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鈥檚 centralized system.
Nearly four months into Missouri鈥檚 distribution of the COVID-19 vaccine, the state continues to struggle with data issues 鈥� 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 . And problems with vaccine data are reminiscent of issues that being added to Missouri鈥檚 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.
鈥淭hroughout this entire process, I鈥檝e just been mystified that they weren鈥檛 more prepared to do all of these logistical things,鈥� said Chris Prener an assistant professor of sociology at Saint Louis University who has been 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 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 鈥渕ost up-to-date, Missouri-specific data available鈥� while others 鈥渢asked with reporting Missouri鈥檚 vaccine data often fail to report the complete picture.鈥�
But the state鈥檚 own data has had gaps from the beginning.
The Department of Health and Senior Services announced Thursday it鈥檚 now using more accurate population totals for demographic groups. The same day the state also made and available to download.
The change caused some groups to see dramatic increases in their vaccination rates 鈥� 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 . According to the state鈥檚 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 鈥渞elied on national population demographic percentages which were attributed to Missouri and not taking into account the differences between Missouri鈥檚 demographic landscape and national averages,鈥� .
Going forward, the dashboard is now using Missouri-specific demographic data from .
Prener said it鈥檚 a section of the state鈥檚 dashboard that he has never been able to reproduce in his own analyses.
鈥淲hen I dug into the dashboard, I had this moment of like, 鈥榃ow, this really doesn鈥檛 make a lot of sense. These numbers are not clear to me. I can鈥檛 replicate them,鈥欌�� Prener said of the state鈥檚 percentages for demographic groups.
It鈥檚 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鈥檚 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 .
As of Sunday, the state鈥檚 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鈥� Division of Community and Public Health, said one factor may be that some vaccinators mark residents鈥� race for their first dose, but not the second.
鈥淗owever, 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,鈥� Crumbliss said during a meeting earlier this month of the Advisory Committee on Equitable COVID-19 Vaccine Distribution.
Vaccine Navigator
The state鈥檚 registration system, , has also undergone recent changes.
On Thursday, residents who had signed up through the system received an email letting them know that its privacy policy had been updated and asking whether they would opt in. The change will now allow local public health departments to obtain registrant lists for their events from the system, Cox said.
The Missouri Vaccine Navigator has . The system was launched in February 鈥� weeks after many providers had already created their own waitlists 鈥� 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鈥檚 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 鈥渁 reasonable and correct thing to do,鈥� Clardy it鈥檚 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鈥檚 dashboard.
鈥淚t looks like that will decrease to 48 hours or less very soon with some automation that has been in progress,鈥� 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 鈥渕ultiracial鈥� when registering through the Vaccine Navigator. The only options are to choose one race, 鈥渞efused鈥� or 鈥渘one specified.鈥�
When selecting which gender, in addition to male, female, prefer not to answer and other, Vaccine Navigator and also simply lists 鈥渢ransgender.鈥�
The Centers for Disease Control and Prevention鈥檚 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鈥檚 emblematic of ways in which the LGBTQ community can be invisible when navigating forms and healthcare more broadly.
鈥淔or too long, it was simply male or female, and then maybe 鈥榦ther,鈥欌�� Eisele said, 鈥渁nd just creating an environment where people are unwilling to even fill out the rest of the form, if they feel like they鈥檙e not going to get the treatment that they need.鈥�
Eisele said it鈥檚 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 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.
鈥淚 don鈥檛 think you can really tackle a problem,鈥� Eisele said, 鈥渋f you鈥檙e not identifying it and naming it.鈥�
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