Increases In COVID-19 Vaccination Among NYC Municipal Employees After Implementation Of Vaccination Requirements

Community Health Worker Influence on COVID-19 Vaccine Uptake in New York City, 2021‒2022

Objectives. To evaluate a community health worker (CHW) intervention to decrease COVID-19 vaccine uptake disparities in historically disinvested communities of color. Methods. The New York City Health Department partnered with community-based organizations that served 75 zip code‒defined communities targeted for rapid response intervention. Analyses used community demographic and COVID-19 vaccine uptake data. Linear regression models evaluated high and low CHW outreach on community vaccine uptake between July 1, 2021, and June 30, 2022. Results. Of 75 communities, 65 (85%) experienced high CHW outreach, which prioritized trauma-informed engagement with 4.2 million Black and Latino community residents. On average, residents were 70% Black and Latino. Significant differences existed between high and low outreach communities for baseline community COVID-19 vaccine uptake (44% vs 59%; P < .001). CHWs provided vaccine information to community residents 18 million times and increased community vaccine uptake from 44% to 76% (P < .001) in 1 year. Conclusions. This research expands the body of evidence documenting the essential role played by CHWs to change population health behaviors. Public Health Implications. Response readiness during public health crises relies on pre-established trust. When this is lacking, CHW outreach can bridge the gap. (Am J Public Health. 2025;115(6):910-919. https://doi.org/10.2105/AJPH.2025.308039).

COVID-19 Vaccine Mandate and Vaccination Rates in the US Military, 2020‒2022

Objectives. To assess the effect of the vaccination mandate on COVID-19 vaccination rates and identify independent factors associated with lack of postmandate vaccination among service members. Methods. We assessed all active component service members for COVID-19 vaccination status from December 11, 2020, to January 1, 2022. We used comparative interrupted time series analysis and logistic regression to compare pre- and postmandate completion of the vaccine series between the US military and the US general population. Results. Previous documented infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), lower rank, and non-Hispanic Black race were associated with lower premandate vaccination. Postmandate vaccination rates were significantly higher in the active component population (P < .001) compared with the premandate period and the US population. Also notable was the higher incidence of postmandate vaccination among those who were non-Hispanic Black or of lower rank. Conclusions. The US military's COVID-19 vaccination mandate was effective at both increasing overall vaccination rates and reducing disparities in vaccination, including race and ethnicity and rank. Vaccine mandates increase the receipt of vaccines and promote health, readiness, and equity within the US military. (Am J Public Health. Published online ahead of print May 15, 2025:e1-e11. https://doi.org/10.2105/AJPH.2025.308120).

Using regression tree analysis to examine demographic and geographic characteristics of COVID-19 vaccination trends over time, United States, May 2021-April 2022, National Immunization Survey Adult COVID Module

Using data from the nationally representative National Immunization Survey (NIS), we applied conditional linear regression tree methodology to examine relationships between demographic and geographic factors and propensity of receiving various doses of COVID-19 vaccine over time; these analyses identified temporal changes in these relationships that heretofore had not been identified using conventional logistical regression methodologies. Three regression tree models were built using an R package, Recursive Partitioning for Modeling Survey (rpms), to examine propensities over time of receiving a (1) first dose of a two-dose COVID-19 mRNA primary vaccination series or single dose of the Janssen vaccine (vaccine initiation), (2) primary series completion, and (3) monovalent booster dose, using a conditional linear effect model. Persons ≥50 years were more likely to complete a primary series and receive a first booster dose; persons reporting having received non-COVID-19 vaccines recently were more likely to initiate vaccination, complete the primary series, and get a first booster dose; persons reporting having work or school requirements were more likely to complete the primary series. Persons not reporting having received non-COVID-19 vaccines in 2 years but reporting having work or school vaccination requirements were more likely to initiate vaccination than those without work/school requirements. Among persons not reporting having received non-COVID-19 vaccines in 2 years and not reporting having work or school vaccination requirements, those aged ≥50 years were more likely to initiate vaccination than were younger adults. Propensity of receiving various doses was correlated with age, having recently received non-COVID 19 vaccines, and having vaccination requirements at work or school. Regression tree methodology enabled modeling of different COVID-19 vaccination dose propensities as a linear effect of time, revealed changes in relationships over time between demographic factors and propensity of receipt of different doses, and identified populations that may benefit from vaccination outreach efforts.

State COVID-19 Vaccine Mandates and Uptake Among Health Care Workers in the US

Importance

Seventeen states introduced COVID-19 vaccine mandates for health care workers (HCWs) in mid-2021. Prior research on the effect of these mandates was centered on the nursing home sector, and more evidence is needed for their effect on the entire HCW population.

Objective

To examine the association between state COVID-19 vaccine mandates for HCWs and vaccine uptake in this population.

Design, Setting, and Participants

This repeated cross-sectional study included biweekly, individual-level data for adults aged 25 to 64 years who were working or volunteering in health care settings obtained from the Household Pulse Survey between May 26 and October 11, 2021. Analyses were conducted between November 2022 and October 2023.

Exposure

Announcement of a state COVID-19 vaccine mandate for HCWs.

Main Outcomes and Measures

An indicator for whether a sampled HCW ever received a COVID-19 vaccine and an indicator for whether an HCW completed or intended to complete the primary COVID-19 vaccination series. Event study analyses using staggered difference-in-differences methods compared vaccine uptake among HCWs in mandate and nonmandate states before and after each mandate announcement. The sample was further stratified by the availability of regular COVID-19 testing in place of a vaccination (ie, a test-out option) and by the ages of HCWs (25-49 or 50-64 years) to examine heterogeneous associations.

Results

The study sample included 31 142 HCWs (mean [SD] age, 45.5 [10.6] years; 72.1% female) from 45 states, 16 of which introduced COVID-19 vaccine mandates for HCWs. Results indicated a mandate-associated 3.46-percentage point (pp) (95% CI, 0.29-6.63 pp; P = .03) increase in the proportion of HCWs ever vaccinated against COVID-19 and a 3.64-pp (95% CI, 0.72-6.57 pp; P = .02) increase in the proportion that completed or intended to complete the primary vaccination series 2 weeks after mandate announcement from baseline proportions of 87.98% and 86.12%, respectively. In the stratified analyses, positive associations were only detected in mandate states with no test-out option and among HCWs aged 25 to 49 years, which suggested vaccination increases of 3.32% to 7.09% compared with baseline proportions.

Conclusions and Relevance

This repeated cross-sectional study found that state COVID-19 vaccine mandates for HCWs were associated with increased vaccine uptake among HCWs, especially among younger HCWs and those in states with no test-out option. These findings suggest the potential for vaccine mandates to further promote vaccinations in an already highly vaccinated HCW population, especially when no test-out option is in place.

Projected Health Outcomes Associated With 3 US Supreme Court Decisions in 2022 on COVID-19 Workplace Protections, Handgun-Carry Restrictions, and Abortion Rights

Importance

Several recent US Supreme Court rulings have drawn criticism from the medical community, but their health consequences have not been quantitatively evaluated.

Objective

To model health outcomes associated with 3 Supreme Court rulings in 2022 that invalidated workplace COVID-19 vaccine or mask-and-test requirements, voided state handgun-carry restrictions, and revoked the constitutional right to abortion.

Design, Setting, and Participants

This decision analytical modeling study estimated outcomes associated with 3 Supreme Court rulings in 2022: (1) National Federation of Independent Business v Department of Labor, Occupational Safety and Health Administration (OSHA), which invalidated COVID-19 workplace protections; (2) New York State Rifle and Pistol Association Inc v Bruen, Superintendent of New York State Police (Bruen), which voided state laws restricting handgun carry; and (3) Dobbs v Jackson Women's Health Organization (Dobbs), which revoked the constitutional right to abortion. Data analysis was performed from July 1, 2022, to April 7, 2023.

Main Outcomes and Measures

For the OSHA ruling, multiple data sources were used to calculate deaths attributable to COVID-19 among unvaccinated workers from January 4 to May 28, 2022, and the share of these deaths that would have been prevented by the voided protections. To model the Bruen decision, published estimates of the consequences of right-to-carry laws were applied to 2020 firearm-related deaths (and injuries) in 7 affected jurisdictions. For the Dobbs ruling, the model assessed unwanted pregnancy continuations, resulting from the change in distance to the closest abortion facility, and then excess deaths (and peripartum complications) from forcing these unwanted pregnancies to term.

Results

The decision model projected that the OSHA decision was associated with 1402 additional COVID-19 deaths (and 22 830 hospitalizations) in early 2022. In addition, the model projected that 152 additional firearm-related deaths (and 377 nonfatal injuries) annually will result from the Bruen decision. Finally, the model projected that 30 440 fewer abortions will occur annually due to current abortion bans stemming from Dobbs, with 76 612 fewer abortions if states at high risk for such bans also were to ban the procedure; these bans will be associated with an estimated 6 to 15 additional pregnancy-related deaths each year, respectively, and hundreds of additional cases of peripartum morbidity.

Conclusions and Relevance

These findings suggest that outcomes from 3 Supreme Court decisions in 2022 could lead to substantial harms to public health, including nearly 3000 excess deaths (and possibly many more) over a decade.