Historical influenza trends illuminate how to roll out coronavirus vaccines to underserved racial, ethnic, and socioeconomic groups.
Influenza vaccination trends provide valuable insight into the equitable rollout of coronavirus vaccines, a new report says.
The coronavirus pandemic has exposed inequities in the U.S. healthcare system, particularly for racial and ethnic groups, according to the Centers for Disease Control and Prevention. Research published by JAMA Network Open shows Americans with low incomes are also suffering disproportionate coronavirus infection and death burdens.
The new report, which was published by Urban Institute researchers with funding from the Robert Wood Johnson Foundation, examines historical trends for flu vaccination that indicate ways to address racial, ethnic, and economic inequities in the rollout of coronavirus vaccines. The report is based on data from the 2016 to 2018 National Health Interview Survey.
The Urban Institute report focuses on three risk groups: Nonelderly adults from 19 to 64 who are a low risk of severe COVID-19 illness, nonelderly adults from 19 to 64 who are at high risk of severe COVID-19 illness, and elderly adults 65 and over who are at high risk of severe COVID-19 illness due to their age. The report includes several key data points.
- Low- and high-risk nonelderly Black and Hispanic adults had lower flu vaccination rates than their White counterparts. For example, among low-risk nonelderly adults, the flu vaccination rate for Black adults was 26.2% and the vaccination rate for White adults was 40.6%.
- Risk was associated with likelihood to receive a flu vaccine among nonelderly adults with public forms of health coverage. High-risk nonelderly adults with Medicaid (34.2%) and Medicare or other public coverage (51.2%) had a higher likelihood of getting a flu vaccine than their lower risk counterparts with the same coverage (29.5% and 42.9%, respectively).
- American Indians and Alaska Natives had flu vaccination rates that compared favorably with Whites. For example, among low-risk, nonelderly adults, the AI/AN vaccination rate was 45.2% and the White vaccination rate was 40.6%.
- For all three COVID-19 risk groups, the presence or absence of a usual source of care was highly associated with flu vaccination rates. For example, among elderly adults, those with a usual source of care had a 69.2% flu vaccination rate compared to a 33.4% flu vaccination rate for those with no usual source of care.
- Uninsured nonelderly adults had the lowest flu vaccination rates: 15.4% for low-risk nonelderly adults and 16.9% high-risk nonelderly adults.
"These findings emphasize the need to explicitly consider racial and socioeconomic equity in prioritizing rollout of the COVID‑19 vaccine. This will involve addressing access issues by expanding delivery site options and providing assistance with appointment scheduling and other logistics," the Urban Institute researchers wrote.
Four coronavirus vaccine insights from flu vaccination trends
The historical flu vaccination trends have four primary implications for the equitable rollout of coronavirus vaccines, the researchers wrote.
1. Risk has a significant impact on ethnic, racial, and socioeconomic likelihood to get vaccinated. "Among the nonelderly Black, Hispanic, Medicaid/CHIP and lower income adult populations, the higher risk group was more likely to receive their flu vaccine than their lower risk counterparts, and this pattern was particularly pronounced among lower income Black and Hispanic adults. The health conditions that put individuals at higher risk may also increase their contact with and trust in their healthcare providers and thereby increase vaccine uptake," the researchers wrote.
2. The relatively high flu vaccination rates of the American Indian and Alaskan Native populations provides insights for rolling out coronavirus vaccines to other groups that have historically experienced healthcare disparities. "Early evidence suggests that the COVID‑19 vaccine rollout among Native Americans has been very successful, with many tribes using call centers rather than online systems to schedule appointments and taking advantage of a variety of existing outreach media including newsletters, radio announcements and direct mail," the researchers wrote.
There is a lesson to be learned in avoiding reliance on the Internet to engage and enroll people for vaccination, they wrote. "Some of these strategies, especially less reliance on Internet‑based scheduling and extremely targeted outreach to the most vulnerable, could improve access for other older, less tech savvy populations."
3. It will be crucial to address low vaccination rates among uninsured adults and adults without a usual source of care. "Low vaccination rates in the South may also be related to lower rates of insurance coverage, and in the absence of progress on Medicaid or other coverage expansions, it will be important to focus on community health centers and other delivery sites that serve the uninsured," the researchers wrote.
Adults without a usual source of care would be well-served by nontraditional vaccine delivery sites, they wrote. "These may include retail pharmacies, which have also started receiving direct shipments of COVID‑19 vaccines in an effort to improve equity of vaccine distribution, and mass vaccination sites such as stadiums and convention centers."
4. Employers and community groups need to be enlisted to distribute coronavirus vaccines, the researchers wrote.
"Given that most nonelderly adults who did not receive a flu vaccine were working, employers could potentially play an important role in outreach and as delivery sites as the economy continues to reopen and vaccine supply increases. Similarly, leveraging the communication networks of places of worship, schools, sports leagues, and other trusted community organizations to promote vaccination will be critical in reaching individuals who may not regularly interact with the healthcare system."
Christopher Cheney is the senior clinical care editor at HealthLeaders.
Historically, nonelderly Black and Hispanic adults had lower flu vaccination rates than their White counterparts.
Uninsured nonelderly adults had the lowest flu vaccination rates: 15.4% for low-risk nonelderly adults and 16.9% high-risk nonelderly adults.
American Indians and Alaska Natives had flu vaccination rates that compared favorably with Whites.