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A summary of presentations from the weekly Summit partner webinars

November 16, 2023 – The latest Summit Summary

Respiratory Virus Surveillance Update – Katie Tastad (CDC)

Katie Tastad, MPH, Influenza Division, Domestic Surveillance Team, CDC, gave a presentation on respiratory virus surveillance for week 44, ending November 4, 2023.

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Outpatient Respiratory Illness (See: FluView)

  • Influenza-like Illness (ILI), fever plus cough or sore throat
    • Slow increase each week over past few weeks
    • Week 44 at national baseline of 2.9%
  • ILI by age
    • Trending upwards for group age 0–4 years and group age 5–24 years
  • ILI geographically
    • Southeastern and southcentral U.S. seeing moderate or high activity

Emergency Department Visits

CDC: Respiratory Virus Activity Levels

CDC: Groups Most Impacted—Emergency Department Visits

  • COVID-19
    • ER visits have stabilized or plateaued in recent weeks
    • ER visits highest among age 65 and older
  • Influenza
    • Increasing ER visits
    • ER visits highest among age 5–17 years
  • RSV
    • Increasing ER visits
    • ER visits highest among age 0–4 years

Laboratory Testing

CDC: Weekly U.S. Influenza Surveillance Report

CDC: Respiratory Virus Activity Levels

  • Percent of tests positive for respiratory viruses: RSV, COVID-19, and flu
    • COVID-19 has plateaued over the past couple of weeks
    • RSV has increased rapidly
    • Influenza has started to increase
  • Clinical labs
    • Influenza has been increasing
    • Mostly influenza A (primarily H1N1)
    • Some influenza B (mostly Victoria lineage)

Hospitalizations

CDC: Weekly U.S. Influenza Surveillance Report

CDC: Severe Viral Respiratory Illness

  • COVID-19 and RSV hospitalization rates are steady
  • Flu is low but starting to increase
  • Last flu season was mild and began early. This year is well below last season at this time last year.

Mortality

CDC: Severe Viral Respiratory Illness

CDC FluView Interactive: Pneumonia and Influenza Mortality Surveillance from the National Center for Health Statistics Mortality Surveillance System

  • Respiratory deaths mainly driven by COVID-19
  • No big increases in flu deaths

Summary

  • The number of jurisdictions experiencing high or moderate levels of outpatient influenza-like illness continues to slowly increase
  • Emergency department visits for COVID-19 have been fairly stable; visits for influenza and RSV have been increasing
  • Most influenza viruses tested in clinical laboratories have been influenza A. Influenza A(H1N1) has been most commonly detected so far this season.

Resources

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Flu Vaccination Campaigns and National Influenza Vaccination Week Update – Erin Burns (CDC) and Nicole Richardson-Smith (CDC)

Erin Burns, Associate Director for Communications Science, CDC, and Nicole Richardson-Smith, PhD, MA, Campaign and Digital Outreach Lead, Influenza Division, National Center for Immunization and Respiratory Diseases, CDC, gave a presentation on CDC flu vaccination campaigns and National Influenza Vaccination Week (NIVW). 

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Erin Burns – Flu Vaccination Campaigns

2023–2024 Flu Vaccination Campaign

  • Collaboration with Ad Council/AMA and Weber Shandwick to address drops in flu vaccine uptake across several key audiences:
    • Parents of children age 6 months–17 years – concerning drops in coverage
    • Pregnant people – concerning drops in coverage
    • Other at-risk groups like adults age 65 and older, and adults with certain chronic health conditions
    • Black and Hispanic American adults – long-standing inequities, disproportionate severe effects of flu, and less likely to get vaccinated
    • Rural population – long-standing inequities, disproportionate severe effects of flu, and less likely to get vaccinated

Flu season 2023–2024 highlights (Sep–0ct 2023) – Year 4 of working with the Ad Council

  • Last year assets on market late September. This year, they were available at the beginning of September.
  • Early availability of assets helped in the month of October
  • $1.2 million in donated media for Ad Council

Terraboost

  • Group that sets up bulletins in retail locations across country
  • Middle of October had placed more than 1,700 bulletins nationally with audience impression estimate of more than 300 million people

Wild to Mild Campaign Metrics

  • Campaign: while flu vaccine may not completely prevent infection, it can reduce severity of illness
    • People who get vaccinated and still get sick but with reduced severity was an important and motivating message
  • Digital Campaign
    • Around 16 million impressions – 9 million impressions for parent audiences and 7.5 million for pregnant audiences
  • Organic social media on CDC channels have had more than a million impressions, with more than five thousand engagements
  • MAT articles placed broadly in the U.S. with the potential audience exposure of about a billion people

Wild to Mild Social Highlights

  • Drawing audiences in with “thumb-stopping” creative, including seasonal animal pairings and color palettes, and dynamic animations
  • In December CDC will launch winter-themed assets

News Coverage of Wild to Mild

  • Weber Shandwick has been creative in making digital assets more engaging and interactive
    • Series of animated graphics
    • High interest in campaign this year
  • Ad Council/AMA collaborated on media tour
    • Nearly 300 media placements (last year 68 media placements)
    • More than two million TV impressions
    • Planning a second media tour the week of December 17, focusing on “it’s not too late” and “there’s still time to get your vaccine” messaging

Micro-influencer Content Preview

  • First round included Instagram posts encouraging followers to get a flu vaccine
    • Collaborated- with micro and macro-influencers
    • Launched in mid-October

Support the Flu Vaccination Campaign

 

Nicole Richardson-Smith – National Influenza Vaccination Week (NIVW) (December 4–8)

Creating a Steady Drumbeat around NIVW

  • Building on the success of past years
  • Leveraging NIVW as a critical moment in time to draw attention to the seriousness of flu and the importance of flu vaccination
  • Focus on pregnant people and parents with children age 6 months–17 years
  • Partner activities on social media and engagement during the week
  • Micro-influencer content will roll out on Instagram
  • Ongoing organic social media push
  • Paid social media
  • Flu Fighter series for partners to let CDC know what they’re doing during NIVW
  • Ongoing earned media outreach and pitching to national outlets

Driving Conversation on Social Media

  • Social media is one of the main tactics during NIVW
  • Wild to Mild campaign graphics with added NIVW dates

Building on Last Year’s Success

  • Expanding engagement with micro-influencers to develop content to be shared during NIVW
    • 15 micro-influencers this year, including:
      • Seven top-performing from last year to share the message that the flu vaccine is important every year
      • Eight to get the message across to a larger audience that CDC doesn’t reach on its own channels
    • Working with partners to create new Instagram Reels (“flu-ettes”), leveraging the “Things You Should Know” and “A Day in the Life” social benefits of flu vaccination
      • Includes tag to CDC so it’s seen across social media audiences for both the partner and CDC

 

Leveraging Partner Networks

  • Other partner content will include social media graphics, sample newsletter content, posters, patient reminder messages, and a template article

Ad Council/AMA/CDC Influencer Activation

  • CDC working with Ad Council and AMA micro-influencers to influence the work with Weber Shandwick

Questions

Q: Are the animated graphics available for use for health departments?

Nicole Richardson-Smith (CDC): One should have gone up this week. If you are having trouble downloading it, reach out to me so you can have that to share directly. Contact Nicole at: ewo0@cdc.gov.

 

Q: Will the Wild to Mild campaign be fully translated into Spanish?

Erin Burns (CDC): We were concentrating on getting the English assets out, and we’re going to translate the campaign fully into Spanish soon. It’s behind because we had to go back and do confirmatory testing to make sure that the translation was effective and that we weren’t losing anything by translating it into Spanish. We did some small focus groups and found that it tested well in Spanish and that the translation was appropriate. More of those assets will be coming out. We’ve had interest from other countries, as well as in China. There’s a group that developed their own Wild to Mild and translated it into Chinese. There are a number of country offices asking for our help in translating the campaign into their language, so that’s something that we’re working on. I think that Wild to Mild has been successful, so we are entertaining doing a second year with this.

L.J Tan (Immunize.org): There was a question that was answered in the Q&A that I want to read out loud. The question was: what is the difference between an impression and an engagement? Erin, you responded that an impression is the number of times your content is seen, and an engagement is when your audience interacts with your content either by liking it, sharing it, or adding a comment.

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Vaccines Save Lives: Insurance Provider Commitment to Promoting Equitable Vaccine Access –Christopher Regal (AHIP)

Christopher Regal, MS, Director of Clinical Innovation, AHIP (formerly America’s Health Insurance Plans), gave a presentation on insurance provider commitment to promoting equitable vaccine access. AHIP is the trade association that represents payers across the spectrum. It’s a Medicare and Medicaid commercial insurance employer.

Chris contributes to programs and industry-wide initiatives with commercial, Medicare, and Medicaid plans and works with AHIP member organizations to highlight their innovative programs. Chris leads AHIP efforts on a variety of relevant topic areas, including vaccines, maternal and infant health, and telehealth. Chris leads industry work groups on Prevention and Population Health and Substance Use Disorder, and works closely with member Chief Medical Officers. Prior to joining AHIP, Chris was a consultant with the Lewin Group, where he worked on projects with the Center for Medicare & Medicaid Innovation (CMMI), the Center for Consumer Information and Insurance Oversight (CCIIO), the Centers for Medicare and Medicaid Services (CMS), and the Maryland Health Benefit Exchange. Chris received his master’s in health and medical policy from George Mason University and completed his undergraduate work in politics at the Catholic University of America.

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 Insurance Providers Support Recommended Vaccines

  • Overall message is that vaccines save lives, help keep people healthy, and lower community spread
  • AHIP engages with ACIP, NVAC, FDA VRBPAC, and other stakeholders
  • Collaborate across public health, network providers, and others to promote equitable access to vaccines
    • Make sure approaches are tailored to the communities that AHIP serves. Three examples:
      • Minneapolis measles outbreak around ten years ago
        • Took active role in working with the health departments to suppress an outbreak of measles located in the Somali migrant community
        • Set up clinics and proactive with messaging approaches to tailor to trusted messengers in the communities
      • HPV messaging strategies
        • Change messaging to sell the vaccine as a cancer prevention tool and not necessarily as an STI prevention tool
        • Increase in uptake in HPV vaccine
        • Barber shops as a way to open lines of communication with COVID-19 vaccines
      • Key challenges
        • Find new ways to message creatively to reinforce that vaccines are safe, effective, that they have been around for decades, and that they are incredibly important
        • Increased efforts to work with pediatricians and schools to increase childhood vaccination rates
        • Engage network pharmacy partners due to their bigger reach than providers
          • About 95% of the country live within 5 miles of a pharmacy
          • Important messengers for vaccine equity

Initial COVID-19 Vaccines – Health Insurer Leadership

  • AHIP engaged heavily with the Administration and member health plans to promote access to the new COVID-19 vaccines, especially among seniors and other vulnerable populations
  • Project called Vaccine Community Connectors Initiative initiated in spring 2021 as COVID-19 vaccines had come out for the highest risk groups
    • Connecting those people with vaccines
    • Goal to vaccinate 2 million seniors as quickly as possible (achieved in under 100 days)
    • Set up clinics at churches and schools where entire families could come
    • Carved out appointments just for seniors
  • Health insurers embarked on creative community-based partnerships to reach people where they are
    • Make sure appointments and transportation not a barrier to getting vaccinated

Current Updated COVID-19 Vaccines – Health Insurers Stepped Up

  • Challenges in the early weeks of the roll out
    • Issues with access
    • Transition to private purchase and reimbursement
    • Confusion regarding in- and out-of-network
    • Problems with coding
    • Supply issues
  • Health plans stepped up
    • AHIP, trade associations, and health plan space engaged with Administration to address the issues as quickly as possible
    • Daily calls with Administration to update on progress
    • Communication with health plans
    • Secretary Becerra recognized health efforts and issued a statement
    • AHIP and trade associations reaffirmed commitment to ensure patients have timely access to the updated COVID-19 vaccines at no-cost sharing

Common Health Coalition

  • Recently launched a project alongside community health plans, American Hospital Association, American Medical Association, and Kaiser Permanente
  • Goal to translate lessons learned from COVID-19 pandemic to move public health forward through a general partnership

Questions

Q: Were your partnerships in select states or all states, and how were community-based partnerships and/or organization selected? Were there prior arrangements before the pandemic?

Christopher Regal (AHIP): We cover plans across the entire country—national plans, regional plans, state-specific plans—and we messaged out and communicated with them to reach out to their members. They did not make the connections themselves, but ultimately, yes, it did rely on a lot of existing partnerships. I know that there that are member plans that are constantly engaging with different community organizations across a variety of different conditions including addressing social determinants with community-based organizations (CBO). I can’t speak specifically to how each CBO was identified, but it was a concerted effort. Those are ongoing, so if you do have involvement with a CBO, I encourage you to contact your local plans. There are partnership opportunities across the country.

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New Vaccine Implementation: Opportunities for Success – Carrie Regnier (Norton Healthcare)

Carrie Regnier, BS, BSN, MPH, RN, COVID-19 Director for Norton Healthcare in Louisville, Kentucky, gave a presentation on new vaccine implementation.

Carrie is responsible for operationalizing COVID-19 vaccination in over 70 locations and works as the system leader for COVID-19 processes.  She also oversees all new vaccine implementations for Norton Medical Group.  Carrie has a background in ambulatory quality, process improvement, Medicare payer quality, population health, and cardiac nursing.

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Norton Healthcare

  • Not-for-profit integrated delivery system headquartered in Louisville, Kentucky
  • Eight hospitals across Louisville and southern Indiana, including Norton Children’s Hospital, which is the only freestanding Children’s Hospital in the state
  • Has about 21,000 employees and about 1,700 employed physician or provider partners
  • The global second largest employer
  • Provides outpatient care at over 430 locations throughout Kentucky and southern Indiana
  • Opening its first hospital in over 150 years in the West Louisville area, which is one of Kentucky ‘s most underserved areas
  • Its medical group includes Norton Children’s Medical Group, Norton Medical Group, and Norton Cancer Institute
  • Services include primary care, specialty heart neuroscience cancer, orthopedic, women’s, pediatric services, 14 outpatient centers, 17 immediate care centers (urgent care), and a recently expanded telehealth program that puts telehealth in all of the 89 public elementary schools in Jefferson County
  • Telehealth program has a PRN who can virtually log in to the school with the school health nurse and see a child or an employee without them having to leave the location

Norton Healthcare’s Ambulatory Vaccine Access

  • Widely available in its area
  • A lot of its vaccines are offered in adult primary care and specialty offices
  • 65 adult pediatric primary care offices
  • Four retail pharmacies in its hospital campuses that allow quick access to patients who have Medicare Part D
  • Nine prompt care locations
    • Same-day access convenient care that sees patients
    • One of its largest community vaccine access points
    • See patients that need easy access to a vaccine
  • Norton express care services vaccine sites
    • Permanent drive-through location
  • Prompt care community locations
    • Patients can drive through for labs, X-ray, international normalized ratio (INR) blood test, and immunizations
    • Central hub for COVID-19 and immunizations
  • Community pop-up clinics

Notable Recent Immunization Achievements

  • Administered over 470 thousand COVID-19 vaccines since the beginning of the pandemic
  • Only area community baby vaccine clinic
  • Successfully deployed the only mpox clinic in the area
  • Administered over 60,000 flu shots since September 2023

Norton Healthcare Immunization Program New Vaccine Team

  • Pharmacist
  • Infectious disease
  • Clinical educator
  • Billing
  • Ambulatory
  • Project leader and project manager

Fall 2023 Vaccine Implementations

  • Flu – September yearly implementation
  • PCV20 – converted to pediatric population
  • COVID-19 – started monovalent for 2023–2024 season
  • Beyfortus – in two birthing hospitals and 2 in NICU, 36 pediatric primary care offices
  • Adult RSV – age 60–64 and age 65 and older, as well as pregnancy

Implementation Challenges

  • Supply chain
    • What are the contracts?
    • What are the rates?
    • Moving into private coverage was confusing for public and clinical staff
    • Change in distribution and procuring in offices
  • Insurance coverage
    • Unsure about reimbursement and out-of-pocket costs
    • Vaccines not typically added to insurance billing until 12 months after ACIP-recoomendation and CDC adoption
  • Multiple vaccines
    • Changing recommendations
    • Public confusion and access problems
    • Clinical staff burnout
  • Tight timelines
    • Public expectations
    • The approval came quickly at respiratory season
    • Updates to CDC reference documents and resources did not occur quickly enough

Recommendations for Future Vaccine Implementation Success

  • Timing of approvals
    • Four to six months of lead time, if possible, before adoption of recommendations
  • Ensuring that clinical resources are easy to find and updated within days, if not on the day of approval
  • Supply chain accountability
    • COVID-19 has supply chain challenges
    • New vaccines need a pre-book process
  • Setting realistic expectations
    • Working with the public and media to communicate appropriate timelines
  • Policy changes for insurance coverage
    • Looking at how we can get vaccines ASAP once they are recommended
    • Insurance companies have to cover vaccine day of availability to patients
    • Patients with Medicare should be able to receive the vaccines in the office especially if it’s a vaccine that requires shared clinical decision-making because they need to see that provider before they get the vaccine

Questions

Q: How did you monitor for potential post-immunization reactions? Did you have a pull-off site or did you send them off with instructions for if they have a reaction?

Carrie Regnier (Norton Healthcare): Currently, only our COVID-19 vaccine is one that requires waiting time, so we are not administering that in the drive-through site. We’re having discussions about best practices for that. For other immunizations like flu and Tdap, we don’t require a wait time. For HPV and any of those for adolescents, they’re not driving through.

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Announcements
  • There will be an upcoming webinar on adult immunizations and rural health; watch for more information
  • org has a new streamlined look! Please feel free to give feedback: www.immunize.org/about/org/contact.
  • The Summit held a workshop on August 2nd to develop tools to address challenges in providing multiple adult vaccines along with COVID-19, flu, and RSV vaccines. Tools that address billing and insurance issues that go along with vaccinating patients were also developed. See the Summit’s Operationalizing Adult Immunizations in the 2023 Fall Season and Beyond Workshop web page for the deliverables. Note: some deliverables are in process of being finalized and uploaded to the website so check back for more.
  • If you are registered for the Summit not getting the emails from Mailchimp, please add “NAIIS” at info@izsummitpartners.org to your contact list
  • If you have any agenda items that you are interested in sharing with the Summit, please let us know and we can add you to an upcoming call as a speaker or panelist. Contact information: info@izsummitpartners.org

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