COVID-19 and Historic Influenza Vaccinations in the United States: A Comparative Analysis

The COVID-19 vaccination effort is a monumental global challenge. Recognizing and addressing the causes of vaccine hesitancy will improve vaccine uptake. The primary objective of this study was to compare the COVID-19 vaccination rates in US counties to historical vaccination rates for influenza in persons aged 65 and older. The secondary objective was to identify county-level demographic, socioeconomic, and political factors that influence vaccination rates. County level data were obtained from publicly available databases for comparison and to create predictive models. Overall, in US counties the COVID-19 vaccination rate exceeded influenza vaccination rates amongst those aged 65 or older (69.4.0% vs. 44%, p < 0.0001). 2690 (83.4%) of 3224 counties had vaccinated 50% or more of their 65 and older residents in the first seven months of the COVID-19 vaccination roll out. There were 467 (14.5%) of 3223 counties in which the influenza vaccination rate exceeded the COVID-19 vaccination rate. Most of these counties were in the Southern region, were considered politically “red” and had a significantly higher non-Hispanic Black resident population (14.4% vs. 8.2%, p < 0.0001). Interventions intended to improve uptake should account for nuances in vaccine access, confidence, and consider factual social media messaging, especially in vulnerable counties.

Download Full-text

Impact of SARS-CoV-2 Vaccines on Covid-19 Incidence and Mortality in the United States

10.1101/2021.11.16.21266360 ◽

2021 ◽

Author(s):

Fang Fang ◽

John David Clemens ◽

Zuo-Feng Zhang ◽

Timothy F. Brewer

Keyword(s):

Negative Binomial ◽

Herd Immunity ◽

The United States ◽

Vaccination Rate ◽

Vaccine Hesitancy ◽

Percentage Increase ◽

Protective Effects ◽

Vaccination Rates ◽

Incidence And Mortality ◽

Before And After

Background: Despite safe and effective vaccines to prevent Severe Acute Respiratory Syndrome coronavirus 2 (SARS-CoV-2) infections and disease, a substantial minority of the US remains resistant to getting vaccinated. It is imperative to know if expanding vaccination rates could reduce community-wide Coronavirus 2019 (COVID-19) disease, not just among those vaccinated. Methods: Negative binomial models were used to estimate associations between U.S. county-level vaccination rates and county-wide COVID-19 incidence and mortality between April 23rd and September 30th, 2021. A two-week lag and a four-week lag were introduced to assess vaccination rate impact on incidence and mortality, respectively. Stratified analyses were performed for county vaccination rates >40%, and before and after Delta became the dominant variant. Findings: Among 3,070 counties, each percentage increase in population vaccination rates reduced county-wide COVID-19 incidence by 0.9% (relative risk (RR) 0.9910 (95% CI: 0.9869, 0.9952)) and mortality by 1.9% (RR 0.9807 (95% CI: 0.9745, 0.9823)). Among counties with vaccination coverage >40%, each percentage increase in vaccination rates reduced COVID-19 disease by 1.5%, RR 0.9850 (95% CI: 0.9793, 0.9952) and mortality by 2.7% (RR 0.9727 (95% CI: 0.9632, 0.9823)). These associations were not observed among counties with <40% vaccination rates. Increasing vaccination rates from 40% to 80% would have reduced COVID-19 cases by 45.4% (RR 0.5458 (95% CI: 0.4335, 0.6873)) and deaths by 67.0% (RR 0.3305 (95% CI: 0.2230, 0.4898)). An estimated 5,989,952 COVID-19 cases could have been prevented and 127,596 lives saved had US population vaccination rates increased from 40% to 80%. Interpretations: Increasing U.S. SARS-CoV-2 vaccination rates results in population-wide reductions in COVID-19 incidence and mortality. Furthermore, increasing vaccination rates above 40% has protective effects among non-vaccinated persons. Given ongoing vaccine hesitancy in the U.S., increasing vaccination rates could better protect the entire community and potentially reach herd immunity. Funding: National Cancer Institute

Download Full-text

Higher COVID-19 vaccination rates are linked to decreased county-level COVID-19 incidence across USA

10.1101/2021.03.05.21252946 ◽

2021 ◽

Author(s):

Arjun Puranik ◽

AJ Venkatakrishnan ◽

Colin Pawlowski ◽

Bharathwaj Raghunathan ◽

Eshwan Ramudu ◽

...

Keyword(s):

Incidence Rate ◽

Vaccine Efficacy ◽

Vaccine Dose ◽

The United States ◽

Vaccination Rate ◽

Incidence Rates ◽

P Value ◽

County Level ◽

Vaccination Rates ◽

The Impact

Real world evidence studies of mass vaccination across health systems have reaffirmed the safety1 and efficacy2,3 of the FDA-authorized mRNA vaccines for COVID-19. However, the impact of vaccination on community transmission remains to be characterized. Here, we compare the cumulative county-level vaccination rates with the corresponding COVID-19 incidence rates among 87 million individuals from 580 counties in the United States, including 12 million individuals who have received at least one vaccine dose. We find that cumulative county-level vaccination rate through March 1, 2021 is significantly associated with a concomitant decline in COVID-19 incidence (Spearman correlation ρ = −0.22, p-value = 8.3e-8), with stronger negative correlations in the Midwestern counties (ρ = −0.37, p-value = 1.3e-7) and Southern counties (ρ = −0.33, p-value = 4.5e-5) studied. Additionally, all examined US regions demonstrate significant negative correlations between cumulative COVID-19 incidence rate prior to the vaccine rollout and the decline in the COVID-19 incidence rate between December 1, 2020 and March 1, 2021, with the US western region being particularly striking (ρ = −0.66, p-value = 5.3e-37). However, the cumulative vaccination rate and cumulative incidence rate are noted to be statistically independent variables, emphasizing the need to continue the ongoing vaccination roll out at scale. Given confounders such as different coronavirus restrictions and mask mandates, varying population densities, and distinct levels of diagnostic testing and vaccine availabilities across US counties, we are advancing a public health resource to amplify transparency in vaccine efficacy monitoring (https://public.nferx.com/covid-monitor-lab/vaccinationcheck). Application of this resource highlights outliers like Dimmit county (Texas), where infection rates have increased significantly despite higher vaccination rates, ostensibly owing to amplified travel as a “vaccination hub”; as well as Henry county (Ohio) which encountered shipping delays leading to postponement of the vaccine clinics. This study underscores the importance of tying the ongoing vaccine rollout to a real-time monitor of spatio-temporal vaccine efficacy to help turn the tide of the COVID-19 pandemic.

Download Full-text

Characterization of influenza vaccination recommendation across spatial scales in the United States

10.1101/2021.01.19.21250118 ◽

2021 ◽

Author(s):

Madeline C. Kuney ◽

Casey M. Zipfel ◽

Shweta Bansal

Keyword(s):

Public Health ◽

Influenza Vaccine ◽

Influenza Vaccination ◽

Spatial Scales ◽

The United States ◽

Vaccine Uptake ◽

County Level ◽

Health Administration ◽

Vaccination Recommendation ◽

Vaccination Recommendations

AbstractThe US public health system is organized in 3 levels: national, state-level, and county-level. Public health messaging both within and across these scales may not always be consistent, and for transmissible public health threats where cases in one spatial location may impact other areas, this lack of consistency could create problems. Here, we collected and analyzed data on influenza vaccination recommendations across public health administration levels. We assess spatial heterogeneity at the county level, and analyze consistency in recommendations across spatial scales. We also compare information accessibility with influenza vaccine affordability and availability to identify factors that may be most related to vaccine uptake. We find that influenza vaccine recommendations are highly variable in both their priority group specificity and in their ease of access, and there is poor agreement across spatial scales. This lack of consistency results in a lack of clear relationship between vaccination information and vaccine uptake. This work highlights the need for greater consistency in specific, easily accessed public health information from trusted sources.

Download Full-text

COVID-19 Vaccination Rates Are Lowest among Political Outsiders in the United States

10.31235/osf.io/hy7gx ◽

2021 ◽

Author(s):

Byungkyu Lee ◽

James Chu

Keyword(s):

United States ◽

Presidential Elections ◽

The United States ◽

Vaccination Rate ◽

Longitudinal Survey ◽

Vaccine Hesitancy ◽

Vaccination Rates ◽

Longitudinal Survey Data ◽

Nationally Representative ◽

The U.S

Vaccine hesitancy is a critical barrier to widespread vaccination uptake and containment of the COVID-19 pandemic. In the United States, vaccines have become politically polarized, with high rates of vaccine hesitancy observed among Republicans. In contrast to prior research focusing on partisan gaps, we investigate vaccination attitudes and uptake among a group overlooked in prior research: those who are eligible to vote but did not register in the presidential elections. Drawing on nationally representative and longitudinal survey data from April 2020 to October 2021, we show that this group – whom we call “political outsiders” – represents about 16% of the U.S. population. They had the lowest vaccination rate (47%) by 2021 October, significantly lower than Republican (65%), Independent (76%), and Democratic voters (88%). Further, we find that political outsiders are less likely to trust physicians compared to other partisan groups. Because the sources they trust differ from partisans, existing public health messaging may be less likely to reach them successfully. Finally, we find that political outsiders experience more socio-economic hardships and are less integrated into society. Hence, our results underscore the importance of targeted efforts to reach this highly vulnerable population.

Download Full-text

Changing the Narrative: Structural Barriers and Racial and Ethnic Inequities in COVID-19 Vaccination

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18189904 ◽

2021 ◽

Vol 18 (18) ◽

pp. 9904

Author(s):

Anuli Njoku ◽

Marcelin Joseph ◽

Rochelle Felix

Keyword(s):

Minority Groups ◽

Ethnic Disparities ◽

The United States ◽

Vaccine Uptake ◽

Vaccine Hesitancy ◽

Structural Barriers ◽

Structural Racism ◽

Vaccination Rates ◽

Promising Solution ◽

The Impact

The COVID-19 pandemic has disproportionately affected racial and ethnic minority groups in the United States. Although a promising solution of the COVID-19 vaccination offers hope, disparities in access again threaten the health of these communities. Various explanations have arisen for the cause of disparate vaccination rates among racial and ethnic minorities, including discussion of vaccine hesitancy. Conversely, the role of vaccine accessibility rooted in structural racism as a driver in these disparities should be further explored. This paper discusses the impact of structural barriers on racial and ethnic disparities in COVID-19 vaccine uptake. We also recommend public health, health system, and community-engaged approaches to reduce racial disparities in COVID-19 disease and mortality.

Download Full-text

Addressing Parental Vaccine Hesitancy and Other Barriers to Childhood/Adolescent Vaccination Uptake During the Coronavirus (COVID-19) Pandemic

Frontiers in Immunology ◽

10.3389/fimmu.2021.663074 ◽

2021 ◽

Vol 12 ◽

Author(s):

Olufunto A. Olusanya ◽

Robert A. Bednarczyk ◽

Robert L. Davis ◽

Arash Shaban-Nejad

Keyword(s):

Public Health ◽

Healthcare Providers ◽

Policy Decision ◽

The United States ◽

Vaccine Uptake ◽

Vaccine Hesitancy ◽

Surveillance Systems ◽

Health Crisis ◽

Children And Adolescent ◽

Vaccination Rates

Routine childhood immunizations are proven to be one of the most effective public health interventions at controlling numerous deadly diseases. Therefore, the CDC recommends routine immunizations for children and adolescent populations against vaccine-preventable diseases e.g., tetanus, pertussis, diphtheria, etc. This current review sought to examine barriers to pediatric vaccine uptake behaviors during the COVID-19 pandemic. We also explored the implications for parental vaccine hesitancy/delay during an ongoing health crisis and proposed recommendations for increasing vaccine confidence and compliance. Our review determined that the receipt for vaccinations steadily improved in the last decade for both the United States and Tennessee. However, this incremental progress has been forestalled by the COVID-19 pandemic and other barriers i.e. parental vaccine hesitancy, social determinants of health (SDoH) inequalities, etc. which further exacerbate vaccination disparities. Moreover, non-compliance to routine vaccinations could cause an outbreak of diseases, thereby, worsening the ongoing health crisis and already strained health care system. Healthcare providers are uniquely positioned to offer effective recommendations with presumptive languaging to increase vaccination rates, as well as, address parental vaccine hesitancy. Best practices that incorporate healthcare providers’ quality improvement coaching, vaccination reminder recall systems, adherence to standardized safety protocols (physical distancing, hand hygiene practices, etc.), as well as, offer telehealth and outdoor/drive-through/curbside vaccination services, etc. are warranted. Additionally, a concerted effort should be made to utilize public health surveillance systems to collect, analyze, and interpret data, thereby, ensuring the dissemination of timely, accurate health information for effective health policy decision-making e.g., vaccine distribution, etc.

Download Full-text

Distance to Vaccine Sites is Associated with Lower COVID-19 Vaccine Uptake

10.31234/osf.io/mux5s ◽

2022 ◽

Author(s):

Asaf Mazar ◽

Geoffrey Tomaino ◽

Ziv Carmon ◽

Wendy Wood

Keyword(s):

United States ◽

Cause Of Death ◽

Distance Effect ◽

The United States ◽

Vaccine Uptake ◽

Vaccine Hesitancy ◽

Reverse Causality ◽

Vaccination Rates ◽

Wide Availability

COVID-19 remains a leading cause of death in the United States, despite wide availability of vaccines. Distance may pose an overlooked barrier to vaccine uptake. We analyzed the association between distance to vaccine sites and vaccination rates. Zip codes farther away from vaccine sites had consistently lower vaccine uptake. This effect persisted after controlling for potent covariates (e.g., partisanship, vaccine hesitancy), as well as in multiverse analyses testing across more than 1,000 specifications. Suggesting that the effect was not explained by reverse causality (i.e. proximity driven by demand), the distance effect maintained in analyses limited only to retail locations (e.g., CVS), whose location was set pre-pandemic. Findings suggest that reducing distance to vaccine sites as a powerful lever for encouraging COVID-19 vaccination.

Download Full-text

A Mixed-Methods Analysis of Barriers to and Facilitators of Human Papillomavirus Vaccination Among Adolescents in Montana

Public Health Reports ◽

10.1177/0033354920954512 ◽

2020 ◽

Vol 135 (6) ◽

pp. 842-850

Author(s):

Sophia R. Newcomer ◽

James Caringi ◽

Beth Jones ◽

Emily Coyle ◽

Timothy Schehl ◽

...

Keyword(s):

Human Papillomavirus ◽

Mixed Methods ◽

Qualitative Data ◽

Hpv Vaccination ◽

The United States ◽

Vaccine Uptake ◽

Vaccine Hesitancy ◽

Medical Providers ◽

Medical Provider ◽

Vaccination Rates

Objectives Human papillomavirus (HPV) vaccination rates among adolescents are lower in rural areas than in urban areas of the United States. The objective of this study was to identify barriers to and facilitators of adolescent HPV vaccination in Montana, a large, primarily rural state. Methods Using a mixed-methods design, we integrated quantitative analyses of Montana’s National Immunization Survey–Teen (NIS-Teen) data from 2013-2017 with qualitative data collected at a statewide meeting in October 2018 and from stakeholder interviews conducted from October 2018 through June 2019. Using NIS-Teen data, we identified trends and estimated adjusted prevalence ratios (aPRs) to identify factors associated with vaccine uptake. Using directed content analysis of qualitative data, we identified themes related to vaccine uptake. Results In Montana, initiation of the HPV vaccine series among adolescents aged 13-17 increased from 34.4% in 2013 to 65.5% in 2017. We identified 6 themes related to HPV vaccination from qualitative analyses, including medical providers’ recommendation style as a facilitator of vaccination and parental vaccine hesitancy as a barrier to vaccination. In NIS-Teen 2017 data (n = 326 adolescents), receiving a medical provider recommendation was significantly associated with series initiation (aPR = 2.3; 95% CI, 1.5-3.6). Among parents who did not intend to initiate the vaccine series for their adolescent within 12 months (n = 71), vaccine safety was the top concern (aPR = 24.5%; 95% CI, 12.1%-36.9%). Conclusions HPV vaccination rates have increased in Montana but remain lower than rates for other adolescent vaccines. Future work should focus on reducing missed opportunities, increasing parents’ knowledge of and confidence in vaccination, and training medical providers on addressing common vaccine concerns.

Download Full-text

Varying Vaccination Rates Among Patients Seeking Care for Acute Respiratory Illness: A Systematic Review and Meta-analysis

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa234 ◽

2020 ◽

Vol 7 (7) ◽

Author(s):

Fadi Shehadeh ◽

Ioannis M Zacharioudakis ◽

Markos Kalligeros ◽

Evangelia K Mylona ◽

Tanka Karki ◽

...

Keyword(s):

Influenza Vaccination ◽

Time Trend ◽

Meta Analysis ◽

Respiratory Illness ◽

The United States ◽

Vaccination Rate ◽

Acute Respiratory Illness ◽

Care Providers ◽

Vaccination Rates ◽

Significant Difference

Abstract Background Complications following influenza infection are a major cause of morbidity and mortality, and the Centers for Disease Control Advisory Committee on Immunization Practices recommends universal annual vaccination. However, vaccination rates have remained significantly lower than the Department of Health and Human Services goal. The aim of this work was to assess the vaccination rate among patients who present to health care providers with influenza-like illness and identify groups with lower vaccination rates. Methods We performed a systematic search of the PubMed and EMBASE databases with a time frame of January 1, 2010, to March 1, 2019 and focused on the vaccination rate among patients seeking care for acute respiratory illness in the United States. A random effects meta-analysis was performed to estimate the pooled seasonal influenza vaccination rate, and we used a time trend analysis to identify differences in annual vaccination over time. Results The overall pooled influenza vaccination rate was 48.61% (whites: 50.87%; blacks: 36.05%; Hispanics: 41.45%). There was no significant difference among gender groups (men: 46.43%; women: 50.11%). Interestingly, the vaccination rate varied by age group and was significantly higher among adults aged >65 (78.04%) and significantly lower among children 9–17 years old (36.45%). Finally, we found a significant upward time trend in the overall influenza vaccination rate among whites (coef. = .0107; P = .027). Conclusions In conclusion, because of the significantly lower influenza vaccination rates in black and Hispanic communities, societal initiatives and community outreach programs should focus on these populations and on children and adolescents aged 9–17 years.

Download Full-text

Factors affecting influenza vaccine uptake among health care workers in the Medical and Health Sciences Center of Debrecen University, Hungary

Orvosi Hetilap ◽

10.1556/oh.2012.29328 ◽

2012 ◽

Vol 153 (13) ◽

pp. 505-513 ◽

Cited By ~ 2

Author(s):

Piroska Orosi ◽

Ágnes Borbély ◽

Judit Szidor ◽

János Sándor

Keyword(s):

Health Care ◽

Influenza Vaccination ◽

Health Care Workers ◽

Vaccination Rate ◽

Internal Communication ◽

Health Science ◽

Vaccine Uptake ◽

Science Center ◽

Family Doctors ◽

Care Workers

Influenza vaccination is the most effective way of influenza prevention. The vaccination rate is low worldwide. In Hungary, the vaccine is free of charge to health care workers and, therefore, the low vaccination rate is unaccountable. Aims: In this study, the authors wanted to explore those factors which influence the refusal of vaccination. Methods: The Health Science Center of Debrecen University has about 4000 employees. The authors adjusted a questionnaire with 45 questions and sent it to 525 randomly selected health care workers, 294 of whom responded (response rate, 56%). The Epiinfo software was used for statistical evaluation. Results: The respondents strongly agreed that the vaccine is free and easy to obtain at the workplace. Official recommendations of the occupational health, the Medical Association of Hungary and advice of the family doctors failed to influence the decision. However, a significant impact of communication with family members, friends and colleagues on the decision was documented. Conclusions: The results indicate that the most important tool in decision making of influenza vaccination is the internal communication, but this effect is not a permanent one. International data show highly variable vaccination rates (between 2.1% and 82%). A better vaccination rate (98% or above) may be achieved with a mandatory influenza vaccination program among health care workers. Orv. Hetil., 2012, 153, 505–513.

Download Full-text