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CO-mmunity Corps Blog Series: Vaccination in Chaffee County and Potential Interventions to Improve Rates

By Clara Holder

The CO-mmunity Corps blog series highlights the incredible work that members of the CO-mmunity Corps (Immunize Colorado’s AmeriCorps VISTA program) are doing across Colorado to build capacity for immunization programs.

My name is Clara, and I am one of the AmeriCorps VISTAs working on immunization education and outreach with Immunize Colorado. I work in Salida, Colorado at Chaffee County Public Health and spend my time engaging community partners and working on the COVID-19 response as well. I feel lucky to have been placed at a small LPHA (local public health agency) for all of the incredible experience that I’m getting, and am excited to share the research I’ve conducted over the past few months and the planned interventions I’ll be working on for the rest of my service year.

Using data from national, state, and county sources gave the most complete picture possible of Chaffee County’s vaccination environment. I was able to conduct some of my own qualitative research at this time, through a survey and focus group distributed to parents in the county. This information I found and the results from the survey and focus groups provided the background for a number of interventions that I’ll be working on for the next nine months. There is more work to be done to reach a larger number of Chaffee County residents who are at risk for undervaccination, including residents not targeted during the survey/focus group data collection, and who may fall closer to medium income in the county or also make up a more diverse group of people.

What marks this particular moment in time is the presence of dual pandemics; that is, both COVID-19 and the structural racism woven into the fabric of American life. Both of these issues have placed a significant burden on public health and healthcare systems. Efforts to improve vaccine uptake are occurring with these two very large issues at hand simultaneously, creating unique challenges and also unique opportunities.

Immunizations in Chaffee County
At Chaffee County, our main focus for increasing vaccination is among school-aged children, especially those in the R32 school district in Salida. According to CDPHE data, this district has the lowest rates of vaccination in the county, falling significantly below state averages as well as below the neighboring school district’s rates (Buena Vista). These rates varied, with Tdap vaccinations coming in the lowest at 77%, compared to DTaP which had rates at 86%. All vaccination rates were below the goals indicated in Healthy People 2020. Rates of non-medical exemptions were also very high in the Salida school district, with up to 13.43% non-medical exemption for Tdap vaccine. In the coming 2020-21 school year, this is a great place and time to emphasize vaccine uptake. 

Parental Opinions & Beliefs on Childhood Vaccinations: Survey and Focus Group
To gauge local opinions and beliefs regarding childhood vaccination, I conducted a survey during the summer of 2020, followed by a focus group. The questions asked in the survey and focus group can be found here and an in-depth summary of the data can be found here.

Approximately 80% of survey respondents were mothers of child(ren) and tended to be 30 years or older, white, married, and with an income of $75,000 or more per year. For reference, the race distribution of Chaffee County is 85.4% non-Hispanic White, 10% Hispanic, and 5% other races (including Black, Asian, Native American, Alaskan Native, or Hawaiian Pacific Islander, and Biracial/Mixed Race), and median income in Chaffee County is $48,012.

The responses from survey participants tended toward trust in vaccines for their children, and many participants felt that they had a good, trusting relationship with the health care provider giving the vaccines. The parent’s relationship with their healthcare provider seemed to be the most important factor in reducing vaccine hesitancy. However, over half of parents (52%) felt strongly that it was their role to question the vaccines given to their children. 30% of parents were either unsure or against giving recommended vaccines to their child, should they have another one. Only 1 in 3 parents were “not at all hesitant” about vaccines. 

Parents felt for the most part that vaccines were good for children to protect against harmful disease, and believed that vaccines were much better for children than developing immunity naturally through getting sick. As for a future COVID-19 vaccine, some respondents were very concerned about the safety and testing of vaccines, while others were committed to getting a vaccine for COVID once it becomes available. 

Overall, parents tended to be confident in both vaccines and their use in prevention of childhood disease. Parents were more confident in vaccines if they had positive historical experiences with them, and if they had a strong relationship with their healthcare provider.

Possible Interventions
Thanks to the data pulled from both the state and county as well as that used from the vaccination-specific survey of Chaffee County parents, we can better understand the environment surrounding vaccination in Chaffee County. A number of interventions are indicated, and can be made for improving vaccination rates locally to target those populations at highest risk. These include an educational program for 9-15 year olds on vaccinations, use of Instagram for posts about vaccines (including answers to commonly asked questions, educational materials to help clinicians address questions from vaccine-hesitant parents, mailing of Vaccine Information Statements (VIS sheets) directly to parents, and providing mass-prophylaxis events for flu vaccine and a future COVID-19 vaccine.

Wrapping Up
It is important to address concerns of vaccine-hesitant parents in Chaffee County, and work to increase the number of vaccinated students at Salida School District. Addressing racial justice and vaccine equity in the valley is also important. Finally, working to see uptake of the COVID-19 vaccine when it is publicly available is also a priority. The Fall and Winter of 2020-21 will present a unique and also complex situationfor public health; preparing for dual outbreaks of COVID-19 and flu will be a challenge, but also an opportunity to remind people of the importance of vaccines. Focusing on vaccines in this time is therefore more important than ever to prevent disease that could otherwise compromise healthy patients, and also to ensure space in healthcare systems to treat those affected by respiratory disease like COVID-19. 

Working in public health during the COVID-19 pandemic is an incredible privilege, but also an overwhelming experience. As a VISTA I hope to reduce poverty through increasing capacity at my LPHA (Local Public Health Agency), and evoking change (especially now) feels quite powerful. It is my hope that with this Community Assessment and following interventions, we see an increase in vaccination coverage in Chaffee County and an increase in capacity for public health and community partners in the years to come. 

For access to the full focus group transcript and/or the results from the survey, please contact Clara at Clara.Holder@coloradoimmunitycorps.org

Clara Holder is an Americorps VISTA placed at CCPH in Salida, CO. She is working on immunization outreach and education with Immunize Colorado until May of 2021. 

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