The COVID-19 pandemic has disproportionately affected racial and ethnic minority groups in the United States. Although a promising solution of the COVID-19 vaccination offers hope, disparities in access again threaten the health of these communities. Various explanations have arisen for the cause of disparate vaccination rates among racial and ethnic minorities, including discussion of vaccine hesitancy. Conversely, the role of vaccine accessibility rooted in structural racism as a driver in these disparities should be further explored. This paper discusses the impact of structural barriers on racial and ethnic disparities in COVID-19 vaccine uptake. We also recommend public health, health system, and community-engaged approaches to reduce racial disparities in COVID-19 disease and mortality.