State/Local/Territorial Immunization Program Vaccine Hesitancy/Confidence/Safety

Activities-Lessons Learned- Recommendations

Katelyn Wells PhD

AIM Research Coordinator

AIM Best Practice Webinar 6/17/2014

1

Objectives

Understand IP priority level for addressing Vaccine Hesitancy/Confidence/Safety (VHCS)

Provide examples of IPs VHCS activities

Review top challenges and successes

Review IP recommendations to NVAC to help support state/local efforts (not official AIM recommendations)

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Methods: Information Gathering

2013 AIM Annual Survey – Preliminary Results (open 1/2014-3/2014)

AIM VHCS Survey and follow-up emails (open 3/31/2014-4/8/2014)

AIM VHCS Webinar – 3/12/2014

AIM VHCS Peer-to-Peer Sharing Call – 9/29/2013

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No Response

(13%, N=8)

Not a priority Moderate priority Low priority

(1%, N=1) (28%, N=18) (13%, N=8) (31%, N=20)

High Priority Essential Priority

(14%, N=9)

Immunization Program Priority Level for Addressing

Vaccine Hesitancy/Confidence - CY2014

2013 AIM Annual Survey – Preliminary Results 4

Cities / Metropolitan Areas Territories Chicago American Samoa

District of Columbia Guam

Houston Republic of Marshall Islands

New York City Federated States of Micronesia

Philadelphia Northern Mariana Islands

San Antonio Palau

Puerto Rico

Virgin Islands

Immunization Program Priority Level for Addressing

Vaccine Hesitancy/Confidence - CY2014

Cities / Metropolitan Areas &Territories

No Response

(13%, N=8)

Not a priority Moderate priority Low priority

(1%, N=1) (28%, N=18) (13%, N=8) (31%, N=20)

High Priority Essential Priority

(14%, N=9)

2013 AIM Annual Survey – Preliminary Results 5

Immunization Program Priority Level for Addressing

Vaccine Hesitancy/Confidence - CY2014

No Response

(13%, N=8)

Not a priority or low priority

(14%, N=9)

Moderate to Essential Priority

(73%, N=47)

2013 AIM Annual Survey – Preliminary Results 6

Low priority Moderate priority High Priority Essential Priority

2013 AIM Annual Survey – Preliminary Results

7

No

Response

VHCS Only

VHCS Survey

Response Only Moderate priority Low priority

(3 of 18; 17%) (3 of 8; 38%) (8 of 20; 40% )

High Priority Essential Priority

(8 of 9; 88%)

2013 AIM Annual Survey – Preliminary Results & AIM VHCS Survey Results 8

IP responding to AIM VHCS Survey by Priority Level for Addressing

Vaccine Hesitancy/Confidence - CY2014 (24 of 64; 38%)

Puerto Rico

Guam

American Samoa

San Antonio

(2 of 8; 25%)

9 AIM VHCS Survey Results - 3/31/2014-4/8/2014

Program Activities: VT Tailored Mass Media Campaign

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“It’s Ok to Ask”

Campaign Contracted with a marketing group

Reviewed key research findings

Held focus groups

Worked with local pediatricians to create a “Vermont” feel www.oktoaskvt.org

YouTube

Face Book

Twitter

TV Ads

Posters

Present information in a way that parent’s fears and concerns are addressed and acknowledged

Create a brand that is positive, approachable and transparent

Provide audience with the information they need via the channels they use

Provide healthcare professionals effective tools

Campaign Strategy:

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Lessons Learned

Model great for gathering different perspectives

Neutral, 3rd party facilitator important

- Importance of available funding to conduct activity

Invite your opposition (but beware)

Steering Committee/Stakeholders should be mutually exclusive

Program Activities: CO Stakeholder Engagement Process

Gain a better understanding of the current state of PBE attitudes and opinions

Meaningfully participate in facilitated in-depth discussions on current PBE policies and practices

Generate potential policy and/or rule changes to the PBE system.

Make final recommendations to be formally submitted to CDPHE in a written report.

Goals

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Connecticut Immunization Registry and Tracking System (CIRTS) captures vaccine refusals

From drop down field - select which vaccine(s) were refused

CIRTS is capable to run a report on vaccine refusals by provider or by Zip Code

CT plans to run these reports in the future

11 Immunization Action Plan (IAP) Coordinators located throughout the state

Target areas of need and conduct outreach

Work closely with the provider offices

Program Activities: CT Capturing Vaccine Refusal in IIS

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New Hampshire staff address vaccine confidence at provider site visits (VFC/AFIX or VFC-only)

Issue is prompted by required CDC site-visit question "Do your health care providers follow the current ACIP routine immunization schedule?"

Provides an opportunity for discussion about: delayed vaccination schedules vaccine hesitant parents how the practice documents vaccine refusals why a delayed vaccination schedule is not recommended

Provides resources: Current Childhood, Adolescent, Adult Immunization schedules Revised Standards for Childhood/Adolescent Immunization Practices Links to web-based resources (Needle tips, etc.)

Program Activities: NH Addressing VHCS at Provider Site-visits

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School exemption form captures parental reasoning for claiming religious and philosophical exemptions

This information is collected and maintained by schools Information was collected and shared with healthcare providers during the

annual Shot Smarts immunization conference -2011 (not routinely collected)

Parent focus groups to assess views Created “Dear Doc” videos

Shot Smarts immunization conferences

Website and Facebook page

Program Activities: ID Assessing Vaccine Refusal and Developing Targeted Approaches

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Established a partnership, called Vax Northwest, to address vaccine

hesitancy http://www.vaxnorthwest.org/

Created a toolkit for providers to support them engaging in

conversations with parents who are hesitant to vaccinate

Created the AAA Approach

Training Videos

Conversation Guide

Literature

Common Questions About

Immunizations fact sheet

Program Activities: WA Partnering to Educate Providers

Lessons Learned: Successes

Partner/Collaborative Approach Partnering with Coalitions (NV; MN; WV; HI; PR)

Task Force (WV)

Partnering with AAP (MA; NC; RI; IA; HI )

Stakeholder Process of Exemption (CO)

Partnering and Community Events (Guam)

Improved Legislation or Policy (VT; OR; WA; NY)

HPV Grant Funding (NY)

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Lessons Learned: Successes

Assessment/Reporting

Identifying VCHS clusters and working with the schools (LA)

IZ Annual Report (VT)

IIS (CO; ID)

Research Project (OR)

Providing quarterly coverage rates (ME)

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Lessons Learned: Successes

Education

Provider Education (NV; WA; PR; NV; SA; RI; WV; ME)

Peer - Parent Education (WA)

Targeted Public Education Campaigns (MN; NC)

Web - Based Tactics/Campaign (VT; ID; PR)

Annual Provider Conference (ID; WY)

Education Materials to Schools & Daycare Facilities (ID)

Educating Parents Before Vaccination & Following - up With Parents After Vaccination (Amer. Sam.)

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Lessons Learned: Challenges

Legislation/Policy (LA; MA; AZ; NM)

Lack of Knowledge Scope of VHCS Among Parents and Providers (NY)

Parent Focus (PR; Amer. Sam.)

Communication Connecting Parents With Reliable Resources/Wrong Information

(SA; RI; HI; PR; WY; NC; ID)

Provider Communication Style/Time/Hesitancy

(WV; NC; NM; PR; WA; MN)

State - Based Media Communications - Marketing (LA; MN; MA)

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Lessons Learned: Challenges

Resources Rural nature and accessing providers a challenge (e.g., transportation) (WA)

Funding (NV; RI; OR; WY)

Lack of Coalition (Guam)

Lack of Support from Child-Care Agency (VT; NM )

Targeted Groups Adolescents (NV)

Refugee Populations – low rates (WA)

Anti- Movement Increase of Alternative Schedules (MN; OR; WA )

Anti-vax Group (VT; CO; OR; WA; PR)

Distrust in Government (ID; RI)

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Unofficial AIM Recommendations to NVAC

Encourage strengthened school exemption laws

Encourage a coordinated national campaign addressing VHCS issues and highlighting the importance of timely immunizations

Encourage research efforts that addresses how state/local/territorial health departments can effectively address vaccine hesitancy/safety – Provider & Population Level

Explore if and how VHCS (provider and patient) can be formally incorporated into IP provider site visits

Encourage the expansion of Immunization Information Systems (IIS) to capture vaccine refusal and exemptions

Encourage ongoing funding opportunities to support IP: venues for training/education & resources to plan, execute and maintain a targeted VHCS campaign

Dr. Melinda Wharton – 3/27 AIM General Membership Call 22

“The rhetoric is out of proportion to the extent

of the problem. It threatens understanding

that it is normative behavior to be vaccinated.”

State/Local/Territorial

IP

Providers

Immunization Organizations & Coalitions

Federal Agencies

Parent Groups

Researchers

Provider Organizations

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Katelyn Wells, PhD

AIM Research Coordinator

615-469-5486

kwells@immunizationmanagers.org

WWW.IMMUNIZATIONMANAGERS.ORG

@AIM_IZ