Successful Vaccine Gap Closure Programs Can Guide Pharmacists in Tailoring to Their Community

Vaccination is one of the easiest and most effective ways to improve health outcomes in a community. However, there are clear obstacles to ensuring everyone who needs and wants a vaccination can receive one, oftentimes based upon uncontrollable factors such as where patients live or their racial and ethnic identities.

Image credit: © Zoran Zeremski | stock.adobe.com

Income and race are clear factors in how likely a person is to receive a vaccine. One study, conducted by Green et al, found that non-low-income White adults (80.9%) had the highest likelihood to receive a COVID-19 vaccination, significantly higher than low-income Latino adults (72.4%), low-income Black Americans (70.7%), and White low-income adults (63.6%).¹

Across the country, rural and urban regions exhibit major differences in vaccination rates. A study published in the American Journal of Public Health analyzed COVID-19 vaccination rates in rural and urban regions in 48 states from May 2021 to April 2022. They found that two-thirds of states had much lower vaccination rates in rural communities.²

These gaps in vaccination rates go beyond COVID-19 vaccines. Vulnerable communities have lower vaccination rates for influenza and other diseases, with responses to a 2023 survey indicating that individuals in these communities had unclear information about vaccination and that they had not been advised by a treatment advisor in the last year to be vaccinated.³

Unfortunately, these gaps in vaccine coverage aren’t going away any time soon. Vaccine gap closure programs can spur community outreach to at-risk individuals to encourage vaccination through providing clinics, education, and other resources. It is essential to learn from the success of past initiatives and combine best practices to tailor programs for any community that may need it.

Missouri

A clear example of a successful program to close immunization gaps in local communities can be seen in Missouri, where multiple key associations and stakeholders worked together to address these gaps across the state.⁴

Through a grant from the Missouri Department of Health, the Missouri Pharmacy Association (MPA), the Community Pharmacy Enhanced Services Network (CPESN) of Missouri, and CPESN Health Equity were able to organize community health workers (CHWs) and pharmacists to vaccinate individuals across 91 pharmacies.⁴

“We’re helping each other. And when you help each other, you just continue to lift everyone up.”

Over 22,000 patients and over 200 providers have been engaged by the program; 6 months in, preliminary data indicates a remarkable 6.6% gap closure rate. The socioeconomic benefit was significant, with pharmacies generating service-based revenue through education services and the increased vaccinations saving society $8.7 million.⁴

How was this effort so successful? Annie Eisenbeis, PharmD, MBA, director of practice development at MPA, and Jake Galdo, PharmD, MBA, BCPS, BCPG, managing network facilitator at CPESN Health Equity, attribute the program’s effectiveness to relationships between local community pillars, from pharmacies to local health departments.⁵

Jake Galdo, PharmD, MBA, BCPS, BCPG, managing network facilitator at CPESN Health Equity.

According to Eisenbeis, working through “the people that do this and love working in their communities every day, and filtering that back up” was a key mechanism in ensuring the program’s operation. “It’s being neighborly, right?” Galdo added. “We’re helping each other. And when you help each other, you just continue to lift everyone up.”⁵

Through 5-to-15-minute encounters regarding a patient’s vaccine eligibility and hesitancy concerns, a pharmacist and CHW were able to address those barriers. Vaccine clinics were established at various locations across the community— “basically, anywhere that the patient doesn’t have access to vaccine education or vaccinations” —to allow for easy access. Once a patient received an immunization, if they required a second dose or were eligible for other vaccines, CHWs were leaned on to organize and coordinate that continued care at the most convenient location for the patient.5

Medication synchronization (med-sync) was an essential aspect of the program. Pharmacists were trained to shift their med-sync operations to a longitudinal education and care process, critical for the successful implementation of quality care. Through this process, “an environment for identifying and resolving care gaps” was formed.⁴

Annie Eisenbeis, PharmD, MBA, director of practice development at MPA.

Another central factor was a focus on health equity. Closing vaccination gaps requires an understanding that many underserved and minority communities face barriers to receiving immunizations, and that the key to closing these gaps is to ensure these groups are top-of-mind. Social detriments of health (SDoH) experts were deployed to manage monthly med-sync calls that addressed vaccine hesitancy and SDoH obstacles, while pharmacists determined eligibility and administered vaccines.⁴

Galdo said a main takeaway from the program was the newfound ability to create “a sustainable model of business at a pharmacy that’s focused on health equity services.” This focus on equity in a vaccine gap program isn’t new, though. Turning to a similar program in California can provide further insights as to what makes a successful program.⁵

California

In the early phases of the COVID-19 pandemic, California was one of—if not the most—impacted state by the virus. Jacinda Abdul-Mutakabbir, PharmD, MPH, AAHIVP, recognized the disparate impact the virus had on minority patients. The same went for vaccinations; at Loma Linda University Hospital, she observed a major difference between admitted Black patients and those patients who were being vaccinated in their clinics.⁶

"Everybody won't agree with you, but that's not the purpose."

“We decided that we needed to have a more concentrated effort to target the community,” Abdul-Mutakabbir said in an interview. The opportunity presented itself when a group of Black pastors reached out to the hospital about plans to reach out to the African American community and increase vaccine rates.⁶

A picture following the launch of the San Diego Outreach Community Clinics (executed by the UC San Diego School of Pharmacy and the County of San Diego Health Department), which provides screenings for blood pressure and blood glucose and vaccinations within vulnerable communities. Taken August 2024.

The decision was made to initiate a vaccine education program that could lead to increased uptake at Loma Linda clinics from minoritized individuals. Abdul-Mutakabbir provided education through webinars before vaccine clinic events to “really facilitate agency in decision making so that they could get the vaccines.”⁶

At one event, 433 individuals were vaccinated, with 85 of them being Black individuals. Abdul-Mutakabbir said that, at their mass vaccination site up to that point, 530 individuals total had been vaccinated; that output was almost matched with one effort. Then, individuals kept coming, and they expanded their efforts to Hispanic communities. Eventually, they shifted to in-person presentations and have now included influenza education and vaccination in their efforts.⁶

“First and foremost, it’s really important to have a community,” Abdul-Mutakabbir said when asked what some of the most essential aspects for an effective gap closure program were. She also mentioned education, noting that many times a factor that leads to vaccine hesitancy is a lack of knowledge.⁶

A picture at Life Changing Church following an education session on preventable viruses and vaccines. 42 vaccines (26 COVID-19, 16 Flu) were given. Taken September 2024.

“Everybody won’t agree with you, but that’s not the purpose,” she explained. “The purpose is to translate the knowledge so that folks can be encouraged, or at least know why it’s important to be vaccinated.”⁶

As was the case in Missouri, community pharmacists and community health workers (CHWs) proved “extremely important” in the program’s implementation. Abdul-Mutakabbir explained that, oftentimes, patients have one provider that they see, and that “education they provide may be the only thing they get.”⁶

CHWs are also critical in helping determine where in the community are the best locations to initiate a vaccine clinic or other outreach programs. Abdul-Mutakabbir explained that a person that close within a community can direct clinicians in where a program may be good for outreach and where it may lead to a poorer response. Given that these key locations will always vary, having stakeholders imbedded in the community is essential.⁶

What Makes a Successful Program

Any community outreach program will vary depending on the population being served. The community makes the program, and the program is shaped by the community. However, the vaccine gap closure programs in Missouri and California share multiple qualities that have made them both successful.

Above all, a healthy dose of community pharmacy is the key ingredient for a successful outreach program. CHWs have a valuable expertise in their community that is unmatched and can provide this knowledge to guide where a program should be located and for which populations it should be targeted.

Of course, a good idea—more eloquently, someone speaking out and suggesting a fix to a problem, or a problem presenting itself and stakeholders coming together to solve it—is the precursor to every good vaccine gap closure program. In the case of Galdo and Eisenbeis’ program in Missouri, financial opportunity and state incentive pushed the program to its fruition. For Abdul-Mutakabbir, it was a group of Black pastors and the realization of the disparate health impacts of COVID-19.

This leads to equity. Perhaps the foremost goal of any vaccine program, ensuring equity in vaccination was a major factor in both Missouri and California. Eisenbeis had the contributions of CPESN Health Equity, in addition to social detriments of health (SDoH) experts, to ensure equitable vaccination across their rural community. Abdul-Mutakabbir and her colleagues specifically targeted Black and Hispanic patients in their educational outreach, especially those who may have additional obstacles to receiving vaccinations such as living in a rural area.

The community makes the program, and the program is shaped by the community.

The COVID-19 pandemic taught clinicians and pharmacists around the world that a large-scale vaccination campaign can be difficult, and people can slip through the gaps. Through coordination with local and state partners, health equity services, and community pharmacists and CHWS, vaccine gaps in underserved populations can be identified and targeted, keeping everybody in a community healthy.

REFERENCES

1. Green AL, Stewart AL, Nápoles AM, et al. COVID-19 vaccination willingness and uptake among low-income Black/African American, Latino, and White adults living in the US. Prev Med Rep. 2023;35:102367. doi:10.1016/j.pmedr.2023.102367

2. Soorapanth S, Cheung R, Zhang X, et al. Rural-urban differences in vaccination and hesitancy rates and trust: US COVID-19 trends and impact survey on a social media platform, May 2021-April 2022. AJPH. 2023;113(6):680-688. doi:10.2105/AJPH.2023.307274

3. Lyons N. Community pharmacy’s next mission: Closing immunization gaps among vulnerable and underserved populations. Pharmacy Times July 2023 Influenza Supplement. Published July 17, 2023. Accessed October 1, 2024. https://www.pharmacytimes.com/view/community-pharmacy-s-next-mission-closing-immunization-gaps-among-vulnerable-and-underserved-populations

4. Eisenbeis A, Stone A, Logan RN, et al. The perfect ingredient: Vaccine education with pharmacy community health workers. Pharmacy Times. Published August 24, 2024. Accessed October 1, 2024. https://www.pharmacytimes.com/view/the-perfect-ingredient-vaccine-education-with-pharmacy-community-health-workers

5. Halpern L. Experts: Pharmacists, community health workers key to success in Missouri vaccine gap program. Pharmacy Times. Published August 26, 2024. Accessed October 1, 2024. https://www.pharmacytimes.com/view/experts-pharmacists-community-health-workers-key-to-success-in-missouri-vaccine-gap-program

6. Interview with Jacinda Abdul-Mutakabbir. Pharmacy Times. Published September 19, 2024. Accessed October 1, 2024.