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A summary of presentations from the weekly Summit partner webinars

March 28, 2024 – The latest Summit Summary

Changes in Vaccination Attitudes – Melissa Koehler (Hillcrest Pharmacy and Compounding of Lancaster County)

Melissa Koehler, PharmD, Owner Hillcrest Pharmacy and Compounding of Lancaster County, gave a talk on the changes in the vaccination climate in her community.

Currently seeing at the pharmacy

  • Decreased rates in COVID-19 vaccination from last season to this season
  • Vaccine fatigue
  • Employees in pharmacy and clinics getting vaccinated less
  • People who say they might get vaccinated are not getting vaccinated
  • Parents less likely to get flu and COVID-19 shots for their children
    • So much more concern about safety Need to work more to convey safety information and importance of vaccination with clients

What the pharmacy is doing to increase vaccination rates

  • Partnering with Medical Reserve Corps and Latino Connection for community vaccination clinics in churches, homeless shelters, and other places
  • Getting out in the community more and educating
  • Creating trustworthy environments
    • Seeing pastors getting vaccinated helps foster trust

 

Questions

Q: Do you see yourselves as taking up the slack from others that used to be doing vaccination clinics out in the community, but are no longer having community clinics? Or are you making additional outreach that others hadn’t before? 

Melissa Koehler (Hillcrest Pharmacy and Compounding of Lancaster County): I think that we’re doing additional outreach. I know that there are some pharmacies that are no longer doing the vaccination clinics. A lot of independent pharmacies that used to do clinics have closed. So, we have picked up a lot of those. We’re always looking for new places that we can go. Wherever we can find people is where we can find people to vaccinate. In my community it’s difficult to get in for your primary care visits, and I know doctors’ offices are so busy. Maybe people are not getting vaccinated there and don’t know that they can walk into any pharmacy and get their flu shots. We try to ask everyone that comes if they got their flu shot. If not, we ask if they know they can get it at the pharmacy. So, a little bit of education as far as where you can get it is important because not everybody knows.

 

Q: How can pharmacies get funding to go out in the community to do vaccinations? Many community pharmacists can’t afford the staffing, so maybe you can address how this works for you guys.

Melissa Koehler (Hillcrest Pharmacy and Compounding of Lancaster County): We do this through partnerships. We work a lot with Latino Connection and the Medical Reserve Corps or the Immunization Coalition of South-Central Pennsylvania. That’s all grant funding so it’s just coordination of efforts. We have the bridge program for COVID-19 but that doesn’t cover staffing so if other community pharmacies are interested, an organization like this one is a great place to start. Or look for your local immunization coalition and ask to work in the community. There’s a lot of funding available for some partners.

 

Q: I’m a pharmacist in central Arkansas and my full-time job is with Immunize Arkansas as vaccine confidence strategist. I’m wondering are you hearing from people coming into your pharmacy or at these clinics that they couldn’t get vaccinated at their primary care clinic?

Melissa Koehler (Hillcrest Pharmacy and Compounding of Lancaster County):  We are hearing that the reimbursement for RSV, shingles, and pneumonia vaccines is tricky. Flu and COVID-19 go through Medicare Part B and the other ones have been going through the Part D or the drug coverage plans. If a patient would try and get a shingles shot or an RSV shot at their physicians office, they might get stuck with a very large bill or the physician’s office wouldn’t be reimbursed for it, so that is a challenge as far as figuring out each person’s insurance and where they need to go to get their shots. We struggle with this challenge in our pharmacy. Most of the time pharmacy is fine, but that is a struggle as far as who’s going to reimburse. We’re finding for the most part that flu and COVID-19 you can get anywhere but the other vaccines you should look into your pharmacy first.

 

Q: Are you planning anything different this upcoming respiratory virus season?

Melissa Koehler (Hillcrest Pharmacy and Compounding of Lancaster County): We’re looking to continue what we’re doing as far as setting up more clinics and getting out into the community more often, but I’m also going to expand my social media platforms to do more education. I hope that we can get people back to feeling confident about getting their flu shots and their COVID-19 shots, because it’s easy to hop over into your pharmacy to get your vaccine. It’s more of the same with a little bit more emphasis on the social media type of education.

 

Q: You mentioned that you were hearing more parents are reluctant to vaccinate their kids against influenza, but of course we know flu vaccine is incredibly safe. It doesn’t have the same rare but known issue in terms of cardiomyopathy for particularly young adult and adolescent males as COVID-19. Are you seeing this trickledown effect for flu? Does it get confused with COVID-19 vaccine?

Melissa Koehler (Hillcrest Pharmacy and Compounding of Lancaster County): I think the parents are hearing many things about vaccines in general. I’ve even had parents who are nurses or work in healthcare tell me I’m not getting the flu shot for my kids this year; it’s just too much. I think that moms in general are just feeling saturated and feel that if their child is healthy, the flu won’t be that bad. I always try and say the vaccine can keep them healthier and there are very few side effects. We just keep trying to educate, but it I think that one thing that I keep hearing is it’s just too much or they don’t want to do it this year. Trying to combat that with education is so important.

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Knowledge and Attitudes on Flu and COVID-19 Vaccination – Dr. Bob Hopkins (University of Arkansas for Medical Sciences)

Bob Hopkins, MD, NFID Medical Director, Professor of Internal Medicine and Pediatrics, University of Arkansas for Medical Sciences, gave a presentation on knowledge and attitudes regarding influenza (flu) and COVID-19 vaccines.

VIEW SLIDES

NFID is dedicated to educating and engaging the public, communities and healthcare professionals about the prevention and treatment of infectious diseases across the lifespan.

NFID Survey Results

Each year, NFID releases results of a national survey to better understand consumer knowledge attitudes and practices around flu, pneumococcal disease, COVID-19, and RSV

Intention to get vaccinated

  • Influenza
    • Since 2019, NFID surveys have consistently found 60% or more of U.S. adults agree that flu vaccination is the best way to help prevent flu-related hospitalization/death
    • In the 2023 survey, found that 75% of U.S. adults trust their healthcare professionals for information about flu vaccines far more than any of the other sources
    • Each year, 40% or more of adults say they either don’t plan to get an annual flu vaccine or are unsure whether they will do so
    • 20% or more of adults who are at higher risk for flu-related complications don’t plan to get vaccinated
    • Higher risk population is less likely to get vaccinated in 2023 than prior four years
      • Age 65 and older
      • Those with chronic health conditions such as heart disease, lung disease, diabetes, or kidney disease
  • Reasons for not getting flu vaccine:
    • Concern about vaccine side effects
    • Concern that flu vaccines do not work very well
    • Misconceptions about getting flu from the flu vaccine
    • Underestimating the potential severity of flu
    • Thinking that since they never get the flu they don’t need the vaccine
  • COVID-19
    • Reasons for not getting COVID-19 vaccine:
      • Concern about vaccine side effects
      • Mistrust of COVID-19 vaccines
      • Concern that COVID-19 vaccines don’t work very well
      • Concern about getting the disease from the vaccine
    • Survey findings reinforce the importance of raising awareness, addressing misconceptions, and the need for healthcare professionals to provide a strong vaccine recommendation for their patients
  • Pneumococcal
    • The majority, 79%, have already gotten pneumococcal vaccine
    • A need to build trust, dispel myths about the vaccine by informing the public
      • Dispel that while vaccine doesn’t prevent disease completely, it can reduce duration and severity of illness
      • Vaccine can prevent hospitalization and death

Tools and Resources for Healthcare Professionals and Public Health Advocates

  • NFID offers a number of tools and resources to help healthcare professionals and public health advocates address vaccine hesitancy and build vaccine confidence
  • Links to webinars, videos graphics, and more can be found in the NFID resource library at nfid.org/resources
  • NFID surveys and related reports can also be found at nfid.org/flusurveys

2023 Flu Season survey

  • Flu
    • Wide variability in uptake of influenza vaccines across the U.S.
    • Major difference in vaccination among rural, urban, and suburban residents, and by income and by race/ethnicity
    • Vaccination increased throughout the influenza season
    • Roughly 25–30% of the population reported they definitely will not receive the vaccine
    • About 10–15% were unsure or probably will get the vaccine
    • Adults aged 18–49, aged 50–64, and aged 65 and older had a slower uptake over this season than over the previous season
      • Similar rates of vaccination compared to the prior season, but lower than 2019-20
      • Still well below where rates need to be
      • Absolute numbers don’t appear to have fallen very much
    • COVID-19
      • Much lower overall vaccination rates
      • Variable uptake from state to state
        • Vermont, D.C. and Minnesota are at the top
      • Rural, suburban, and urban areas vary and there are disparities by income and race/ethnicity
      • Long way to go to convince U.S. population of the critical importance of ongoing COVID-19 vaccination to reduce the risk for severe disease
    • RSV
      • Ongoing wide disparities in racial and ethnic uptake in the first season for adults aged 65 and older
      • Coverage should be less of a challenge because now covered under Medicare Part D
      • Long way to go to get RSV as a routine vaccine for older adult population and pregnant people

Where do We Go from Here?

HCP Recommendations

Confidence

  • Improve vaccine literacy among the public
    • Simple science-based information
      • Focused on organisms, diseases, and vaccines
      • Using examples public can relate to
      • In language public can understand
    • Incorporating information into medical and middle school curriculum and early childhood education for long-term confidence
    • Information on social media in positive messages about vaccine benefits, address safety and disease risk
    • Recognize impact of pandemic on the mental health of many population by increasing anxiety
    • Vaccine-hesitant need one-on-one conversations
    • Recognize mandates can have both positive and negative implications

Complacency

  • Providing information about disease and risk without being perceived as a fear monger can be a really delicate balance
  • Outbreaks may help some people in the community who are hesitant to step beyond complacency
    • Providing supportive conversations in the clinical setting
    • Building collaboration education with communities to build and support a culture of immunization

Convenience

  • Easy access to appropriately reimbursed vaccines
  • Pharmacies, offices, public health clinics, and community health centers for access
  • Minimizing direct and indirect costs of vaccination
  • Coadministration as a strategy to improve uptake
  • Support of robust immunization registries to be sure to get the right vaccine into the right individual at the right time and the right interval

 

Questions 

Q: There’s been an increase in healthcare professionals with vaccine exemptions. And new healthcare providers are not as comfortable with strong recommendations; they want to have one-on-one conversations and a softer touch. Do you have any information about this particular generational and attitudinal issue among younger medical professionals or trainees or any insights that you might want to share? 

Bob Hopkins (University of Arkansas for Medical Sciences): I talk with a lot of medical, pharmacy, and nursing students on a regular basis. I think the challenge that many of our younger people have is that they want a calm conversation in the exam room. If we  think about the importance of vaccination decisions and the thousands of people that are have died from influenza over the course of the last year in this country, the tens of thousands of people that have died from COVID-19, the impact on our small children of RSV, we have a greater opportunity to impact populations than we think by having that focused strong recommendation.

Kelly Moore (Immunize.org): Students don’t get enough education about vaccines during their training to feel confident, so in part, I think we need to take your approach of there being  an urgency, and it matters, and I’m making a strong recommendation. They need to be taught to be strong in their recommendations because if they’re not secure in themselves and their knowledge then they’re not going to be confident.

Bob Hopkins (University of Arkansas for Medical Sciences): I’ve heard for many years from my pharmacy colleagues that they have a required X number of hours course on vaccines, and all of the pieces that go into clinical vaccinology, as opposed to the number of hours that are  done in many medical schools and nursing schools and others. What we’re doing is insufficient for all. I think we need to think about it differently, more in terms of clinical scenarios—in terms of morbidity and mortality and illness averted, rather than just the one person paradigm.

 

Q: How are younger parents thinking about vaccination compared to several years ago?

Melissa Koehler (Hillcrest Pharmacy and Compounding of Lancaster County): It’s hard for me to put a finger on the generational differences. I hate to generalize, but the chunk of the age group that I’m seeing, around age 55—65, seem to be the ones saying they aren’t getting the flu shot. As far as the children, it’s the younger parents that are struggling a little bit more.

Bob Hopkins (University of Arkansas for Medical Sciences): If you look at the literature, it’s all over the place. There are some studies that show that a lot of our hesitancy is the more affluent parents in their 20s and 30s. Other studies show that the bigger problem with hesitation is in those age 40–60, many of which have chronic diseases that put them at higher risk. There are studies that show that that certain groups based on ethnicity and where they live are more likely to have more challenges than others. I think a lot of it really boils down to community and context. If you have a community that has knowledge and belief, then members of that community or those affiliated with that community are more likely to be vaccinated. If the community norms are not to be vaccinated, it’s hard to get over that hump unless somebody has had a catastrophe.

Carolyn Bridges (Immunize.org): That’s very true. In the past we would have flu uptake lagging, and then we would hear about a pediatric death—or another a catastrophic outcome. For this particular year I don’t think we saw media coverage showing that that this is a serious disease, resulting in many deaths, and therefore people didn’t go out to get vaccinated.

Bob Hopkins (University of Arkansas for Medical Sciences): It’s interesting when we start to see a surge of disease and the local news picks on the fact that we’ve had an increase in hospitalizations, whether it be for flu or RSV or COVID-19. We tend to see a little blip in vaccination. The challenge is we don’t see that blip sustain and we don’t see the good stories about how well the vaccine prevents deaths and hospitalizations. Unfortunately, it’s the catastrophes that get clicks.

This is an opportunity for us to get some of the data out you know to the public in a way that they can understand. We’ve saved so many thousands of hospitalizations and so many thousands of lives from vaccination. If you get down to numbers of tests that are positive or that kind of thing, that goes in one ear and out the other. It’s getting numbers across to the public that’s the real challenge.

 

Q: Although pharmacy students get a lot of vaccine training, it’s not specific to vaccine confidence. Improving vaccine confidence is not easy. We’re science minded people so when you give people the facts and the numbers it’s not always convincing. Melissa, you work with a wide variety of providers and settings. Do you do any training with your staff on having difficult conversations or are people coming to work with you already prepared?

Melissa Koehler (Hillcrest Pharmacy and Compounding of Lancaster County): One of the organizations that I work with a lot is the Medical Reserve Corps (MRC). They do a lot of training on having those types of conversations, and they work with my staff on it as well. Their number one focus is education. It’s not so much formal training that we’re seeing in working with those organizations. We try to read everything that we can so that we are knowledgeable. We also talk to each other about conversations we have with patients and the challenges in communications, so we can figure out what is working. Unless we’re seeing collaboration within our healthcare community, we’re not going to get much further. Going to meetings like this and working together with different types of healthcare providers is a valuable way to figure out how to educate in an effective manner.

Bob Hopkins (University of Arkansas for Medical Sciences): The other piece that you mentioned in your presentation, Melissa, about doing outreach efforts. There’s value of getting into communities and spending time with people where they are as a way of engaging some of those that may be sitting on the fence. They see you as making that extra effort to come out to where they are. We had some great successes COVID-19 and I think we need to take those messages to help drive us along way around some of our other immunization challenges.

Melissa Koehler (Hillcrest Pharmacy and Compounding of Lancaster County): I agree. We’re seeing great results in going to the communities and partnering with the leads of communities who are trusted.

 

Q: What’s a better way to convince people that flu is as serious as COVID-19 is? Do you have examples to offer?

Melissa Koehler (Hillcrest Pharmacy and Compounding of Lancaster County): When you hear about actual people in our community who are getting very sick that is really a big motivational way to tell them that the flu is a serious illness. To connect it on a personal level is a great way to portray the message. Protecting HIPAA is a challenge if the parents or the patient does not want to be in the spotlight. It is important to talk about the seriousness in news outlets and let people know numbers of cases to portray the severity of diseases.

Bob Hopkins (University of Arkansas for Medical Sciences): I think Families Fighting Flu has done a great service in this area by having people agree to tell their stories. I think stories really make a huge difference. We did some of that during the pandemic—talking to people that have either had severe disease or had family members that came close to dying or even did pass away from COVID-19. But getting those stories out takes a lot of time and effort. Most of the population really needs to hear a story that they can relate to. Talking about impacts on that people can take and put their hands around and understand can help. Trying to do it with faces rather than numbers is the important piece.

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Announcements
  • The Summit is soliciting nominations for awardees for the 2024 NAIIS Immunization Excellence Awards. Nomination deadline is May 1. For information, visit: https://fs29.formsite.com/uI8uzs/2024NAIISAwards/index
  • Summit will host two webinars for its Virtual Flu days, May 16 and 23, to help partners plan for the respiratory virus season ahead of August, when the Summit’s in-person meeting will follow the National Immunization Conference (NIC). For information on these webinars and to register for one or BOTH, see: Setting the Stage for 2024–2025 Respiratory Virus Season.
  • The Summit in person meeting has been moved to August to accommodate the National Immunization Conference (NIC), which is being held in Atlanta, GA, on August 12–14. The Summit in person meeting, focusing on adult immunizations, will be held August 15 (full day) and August 16 (half day). Registration is being coordinated with the NIC registration and should be available soon.
  • The Summit workshop developed tools to address challenges in providing multiple adult vaccines along with COVID-19, flu, and RSV vaccines. See the Summit’s Operationalizing Adult Immunizations in the 2023 Fall Season and Beyond Workshopweb page for the deliverables.
  • There is a new Zoom link for the 2024 Summit meetings. If you do not have the new link, please contact info@izsummitpartners.org.
  • If you have agenda items you are interested in sharing with the Summit, please tell us and we can add you to an upcoming call as a speaker or panelist. Contact information: info@izsummitpartners.org

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