Access to Health Care Improves COVID-19 Vaccination and Mitigates Health Disparities Among Medicare Beneficiaries

The association between healthcare access and shingles vaccination among older adults in Virginia, United States

INTRODUCTION

Shingles is a debilitating vaccine preventable disease that poses a health threat to older adults. However, the uptake of shingles vaccines remains low, and the factors contributing to the low uptake are not clearly understood. This study assessed the association between healthcare access and shingles vaccination among older adults, as well as the impact of COVID-19 pandemic on vaccine uptake.

METHODS

This was a cross-sectional study among adults 50 + years in Virginia (n = 16,576) using data from the Behavioral Risk Factor Surveillance System (2018, 2019, and 2021). We calculated the prevalence of shingles vaccination by health insurance and access to primary health care provider (used as proxies for healthcare access) and in relation to the COVID-19 pandemic (pre vs during). Log binomial regression models were used to estimate prevalence ratios (PR), adjusting for confounders.

RESULTS

Shingles vaccination was substantially higher among those with healthcare access compared to those without. Specifically, shingles vaccination was 35% among those with health insurance vs. 10% among those without (adjusted PR (aPR): 2.03, 95% CI 1.44, 2.86), and 36% among those with a primary healthcare provider vs 15% among those without (aPR: 1.99, 95% CI: 1.65-2.41). Finally, shingles vaccination was 41% during the COVID-19 pandemic vs. 30% before (aPR:1.26, 95% CI: 1.20-1.33).

CONCLUSION

Individuals with health insurance and access to a primary healthcare provider were significantly more likely to receive the shingles vaccine compared to those without such access. Moreover, the prevalence of shingles vaccination during the pandemic period was substantially higher compared with shingles vaccination before the pandemic.

Interventions to Reduce COVID-19 Vaccine Hesitancy among Black and African American Individuals in the United States: A Systematic Literature Review

COVID-19 vaccine hesitancy had major implications for racial health equity at the beginning of the vaccination campaign in the U.S. Interventions to reduce vaccine hesitancy among Black and African American individuals partially helped to reduce vaccine hesitancy in specific communities. This article describes findings on interventions to reduce COVID-19 vaccine hesitancy among Black and African American individuals from a literature review we conducted. We found 12 studies that described communication, partnerships, and distribution interventions. Regarding communication, examples include a webinar hosted by an academic-community partnership team, information sessions, social media campaigns, educational materials, and virtual town halls. Effective partnerships identified through this literature review were a statewide alliance and one between an academic institution and faith and community leaders. Distribution interventions identified through the literature review were the deployment of multiple tactics to increase COVID-19 vaccine uptake (virtual town halls, a confidential employee hotline, department huddles, written educational material, and accessible vaccination stations) and offering to administer the COVID-19 vaccine during medical appointments. The results of this review show that implementing interventions directed at specific minority groups improves COVID-19 vaccine acceptance without undermining overall vaccine distribution or uptake.

Vaccine hesitancy and equity: lessons learned from the past and how they affect the COVID-19 countermeasure in Indonesia

INTRODUCTION

Indonesia has made progress in increasing vaccine coverage, but equitable access remains challenging, especially in remote areas. Despite including vaccines in the National Immunization Program (NIP), coverage has not met WHO and UNICEF targets, with childhood immunization decreasing during the COVID-19 pandemic. COVID-19 vaccination has also experienced hesitancy, slowing efforts to end the pandemic.

SCOPE

This article addresses the issue of vaccine hesitancy and its impact on vaccination initiatives amidst the COVID-19 pandemic. This article utilizes the vaccine hesitancy framework to analyze previous outbreaks of vaccine-preventable diseases and their underlying causes, ultimately providing recommendations for addressing the current situation. The analysis considers the differences between the pre-pandemic circumstances and the present and considers the implementation of basic and advanced strategies.

KEY FINDINGS AND CONCLUSION

Vaccine hesitancy is a significant challenge in the COVID-19 pandemic, and public health campaigns and community engagement efforts are needed to promote vaccine acceptance and uptake. Efforts to address vaccine hesitancy promote trust in healthcare systems and increase the likelihood of individuals seeking preventive health services. Vaccine hesitancy requires a comprehensive, culturally sensitive approach that considers local contexts and realities. Strategies should be tailored to specific cultural and societal contexts and monitored and evaluated.

Social Determinants of COVID-19 Vaccination Rates: A Time-Constrained Multiple Mediation Analysis

Objective To estimate the multiple direct/indirect effects of social, environmental, and economic factors on COVID-19 vaccination rates (series complete) in the 3109 continental counties in the United States (U.S.). Study design  The dependent variable was the COVID-19 vaccination rates in the U.S. (April 15, 2022). Independent variables were collected from reliable secondary data sources, including the Census and CDC. Independent variables measured at two different time frames were utilized to predict vaccination rates. The number of vaccination sites in a given county was calculated using the geographic information system (GIS) packages as of April 9, 2022. The Internet Archive (Way Back Machine) was used to look up data for historical dates. Methods  A chain of temporally-constrained least absolute shrinkage and selection operator (LASSO) regressions was used to identify direct and indirect effects on vaccination rates. The first regression identified direct predictors of vaccination rates. Next, the direct predictors were set as response variables in subsequent regressions and regressed on variables that occurred before them. These regressions identified additional indirect predictors of vaccination. Finally, both direct and indirect variables were included in a network model. Results  Fifteen variables directly predicted vaccination rates and explained 43% of the variation in vaccination rates in April 2022. In addition, 11 variables indirectly affected vaccination rates, and their influence on vaccination was mediated by direct factors. For example, children in poverty rate mediated the effect of (a) median household income, (b) children in single-parent homes, and (c) income inequality. For another example, median household income mediated the effect of (a) the percentage of residents under the age of 18, (b) the percentage of residents who are Asian, (c) home ownership, and (d) traffic volume in the prior year. Our findings describe not only the direct but also the indirect effect of variables. Conclusions  A diverse set of demographics, social determinants, public health status, and provider characteristics predicted vaccination rates. Vaccination rates change systematically and are affected by the demographic composition and social determinants of illness within the county. One of the merits of our study is that it shows how the direct predictors of vaccination rates could be mediators of the effects of other variables.