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A summary of presentations from the weekly Summit partner webinars

August 31, 2023 – The latest Summit Summary

CDC Dashboard and Influenza Update – Alicia Budd (CDC)

Alicia Budd, MPH, Influenza Division, CDC gave an update on the CDC dashboard and influenza.

CDC has three surveillance system dashboards on the NCIRD webpages to show relative amounts of respiratory virus activity according to each pathogen: RSV, COVID-19, and flu

  • Weekly Emergency Department Visits by Age Group (Emergency Department Visits)
    • Based on discharge diagnosis for one of the three pathogens
    • National level
    • Seeing an uptick in COVID-19 activity; flu and RSV remaining stable at low levels
    • Data by age
      • See how viruses are behaving within a particular age group or pick the pathogen to see what’s going on with each age group
      • COVID-19 is increasing in all age groups
      • RSV activity in age 0–1 years is higher than other age groups and increasing slightly (not increasing in other age groups)
    • Respiratory Virus Laboratory Emergency Department Network Surveillance (RESP-LENS)
      • Emergency data looking at the percent of specimens testing positive for a particular pathogen from people who went to the emergency department
      • COVID-19 activity is increasing
      • RSV and flu are hovering at much lower levels
      • Not everyone that comes in is tested for all of the three organisms, but the amount of testing has been increasing recently
      • Data by region
        • A few regions are showing stable or decreasing values for COVID-19 during week ending August 19 compared to prior week
      • Data by age by percent of tests that are positive for each virus(es)
        • You can pick an age group and see all three viruses within that age group
        • Or pick a virus and look at all the different age groups for that virus
        • Trends have been increasing for COVID-19 activity
        • Flu is trending at low levels for all age groups
      • Weekly Rates of Respiratory Virus-Associated Hospitalizations by Season (FluSurv-NET)
        • Hospitalization data for the three pathogens
        • Data more prone to changes with backfill (i.e. when delays occur in reporting and older weeks’ reports are updated)
        • COVID-19 has been increasing in recent weeks

Influenza Activity

  • Clinical lab data from public health lab data perspective – flu is stable at low levels nationally
  • Last season was an influenza A/H3N2 predominant season
  • Seeing more influenza A/H1N1 and B; less H3N2 this season so far
  • Outpatient respiratory illness
    • Slight uptick in percent of visits for respiratory illness; similar to other seasons
    • Below baseline but starting to see upward trend as children go back to school
      • Children have the highest level of respiratory illness at this time
    • Southeastern part of the country has higher rates of flu; may be due to children going back to school earlier than in other parts of the country
    • Hospitalization data (HHS Protect) show low levels of flu
    • Percent of deaths due to pneumonia, flu, and COVID-19 (PIC) seeing an uptick in recent weeks
      • Driven by COVID-19 and not flu
      • Hardly any flu deaths at this time
    • Pediatric deaths are up to 172 reported to CDC for the 2022-23 season

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CDC Respiratory Virus 2023-2024 Communications Update – Erin Burns (CDC) and Elizabeth Greene (CDC)

Erin Burns, MA, Associate Director for Communications Science, Influenza Division, NCIRD, CDC, and Elizabeth Greene, BS, Associate Director for Communication, Coronavirus and Other Respiratory Viruses Division (CORVD), NCIRD, CDC, gave an update on the CDC respiratory virus 2023–2024 communications. Panelist on the flu team at CDC: Nicole Richardson-Smith.

Erin Burns – CDC Communications Update

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2023–2024 Flu Season

  • Challenges
    • Drop in flu vaccination coverage
    • Drop in coverage among children and pregnant women
    • Disparities
      • Racial/ethnic
      • Rural/urban
    • Ongoing COVID-19 vaccination
    • New RSV vaccination
    • Immunization catch-up

Respiratory Virus Research – trying to find out from parents and the public what they think about respiratory diseases

  • Understanding current knowledge, attitudes, and beliefs
  • Understanding that this season there are flu, RSV, and COVID-19 circulating
  • “Viral respiratory disease” doesn’t mean much to many people
    • Assumption it had anything to do with the lungs, thus could be pneumonia, strep throat, etc.
    • Feels scary, long, and escalated
  • Most people referred to this as cold or flu season, or fall and winter
    • Prefer to be spoken to similarly
  • COVID-19 fatigue and hesitancy
  • Lack of knowledge of RSV, but people willing to talk about it
  • Vaccines aren’t top of mind as preventative medicine
    • Lower priority than everyday common-sense measures
  • Mixed feelings about vaccines
    • Some cherry-picking vaccines based off past experience or doctor recommendations
  • A lot of participants didn’t understand vaccines don’t necessarily prevent illness, but may more likely prevent severe illness
    • Perception that if you get vaccinated and get sick, then vaccine has failed
    • Some understanding that the vaccine could lessen severity
  • People like options and don’t like being told what to do
  • Education can be a door opener
  • Avoid words that can be perceived as scare tactics

Overall Messaging Take 3 Framework

  • Now includes flu, COVID-19, and RSV
  • Consumer testing
    • People understand but don’t necessarily think the vaccine is the most important intervention
    • Little awareness about antiviral drugs
  • Take 3 campaign
    • First: Take the time to get the recommended vaccines—COVID-19, RSV, and flu
    • Second: CDC recommends other preventative actions to help protect you and reduce the spread to respiratory viruses
    • Third: There are treatments for some respiratory illnesses like flu and COIVD-19. Follow your doctor’s treatment advice.

2023–2024 Flu Vaccination Campaign

  • Combination of paid and earned media, organic social media, and digital, and partner activations
  • Campaigns in collaboration with Weber Shandwick and with the Ad Council/AMA to address drops in flu vaccine uptake across key audiences
    • Aimed specifically at Black and Hispanic Americans to reduce disparities in vaccine uptake
  • Geo targeting to reach more rural audiences

2023–2024 Flu Vaccine Campaign: Ad Council, AMA Collaboration

  • Micro influencer outreach had very high levels of positive engagement
  • Introducing a macro influencer—partnering with people who have a larger following

2023–2024 Digital Campaign – Testing Creative Concepts

  • Tested three different assets across parents and pregnant women
    • Two campaigns based on the concept of just the flu
      • Trying to dispel misperceptions
    • “Wild to Mild”
      • Emphasizes the fact that a flu vaccine can make your symptoms less severe
      • Had the most promise in resetting people’s expectations around flu vaccine

“Wild to Mild” Creative Assets

  • Image with mama bear is aimed at pregnant women: “A flu shot can tame flu for two”
  • Other assets are geared toward parents
  • Soft launched all of the digital assets and more will be released in coming weeks

Flu Campaign Testing

  • People liked the message
  • New information and challenged the belief that the flu vaccine was meant to prevent the flu entirely
  • Reset expectations around flu vaccine information
  • Felt truthful and realistic
  • Elevated their perception of the CDC
  • Animal puns may be “too much”
  • A lot of the pregnant women weren’t concerned about the flu and were not planning to get vaccinated
    • Many pregnant women unaware of the fact that getting a flu vaccine during pregnancy could protect the baby after birth
    • Found the information motivating
  • Audiences appreciated getting data from CDC, and also seeing more suspicion and cynicism around CDC and other groups’ recommendations.

Next week Dr. Cohen will be getting vaccinated at the Atlanta Press Club as a  media event. In addition, the NFID conference will start the big kickoff for the flu campaign on September 28.

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Elizabeth Greene – Respiratory Vaccination and Virus Season 2023–2024

Goals for the Fall Respiratory Virus Vaccine Program

  • CDC is taking more of a respiratory virus approach to communication this fall
  • Promoting virus uptake for those at high risk
  • Communicating rapidly evolving recommendations
  • Ensuring access to COVID-19 vaccines during transition to commercialization
  • Challenges
    • New vaccine for RSV and monoclonal antibody for infants
    • Simplified pediatric COVID-19 schedules
    • Different payment methods for COVID-19 vaccines

Overview of Fall Vaccine Recommendations

  • COVID-19
    • 15 vaccine expected sometime mid-month
    • Recommendations to come after ACIP reviews on September 12
  • RSV
    • Adult age 60+ recommended to receive using shared clinical decision making
    • Infants younger than age 8 months who were born during or entering into their first RSV season recommended to get monoclonal antibody (nirsevimab)
    • Small group of children slightly older between age 8–19 months at risk of severe RSV disease, a dose of nirsevimab is recommended in their second season
    • Maternal RSV vaccine to be reviewed by ACIP in next several weeks

Fall/Winter Planning Summary

  • Drops in routine vaccination
  • Increasing amount of hesitancy
  • Situation leading into the 2023–2024 season
    • First time RSV, COVID-19, and flu vaccines are recommended together in a season
    • CDC focusing on vaccination as the first and primary method of being able to prevent serious illness

Immunization Campaigns

  • Some campaigns coming on RSV and COVID-19 starting in September
  • COVID-19 general (not including bridge program)
    • Kickoff in September/October
    • Materials underway to accommodate new recommendations
  • RSV
    • Kickoff in September
    • Older adult vaccine with HCP recommendation and RSV immunization with nirsevimab for infants
    • Communicating materials with a focus on clinicians
    • Outreach to the public

Timeline

  • Phase one: Late September to early October
    • Engaging providers around the importance of ensuring patients get vaccinated early in the season
    • Reminders to consumers of vaccines are available
  • Phase two: October to early December
    • Fully integrated communication effort with approved, tested creative concepts
    • Paid media, various digital activations, earned media, partner health department engagement
    • Outreach to the public and healthcare providers
  • Phase three: mid-December and beyond
    • Continue to implement communications
    • Evolution of the messaging will be responsive to the respiratory virus activity
    • Calls to action around vaccination
    • Target audience
      • National multicultural messages for healthcare providers and consumers age 18–64 years
      • States with low to mid flu/COVID-19 vaccine adoption
      • Small markets to maximize number of markets that crossovers into states with low vaccine adoption
        • Statewide outreach in Louisiana, New Mexico, Alabama, New Hampshire, and Illinois
        • Smaller markets:
          • Portland
          • Auburn
          • Massachusetts – Maine Providence
          • Rhode Island – Greenville
          • North Carolina – New Bern
          • Illinois – Rockford
          • Louisiana, Texas, Oklahoma, Arkansas – Shreveport
          • Alabama, Florida, Mississippi – Pensacola
          • New Mexico, Colorado, Arizona – Albuquerque and Santa Fe

Respiratory Virus Outreach

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Bridge Access Program for COVID-19 Vaccines and Treatments – Angela Tripp (CDC)

Angela Tripp, MPH, Health Communications Specialist, Goldbelt C6, Contractor for ISD, NCIRD, CDC, gave an update on Bridge Funding.

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Bridge Access Program for COVID-19 Vaccines

  • Change: No COVID antiviral treatments provided through the bridge program; only vaccines
  • Distribution of COVID-19 vaccines will be changing this fall as they become commercialized.
    • For many Americans this won’t be a change; they can still receive a no cost COVID-19 vaccine through their health insurance plan
    • 25–30 million adults are uninsured and additional adults with insurance require some type of out-of-pocket costs such as a copay
  • Bridge Access program is a temporary bridge to provide COVID-19 vaccines for the uninsured or underinsured adults
    • Temporary bridge
    • Long-term solution proposed

Why Do We Need the Bridge Access Program

  • There are 25–30 million adults under or not insured
    • As many as 30% age 18–64 are uninsured or underinsured
    • Disparities in health insurance coverage among racial and ethnic minority groups
      • Black
      • Hispanic
      • American Indian
      • Alaska Native
    • Bridge program will provide vaccines at no cost
    • Since temporary, the Vaccines for Adults program (VFA) is proposed in the fiscal year 2023–2024
      • Presidential budget
      • Long-term solution
      • Ensure all adults have access to recommended vaccinations including COVID-19 at no cost
      • Modeled after the Vaccines for Children program

How Will the Bridge Access Program Work?

  • CDC’s Bridge program is working to establish access to no cost vaccines to adults without health insurance
  • Two parts – Partners will work together to implement the program
    • Through established public health infrastructure – Health centers and health departments
    • Through retail chain pharmacies
  • Community based organizations and other partners will have a important role and they will work with jurisdictions
  • CDC partners help reach uninsured people
    • CDC will work with state and local jurisdictions
    • CDC partners to provide access to no cost COVID-19 vaccines for adults without health insurance at no cost vaccine
    • CDC pharmacies health centers to promote the program and conduct outreach to eligible adults to help in reaching adults without health insurance
    • CDC is developing a partner toolkit
      • Program resources and promotional materials that can be used and modified to help promote COVID-19 vaccinations and the bridge access program
    • CDC is currently negotiating with select retail pharmacy chains to provide no cost COVID-19 vaccines in some locations
      • Participating retail pharmacy chains will help ensure access to COVID-19 vaccines for adults without health insurance by using their extensive footprint and existing partnerships that they already have in place
      • Vaccines are expected to be provided to CDC contracted pharmacies by the vaccine manufacturers
      • Cost of vaccination will be covered by USG
        • State and local jurisdictions will use their existing partnerships with CDC to quickly distribute COVID-19 vaccines to their selected providers
      • Jurisdictions and local and state health departments facilitate the distribution of vaccines through their providers and their networks
        • CDC will be managing purchase and distribution of those vaccines and provider technical assistance as neededCDC will be working to make these vaccines available through federally qualified health centers who partner with state and local health departments to provide access and HRSA supported health centers to ensure equitable accessCDC will work to ensure collaboration and coordination between the Bridge Access program partners
          • Coordinate with other Bridge partners
          • Host monthly internal calls to share information
          • Collaborate on planned outreach activities
          • Coordinate with other partners to identify areas that have lower access/coverage/high rates of adults without insurance
          • Set up mobile clinics and pop-up sites to help extend reach
          • Enroll additional providers in areas with low coverage

Updated Program Timeline (June 2023–December 20224)

  • Anticipate mid-September launch
    • FDA authorization and ACIP recommendation for the 2023–2024 COVID-19 vaccines to occur in mid-September
      • ACIP meeting is September 12
    • When vaccines become available, the Vaccines.gov web page will be updated so adults can search for a Bridge provider that offers no cost COVID-19 vaccination
    • Set up a call center and communications campaign
    • Dashboard for monitoring and reporting will be set up in November
    • Will provide no cost COVID-19 vaccines to eligible adults through December 31, 2024

Where can partners and the public get information about the Bridge Access Program?

PolicyISDBridge@cdc.gov for information

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Questions

Q: Will all immunization program awardees be eligible to participate in the Bridge program?

Angela Tripp (CDC):  Yes, all immunization programs are eligible.  The jurisdictions have already started the enrollment process and they will receive additional 317 funding. They can decide how COVID-19 vaccines are  allocated within their state and local jurisdictions.

 

Q: Erin, in the research you did about vaccine messaging to the public, you mentioned that people were put off by words they thought of as scare tactics such as mentioning the number of deaths from vaccine preventable diseases. Are there other things people don’t want to see?

Erin Burns (CDC): Scare tactics and words that imply judgement, like if a parent feels like there was an implication that they were being irresponsible or a “bad parent,” , this language makes people shut down and not listen. These tactics are not helpful to the conversation. The main word that people were stuck on in the examples we tested was “death.” “Hospitalization” was okay because it can show severity, but “death” is perceived as being too much.

 

Q: For Take Three, was there any consideration to including masking since we are talking about prevention of respiratory illnesses since flu and COVID are mostly spread  through the air by droplets, but RSV is know to spread well by contact?

Erin Burns (CDC): We will be distributing a longer version of Take Three with the middle part missing. The middle part is missing because we are still trying to work out how to balance differences between different pathogens and the everyday preventative actions. There is a lot more evidence that handwashing works for RSV, whereas for flu there’s not so much data. It’s a lot more complicated than it seems, like when you’re trying to bring together guidance around all these pathogens while trying to be consistent across each. We are looking at language and using all of the tools at our disposal.

 

Q: Any feedback from the soft launch of the digital campaign for influenza vaccination?

Erin Burns (CDC): No. We are still waiting on numbers. We have heard informally that people are liking the campaign.

 

Q: How are the community-based organizations (CBO) being funded as part of the Bridge program? Are they being funded through the immunization programs and using their funds for CBOs?

Angela Tripp (CDC): The 317 funding will go to the jurisdictions and they will decide how it’s allocated on that portion of the program. So, it would be up to them and we encourage health centers and CBOs to reach out to their jurisdictions and inquire about it.

 

Q: Will all the FQHC’s be partnering or do they need to actively reach out to their health departments or HRSA to be able to participate?

Angela Tripp (CDC): Those centers have to be enrolled with their 317 funding through the jurisdiction and also enrolled in the Bridge program to participate. We encourage those centers to reach out to the jurisdictions.

 

Q: How do you enroll in the Bridge program as a provider? What are jurisdictions?

Angela Tripp (CDC): Reach out to your local jurisdiction to ask about it, and it will be up to them. Jurisdictions are immunization program managers at state and local health departments.

 

Q: Is the Bridge program the primary way for planning to address vaccine accessibility in light of the public health emergency being over? There’s also a proposed Vaccines for Adults (VFA) program. Where is the VFA program in terms of being available to help with vaccination of uninsured adults?

Angela Tripp (CDC): The VFA program was proposed for the fiscal year 2023–2024, presidential budget. I don’t have an update on where that is currently, but if you reach out to the Bridge email box at PolicyISDBridge@cdc.gov, we can make sure that we address that. To clarify, the Bridge program is only COVID-19 vaccines, so people who have challenges with vaccine access have other options such as working with their health department and patient assistance programs. Some states have 317 funds for uninsured adults and the proposed VFA program would address all recommended adult vaccines including COIVD-19, but for the Bridge program it’s to provide no cost COVID-19 vaccines at this time.

 

Q: CBOs have played a big role in the initial COVID-19 vaccine program with a large presence in local communities. Is there guidance out to the health departments or existing CBOs who’ve worked in immunizations to tell them how they can get involved in improving awareness about this program?

Angela Tripp (CDC): The awards will go out to the jurisdictions in the next few days, which will start the process. The CDC will be providing some technical assistance to them, and it will outline some of those things additionally. Additionally, we have health equity partnership who will be helping with some of the community outreach efforts. We are also developing our partner toolkit to provide some guidance as well.

 

Q: You mentioned that some of the market research showed people didn’t like the term “respiratory virus,” and instead they wanted “flu season.” Is that how the public material is going to be discussed? And as a follow up, what’s the wording going to look like for RSV monoclonal antibody, Nirsevimab, for young children?

Erin Burns (CDC): I think the proposal right now is to call it “fall and winter virus season.” I’m not sure that there’s a formal decision, but that’s what’s under consideration now, so I think that’s what you can expect, as well as how to take steps to protect your health. We will have a landing page that’s going to be a place for consumers to access information about these three pathogens and where to get vaccinated, as well as how to protect yourself.

Elizabeth Greene (CDC): CDC has been using all of those terms, and we do have some research from moms that just came in about preferred terms. I think some other research we’ve seen looks like preventative antibody might be what they are more comfortable with. We are still waiting on that, but for now we are trying to use preventative antibody for most of our messaging to the public.

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