The vaccinated population had a higher frequency of reproductive-aged females and same-aged males than expected.

Conclusion: The population vaccinated at the Clark Memorial Health vaccine clinic did not match the surrounding population of Clark County, Indiana, in regard to race or age. There was a lower percentage of non-white vaccinated persons than expected, which further adds to the growing body of literature showing COVID-19 vaccine hesitancy in non-white populations. Another common reason for vaccine hesitancy was fear of impaired fertility. The population vaccinated at Clark Memorial had a higher percentage of female reproductive-age and same-aged males than expected and suggests that fertility fears may not have affected COVID-19 vaccine confidence in this community.