Ensuring Sustainability and Reach of COVID-19 Vaccine Distribution
As part of a comprehensive effort to support state leaders as they navigate the COVID-19 response, the Duke-Margolis Center for Health Policy and the National Academy for State Health Policy (NASHP) convened a meeting in July 2021 with a geographically diverse set of state officials and national experts to share best practices and innovative approaches to increase COVID-19 vaccinations.
Though the landscape continues to evolve rapidly, the participants discussed several themes that remain relevant given the current state of the pandemic. Participating state officials discussed strategies to reach unvaccinated individuals and policy and operational shifts to living with COVID-19 as a constant rather than a crisis.
This issue brief includes a summary of the meeting discussion as well as additional details on specific state approaches, including:
- Identifying reasons for hesitancy and identifying effective, culturally responsive messaging to reach all populations
- Enhancing targeted partnership and outreach and including trusted messengers
- Reducing barriers to vaccine access in primary care settings
- Engaging communities and providing easy access
- Using financial strategies to incentivize vaccine uptake
- Navigating political and legal issues
- Improving the use of data to increase equitable access to vaccines
State and National Strategies to Increase COVID-19 Vaccine Confidence
With vaccine supply outpacing demand, boosting public awareness and confidence in COVID-19 vaccines remains critical. Federal, state, and local governments are identifying and employing strategies to improve vaccine confidence across different populations. In NASHP’s recent webinar, “State Strategies to Improve Vaccine Confidence,” speakers from the Centers for Disease Control and Prevention (CDC), the Oregon Health Authority, and AM TRACE discussed strategies and shared tools policymakers can employ to achieve this goal.
As more than half of all American adults are fully vaccinated, and children 12 years and older continue to receive their vaccinations, states are working to further increase access, removing barriers, and providing incentives for those who are yet to be vaccinated. Recent polling shows that up to 40 percent of adults fall into one of several camps: those who will “wait and see”, those who will only get the vaccine if required, and those who will definitely not get the vaccine, and strategies to reach these different groups vary. Vaccination rates also vary by state: 14 jurisdictions have vaccinated 70 percent of all adults with at least one dose of a COVID-19 vaccine, while in other states, less than 40 percent of the adult population has received one dose. Experts believe that many individuals can be persuaded to receive a COVID-19 vaccine if approached with appropriately targeted strategies, and that outreach efforts should be focused on these populations, rather than those who report that they will definitely not get the vaccine.
Building vaccine confidence requires multi-pronged, tailored strategies to engage with and listen to communities to help build trust in the COVID-19 vaccines and the policies and processes that led to their production. State health officials have found that those with concerns about the vaccines are more receptive to messaging from familiar individuals, like their physicians, clergy, and other community leaders. Partnerships with trusted individuals and local institutions, like schools, universities, and employers, are also key to building confidence, especially among those who are more hesitant.
National Approaches to Building Trust
AM TRACE shared research findings during the webinar that mass marketing campaigns have less effect on individuals in the “wait and see” and “probably not” groups – those typically considered to be in the “movable middle”. AM TRACE recommends conducting refined analyses to better understand each target audience’s hesitations and using this information to create localized and personalized messaging campaigns to tailor to these needs.
Federal, state, and local government agencies also underscore the importance of tailoring messages to specific populations and localities to ensure that the vaccine information provided best addresses each community’s needs and concerns. CDC’s Vaccinate with Confidence program gives strategies to help build trust in a variety of key public health and medical tools, including the COVID-19 vaccines, the vaccine-administrating providers, and more generally, the processes and policies that lead to the vaccine development, licensure, authorization, manufacturing, and recommendations for use. For example, CDC developed a rapid community assessment guide to help health departments understand drivers of low vaccine uptake and identify potential interventions. And, CDC’s Confidence Consults1 provide one-on-one support and technical assistance for building COVID-19 vaccine confidence and are available to state, territorial, and tribal immunization programs. The CDC continues to emphasize building trust among individuals and communities and using that trust to promote vaccine confidence among health care providers, who in turn, will recommend the COVID-19 vaccines to their patients.
AM TRACE’s campaign planning tool is another resource that states can consider using to promote vaccine confidence. This tool supports agencies in developing and implementing localized campaigns with personalized messaging, including a micro-targeting, tailored approach, intended to address a variety of factors that influence hesitancy by using a target audience analysis framework. These tools, in collaboration with a strong state and federal emphasis on data collection and analysis to identify vaccination trends and gaps, can help prioritize priority populations and tailor strategies to improve vaccination rates.
State Strategies: Featuring Oregon
The Oregon Health Authority (OHA) and Oregon Department of Human Services presented a variety of tailored approaches to identify populations and reach out to encourage vaccination in effective ways. For instance, OHA identified challenges in reaching Oregon’s Latinx populations, and subsequently developed a coordinated state response that included: a statewide communication strategy, close partnership with community-based organizations and local health departments, connections with trusted Migrant and Community Health Centers, and a radio talk show where Latinx community members can connect and share their experiences.
Other efforts to provide tailored communication approaches in Oregon include:
- The Oregon Youth Authority (OYA) created resources and vaccine messages in multiple languages for various populations, including youth in OYA custody, and Latinx, Black, and Native American youth and families. OYA’s flyers include messaging around the importance of vaccination from high-profile and trusted messengers, including Vice President Kamala Harris, United States Representative Alexandria Ocasio-Cortez, and physicians of color.
- OHA developed a weekly series, Vaccine Voices, to help address vaccine hesitancy, during which people from a variety of communities who have gotten their vaccine can share their stories and experiences with the process to help alleviate concerns.
Other states officials have shared with NASHP various new strategies to reach specific populations in culturally appropriate ways. For example, some states are organizing community vaccination clinics in popular venues. Kentucky organized a “Derby Day” campaign, which included vaccinating individuals at Churchill Downs, the site of the Kentucky Derby, Alabama set up a vaccine site at the Talladega Superspeedway, and Wyoming has set up sites to vaccinate young people and families at drive-in movie theaters.
Additionally, to promote vaccine confidence among parents and adolescents, many states are partnering with school districts, including working with superintendents and teachers. In some instances, states are locating vaccine clinics on school grounds, which allow people to get vaccinated in a familiar and easily accessible setting. Some health departments are also working with schools to send out targeted educational materials. For example, the Louisiana Department of Health teamed up with the Louisiana Department of Education to distribute flyers to students with FAQs about vaccines for adolescents. New York City is launching a pilot program with four schools in the Bronx as a site for children 12 years and older to get vaccinated, and will be hosting community conversations with parents, educators, and youth. Many states are using these school-based sites as an opportunity to encourage entire families to get vaccinated together.
Experts during the NASHP webinar noted that building trust and vaccine confidence requires patience, time, and trusted messengers. It requires identifying the differences between the need to build vaccine confidence, provide education, and reduce barriers to access. It also requires identifying that these needs differ based on the state and community, and that data is a critical component for states to accurately identify pockets of need and target successful strategies. As states roll out new vaccination strategies and build on existing best practices, NASHP will continue to analyze distribution efforts and support states in identifying effective and successful approaches.
This blog is sponsored by AM TRACE with content development at the sole discretion of NASHP.
Endnotes
- For a CDC Confidence Consult, state and/or jurisdictional health departments can email requests to confidenceconsults@cdc.gov
Two States’ Approaches to Leveraging Data for Equitable COVID-19 Vaccine Distribution
Federal and state governments are continuing to vaccinate residents as quickly as possible, while working to ensure they reach populations experiencing barriers to vaccination. Access to high-quality data to track and identify under-vaccinated areas and populations is critical to this goal. States have a variety of data systems at their disposal, with vaccine registries at the center.
The National Academy for State Health Policy (NASHP) spoke to state officials in Minnesota and North Carolina, two states who took different approaches to developing COVID-19 immunization data systems, to learn about their experiences, including data challenges, successes, and implications for ensuring an equitable vaccine roll out now and in the future.
Tracking and reporting of COVID-19 vaccine distribution and administration data requires collaboration and integration across various systems that are administering and distributing the vaccine. To collect and track data for the COVID-19 vaccine, states are using their existing immunization information systems (IIS), adopting the CDC’s newly developed Vaccine Administration Management System (VAMS), creating a new system specifically designed for the COVID-19 vaccine, or some combination of these different approaches. The ability to connect IIS with other data sources, like Medicaid claims, and hospitals’ and health systems’ electronic health records (EHRs), is critical to identifying gaps and opportunities for improvement.
In addition to aggregating data across data systems, the completeness of patient records affects efforts to address the gaps. Because Black and LatinX communities have been disproportionately affected by the pandemic, complete patient data, including race and ethnicity data, can help target vaccination outreach to vulnerable communities.
Can you give an overview of the system you use to track and collect COVID-19 specific immunization data?
Minnesota: Minnesota uses an immunization information system (IIS), called Minnesota Immunization Information Connection (MIIC). MIIC-enrolled pharmacists are the only providers who are mandated to collect or upload data into the system. However, all health care staff at provider’s offices can access MIIC, so they have flexibility to input data. And, our health systems are excellent partners that share high quality data to MIIC via the electronic health record (EHR). Additionally, MIIC can capture patients’ vaccine refusal comments and has a reminder/recall function that allows providers to assess which patients are overdue for which vaccine. Minnesota also has data sharing laws that allow schools, childcare providers, purchasers, and community health boards to access MIIC. The ability for schools and childcare providers to review data in the system will be important as children get vaccinated. Our IIS has been working well during the pandemic; we can track and enter data into the system, and it can handle the volume of data without issue. We have been able to onboard new providers expediently and have created a more consolidated process that has been extremely useful.
North Carolina: North Carolina developed the COVID-19 Vaccine Management System (CVMS) instead of using our state’s IIS to create a single end-to-end system for COVID-19 vaccinations. CVMS gives us the ability to add or subtract fields at our discretion. For example, we were able to incorporate North Carolina’s vaccine eligibility determinations and include provider enrollment directly into the system. The system also has the ability to configure to meet provider’s needs, It does not have a reminder/recall system like North Carolina’s Immunization Registry (NCIR). However, CVMS does send proactive e-mail reminders to recipients to get their second doses. CVMS is Version 1 of an iterative software, so all enhancements can be developed in an agile manner.
How are you using data to track areas in need of targeted vaccination approaches?
Minnesota: We have pinpointed a growing list of individuals who have not yet received their second dose. We created this list using our data but have been grappling with how we ensure they actually get vaccinated. One solution we are working to implement is a pilot texting reminder/recall program through a partnership with one of our large health systems and are hoping to make this available more broadly across the state. We have also implemented a change in the data system to allow providers to set parameters to see who in a population needs a vaccine. They will be able to define age parameters and see who in that age bracket has not been vaccinated yet (such as seniors). They can also set product-specific parameters to see who in a county needs a second dose of a specific vaccine and do targeted outreach.
North Carolina: We have geospatial and demographic data for everyone who has received the vaccine, and demographic data and Social Vulnerability Index (SVI) data for all census tracts across the state, so we are able to see where vaccination rates are keeping up with the state average, and which regions are in need of more proactive engagement and partnership.
We are building equity into every aspect of vaccine distribution in order to close the vaccination gap between white populations and Black/African American, Hispanic/Latinx, and American Indian populations in North Carolina, including prioritizing data transparency. We require all vaccine providers to collect and report race and ethnicity data; provide a bi-weekly report to each vaccine provider on their vaccination rates by race and ethnicity; update a public dashboard daily that shows vaccine rates by race and ethnicity at the state and county level, and use this data to inform strategies.
How do COVID-19 immunization data systems interact with EHRs?
Minnesota: MIIC created a unique partnership with the state’s 10 largest EHRs through the EHR consortium. Through partner phone calls, we realized EHR systems collected race/ethnicity and other demographic and comorbidity data while MIIC collected individual patients’ full vaccine history. We partnered to share information across systems to create a full data set. MIIC also gets immunization data directly from the EHRs, which avoids double data entry. And, providers can also query MIIC to get vaccine history and forecast recommendations.
North Carolina: CVMS does not conform with HL7 message structure to exchange immunization information with health systems’ electronic health records and IIS but the platform enables imports of data from EHRs using a standardized file format, which prevents the need for double data entry. We are developing a system that will be able to push the COVID-19 vaccine data into the state IIS, which is critical to having one source of vaccine data for providers, schools, etc. The state IIS is also connected to EHRs, and allows providers that have been onboarded to check for vaccine status through the EHRs.
What are some challenges you have seen in accurately identifying areas of need?
Minnesota: Previously, vaccine supply and inconsistency with delivery had been an external factor that created challenges to accurately identify areas of need, though this is less of an issue now given more consistent supply. In terms of data, because we do not have a mandate to enter data into the IIS, we accept many different types of data, and we have heard from individuals that it has been a barrier to use full-scale EHRs in vaccine clinics because of the technology hurdles.
North Carolina: When supply was more limited, we set aside doses for vaccine providers and events focused on historically marginalized populations (HMP) and relied upon provider data of vaccinating these populations to determine allocation strategy. We track equity gaps – i.e., the difference between HMP vaccination rates and proportion of population – at the provider type, county, and individual provider level, and we share this information back with vaccine providers. We found that equity gaps have steadily declined across geographies as a result of this and other equity-focused vaccination strategies. External barriers like internet access, limited interpretation services, and transportation have also created challenges in ensuring access to vaccinations. We have invested in strategies for people to access information without having to go online – i.e., set up a call center with English- and Spanish-speaking agents who can answer common vaccine questions and help people find vaccine providers near them. We also have had to make it clear up front that identification and insurance are not required, and that data collection relies on self-attestation.
What are some “best data practices” you have found to ensure an equitable distribution of the vaccine?
Minnesota: We use data from MIIC to look at vaccine uptake by SVI. A Federal Emergency Management Agency (FEMA) site was placed in St. Paul which targets zip codes with high SVI. FEMA sites can distribute a small percentage of their allocated vaccine doses off-site, and have utilized some mobile vaccinations for the distribution processes.
North Carolina: We regularly review provider race and ethnicity data internally to evaluate progress and share externally. We promote accountability through data transparency and use of data; we share bi-weekly reports to vaccine providers on their race/ethnicity and publish public dashboards that are updated daily with vaccine rates by race/ethnicity at the state and county levels. We use the data to identify census tracts with high SVI and low vaccination coverage to recruit and allocate to new providers and inform micro-targeting of related resources, such as public communications/media or the support of community health workers. Our data platform is also flexible; it is able to handle new requirements over time.
How have you used federal funding to enhance your data capabilities and ensure full vaccination coverage?
Minnesota: We have a cooperative agreement through the CDC on the business and operational side of the IIS and technical funding comes from the HITECH 90/10 match. We used our previous funding to implement the reminder/recall function, as well as other IIS enhancements, like a COVID-19 assessment report, that will be available soon, improvements to geocoding, implementing COVID-19 vaccine ordering in MIIC, and automating our reporting to the CDC.
North Carolina: We fund CVMS through a variety of funding sources, but primarily through the CARES Act Coronavirus Relief funds. We plan to use American Rescue Plan Act (ARPA) funding to support continued vaccine implementation efforts, including strategies that ensure greater equity and access to the COVID-19 vaccine by those disproportionately affected by COVID-19. The new ARPA funding will also be used to support local communities through local health departments, community-based organizations, and current community vendors to provide mobile vaccination. In addition, we are planning to sponsor vendors to go into neighborhoods to provide vaccine education and administer vaccines to historically marginalized populations that have had challenges accessing vaccines.
What lessons have you learned from the pandemic that you will be able to use to improve vaccination rates (both for COVID-19 and for routine immunizations) moving forward?
Minnesota: There continues to be concern around the gap in childhood immunization rates that has developed as the result of children missing primary care visits, and the MN Immunization program is in the process of determing the best method to help close those gaps. In general, we’ve had new funding conversations that could not have happened without our strong partnerships with health systems and are hoping these partnerships will have built a foundation for immunizations that we can continue past the pandemic.
North Carolina: As we move from very limited supply to increased volume, our approach to using data to achieve vaccine equity is evolving. Moving forward, we are focusing even more intently on census tracts with low vaccination rates and high social vulnerability to determine tailored strategies for identifying providers (including state-sponsored vendors) who can vaccinate in those census tracts, paired with trusted community partners and community health workers to optimally establish mobile or fixed vaccination sites. It can be tricky to balance data sharing and transparency with the critical requirement (and value) of preserving privacy, but it is possible. Overall, our team has learned to be flexible and to openly communicate within the team and with partners.
Acknowledgements: This blog is supported by the Centers for Disease Control and Prevention (CDC) of the US Department of Health and Human Services (HHS) as part of a financial assistance award totaling $250,000 with 100 percent funded by CDC/HHS. The contents are those of the author and do not necessarily represent the official views of, nor an endorsement, by CDC/HHS or the US government. CDC General Terms and Conditions for Non-research Awards, Revised: February 2021.
Webinar: State Strategies to Build Vaccine Confidence
This webinar explored state strategies to improve COVID-19 vaccine confidence and reach more communities in an equitable and efficient manner.
As of May 2021, all individuals ages 12 and older are eligible for COVID-19 immunizations. As states continue to design and roll out targeted vaccination campaigns, they are considering:
- The reasons why individuals are hesitant to get the COVID-19 vaccine;
- Current efforts to undermine confidence in the vaccine; and
- Solutions to address vaccine hesitancy.
Speakers from the US Centers for Disease Control and Prevention, the Oregon Health Authority, and AM TRACE discussed various types of vaccine hesitancy, practical issues around vaccination, emerging issues of misinformation, and places where interventions can improve vaccine confidence in order to support pandemic recovery.
Participants included:
- Moderator: Trish Riley, NASHP Executive Director
- Richard Quartarone, Communication Co-Deputy, Centers for Disease Control and Prevention
- Douglas Raymond Lyon, MD, Senior Health Advisor, Oregon Health Authority
- Jens Dakin, Managing Director, Information Operations/Strategic Communications, AM TRACE
This webinar is sponsored by AM TRACE with content development at the sole discretion of NASHP.
Medicaid Agencies Cultivate Partnerships and Deploy Data to Bolster COVID-19 Vaccination Efforts
COVID-19 vaccine distribution has accelerated across states as the Biden Administration updates its vaccine goal to 200 million doses by April 23, 2021 and many states are opening eligibility to all adults by early April. The National Academy for State Health Policy (NASHP) recently spoke with several state Medicaid officials to learn more about how their agencies – and specifically their Medicaid managed care organizations (MCOs) – are leveraging partnerships and data to advance their vaccination efforts.
Leadership and communication across state agencies are enabling optimal coordination.
States’ COVID-19 vaccination efforts are primary led by their departments of health (DOHs), but nearly every other state agency plays a role in helping to raise awareness with the constituencies they serve or by aiding with vaccine logistics and administration – often both. To reduce confusion, agencies must work in lockstep, agreeing on policies while using similar messaging and data sources to promote accurate information about the vaccine. In the case of Medicaid, state officials work not only to convey vaccine updates from their state DOH to Medicaid enrollees, but also to the health plans and providers they work with. Medicaid agencies have revised call center scripts, website content, and other resources so they are in line with the latest language put forth by their DOHs.
To improve coordination, Medicaid agency officials participate in, and sometimes lead, weekly meetings with state and county officials to update them about the latest vaccine progress. They have also worked with state and county officials to identify and share data about Medicaid enrollees to enable improved targeting of high-risk, and/or priority populations for outreach by state and local authorities. Medicaid agencies have also shared data about provider networks to aid vaccine administration efforts. Specifically, data has been used to recruit providers who are already actively engaged in serving certain populations as part of direct vaccination efforts, including as vaccine administrators at mobile vaccination sites.
Empowering Medicaid health plans encourages innovative vaccination promotion strategies.
Along with collaborating with state and local agencies, Medicaid agencies have also cultivated stronger relationships with their MCOs and other participating health plans to promote vaccinations. Several states’ officials report meeting with their health plans on a biweekly or weekly basis to share the latest updates on vaccination policy, as well as to strategize about best practices to encourage vaccination. United by a mutual goal of encouraging members toward health and away from catastrophic illness, the vaccination effort provides a unique opportunity for Medicaid to work in partnership with its health plans and encourages innovative approaches to improve vaccination rates. Some innovative strategies include:
- Distributing educational material about how to schedule appointments and appointment reminders;
- Enabling plans and plan representatives to schedule appointments on behalf of enrollees;
- Active post-vaccination outreach to assess vaccine side effects;
- Communication to family members and care takers about vaccine eligibility and access; and
- Development of training modules for care managers to address vaccine hesitancy.
Several officials especially noted the challenge of ensuring transportation to and from vaccination sites. To mitigate these issues, states have employed various methods of moderating this barrier – from providing access to free transportation services to mandating that health plans cover transportation to and from vaccination sites. One state had a policy to reimburse enrollees for miles traveled, while another worked with carriers to set a rate for transit services that included a “wait time” between arrival at and departure from the vaccination site.
Access to state data is critical to health plan participation in vaccination efforts.
Beyond sharing strategies to encourage outreach and access to vaccination sites, Medicaid agencies have played a key role in sharing critical data about Medicaid enrollees directly with MCOs or other participating carriers.
Medicaid agencies have unique access to state data sources, including Medicaid enrollment and claims data and vaccination data from public health data repositories, which is otherwise not available to private companies or other agencies. Access to this data not only positions a state Medicaid agency to take an active role in identifying enrollees to target for vaccination outreach, but it also enables it to perform analytics across data sources. For example, some states are cross-walking vaccine registry data with Medicaid data to identify Medicaid recipients who have scheduled vaccination appointments or who have been vaccinated. This ability to crosswalk data from vaccine registries is especially important, as many vaccines are scheduled and administered without an insurance claim, leaving health plans without any information about the vaccination status of their enrollees. However, armed with Medicaid data and analytics, health plans are able to conduct direct follow-up with their members. In several cases, states report active participation from health plans that are using data to encourage vaccination, including among high-risk individuals. Others go further and connect enrollees with case managers who may be able to assist with arranging transit to and from appointments or scheduling follow-ups for the second vaccine dose.
Capacity to conduct complex analytics may be limited based on states systems’ ability to extract and share data across agencies, and outdated claims processing systems may affect the timeliness of available data. Meanwhile, vaccination databases are in the midst of being brought to scale in tandem with escalating vaccination efforts, and data may not yet be fully accessible or up to date in state systems. State agencies are rapidly working to improve data capacity, including efforts to enable direct connections between carriers and providers to data sources or analytic information. One state also reported efforts to access data from border states, to ensure it had updated vaccination information even for those that may get vaccinated outside of the state.
States have and continue to rapidly adapt in response to the ever-evolving pandemic. As vaccine capacity increases, they will continue to build on their growing resources and infrastructure to address changing needs and circumstances. As they do, NASHP will report on the development of new policies and promising practices from those at the forefront of addressing the COVID-19 crisis.
Johnson & Johnson COVID-19 Vaccine Helps States Boost Supply, But Messaging Remains Critical
The US Food and Drug Administration’s (FDA) recent approval of the one-dose Johnson & Johnson (J&J) vaccine, which is easier to store and transport than others and reportedly causes fewer side effects, offers opportunities for states to improve vaccination outreach.
At a time when supply remains one of the largest barriers to vaccine administration, the new J&J vaccine helps boosts supply and allows more people to be vaccinated. However, efforts to distribute the newest vaccine have been complicated by mixed messaging around its efficacy. States, with federal guidance, are working to emphasize the benefits of the J&J vaccine and the importance of getting vaccinated as soon as any vaccine is available.
Background
In clinical trials, the J&J vaccine had a 72 percent efficacy overall in the United States, with an 85 percent efficacy against severe COVID-19 infection. While there is some public concern that the J&J vaccine has a lower efficacy than Pfizer and Moderna’s, experts are stressing two facts:
- The (J&J) vaccine has a high efficacy against severe disease and is just as effective at preventing hospitalization and mortality as the older vaccines. Those who do get COVID-19 after J&J vaccination are likely to only experience only mild symptoms.
- Unlike the Moderna and Pfizer vaccines approved in December, J&J was tested in Brazil and South Africa in the presence of the new 1.351 variant. It proved to be highly effective at preventing infection and severe disease from these COVID-19 variants.
J&J Vaccine Advantages
In addition to its success against virus variants, the J&J vaccine has a number of different characteristics that make it easier to transport, store, and administer than the Moderna and Pfizer vaccines.
First and foremost, the vaccine requires one dose rather than two. State officials have shared that scheduling second doses, reminding patients to come in for their second dose, and following up when individuals miss their appointments have been significant challenges in their vaccine rollout. The one-dose J&J vaccine eliminates this issue.
Additionally, the J&J dose is easier to store and can be kept in a regular refrigerator for up to three months. This makes it possible that more and different types of health care providers, such as those working in rural health centers or with communities that have limited access to health care, can keep the vaccine in their facilities so their patients can receive the COVID-19 vaccine from providers whom they view as trusted sources.
Many J&J recipients also report fewer side effects from the vaccine, making the vaccine ideal for individuals who cannot afford to miss a day of work because of severe side effects, or who might not be connected to a health care professional who can help treat symptoms if needed.
Importance of Messaging
Throughout the pandemic, federal and state governments and public health leaders have struggled to find a balance between managing public expectations and encouraging measures that prevent the spread of COVID-19. The introduction of the J&J vaccine has again highlighted the importance of crafting messages for the public to counter any misinformation about its efficacy.
After concerns began arising about the efficacy of the J&J vaccine, the Centers for Disease Control and Prevention (CDC) recommended that jurisdictions use the following language when promoting the J&J vaccine, “All the available vaccines have been proven effective at preventing serious illness, hospitalization, and death from COVID-19 disease.” The CDC also encourages individuals to get the first vaccine available to them. States are beginning to craft their own messages to reach their residents.
Before opening up new vaccine appointments, the Washington, DC Department of Health sent an email using the CDC’s language to all residents who signed up for vaccine alerts. The email noted that individuals will be able to see which vaccine is being administered at each site before choosing an appointment, but emphasized that all vaccines are effective at preventing “serious illness, hospitalization, and death from COVID-19,” and that residents are “highly encouraged to take the first vaccine available to them.” All appointments were booked within minutes, suggesting that Washington, DC residents were willing to take whichever vaccine was available.
In Iowa, Gov. Kim Reynolds received the J&J vaccine during a news conference to help promote the vaccine and emphasized her trust in the vaccine before her constituents. She also addressed concerns about the J&J vaccine’s efficacy, noting, “This information is misleading, and quite frankly, it’s irresponsible to position any vaccine as a less desirable option when it’s undergone the same rigorous clinical trials to test the safety and efficacy and has received approval by the FDA and the CDC.”
Gov. Jay Inslee of Washington State also issued a statement about the J&J vaccine in a recent interview, where he acknowledged the lower efficacy rates in clinical trials, but also praised the advantages of this vaccine compared to others. “It’s going to save your life, which we think is a pretty high value. It has a downside of slightly lower efficacy to prevent you from getting a headache — but you only have to have one shot instead of two,” he explained.
Federal and state governments are also navigating the tension between the value of setting aside allocations of the J&J vaccine for individuals who face more barriers to getting two doses, and the danger of targeting a vaccine that some constituencies believe is less valuable to more vulnerable and historically marginalized populations.
Conclusion
Supply remains a key concern in state and federal vaccination efforts. However, President Biden’s announcement that the United States will have enough supply to vaccinate the entire adult population by May, in part due to J&J’s partnership with Merck to ramp up manufacturing, creates even more pressure to ensure that public health messaging effectively promotes the benefits of all vaccines equally.
In the meantime, the J&J vaccine arrives as many states are broadening their vaccine eligibility guidelines. According to National Academy for State Health Policy analysis, 35 states are now vaccinating individuals age 65 and older and 43 states are vaccinating teachers and/or childcare providers. During the first week of March, 11 states began vaccinating teachers, and four states expanded eligibility to individuals age 50 and older. This new vaccine can help ensure that newly eligible individuals can be vaccinated promptly, bringing the nation closer to herd immunity.
Acknowledgements: This blog is supported by the Centers for Disease Control and Prevention (CDC) of the US Department of Health and Human Services (HHS) as part of a financial assistance award totaling $250,000 with 100 percent funded by CDC/HHS. The contents are those of the author and do not necessarily represent the official views of, nor an endorsement, by CDC/HHS or the US government. CDC General Terms and Conditions for Non-research Awards, Revised: February 2021.
For individuals living with complex, often chronic conditions, and their families, palliative care can provide relief from symptoms, improve satisfaction and outcomes, and help address critical mental and spiritual needs during difficult times. Now more than ever, there is growing recognition of the importance of palliative care services for individuals with serious illness, such as advance care planning, pain and symptom management, care coordination, and team-based, multi-disciplinary support. These services can help patients and families cope with the symptoms and stressors of disease, better anticipate and avoid crises, and reduce unnecessary and/or unwanted care. While this model is grounded in evidence that demonstrates improved quality of life, better outcomes, and reduced cost for patients, only a fraction of individuals who could benefit from palliative care receive it. 
