This is the fourth episode of our new Vaccine Confidence series on At the Core of Care. Over the course of four episodes, we explored the different facets of the COVID-19 vaccination effort, including education, advocacy, and community partnership. 

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You can listen to At the Core of Care on the Pennsylvania Action Coalition’s website, or wherever you listen to podcasts. Stay tuned for new episodes by following us on Twitter and subscribing to our newsletter.

In this episode, we are closing out our special vaccine confidence coverage with Letha Joseph and Adeline Kline who are members of the National Nurse-Led Care Consortium’s Vaccine Confidence Advisory Committee (VCAC). Kline and Joseph discuss the importance of relationship-building with community members to help promote health and wellness goals.

Letha Joseph is a nurse practitioner from Durham, North Carolina. She is also a Program Director at the Durham VA Healthcare System and consulting associate at the Duke University School of Nursing. Adeline Kline is a family nurse practitioner and clinical educator for Hawai’i Keiki, which is a partnership between the University of Hawaii Mānoa School of Nursing and the Hawai‘i Department of Education.

Joseph, who co-authored the recently published journal Medical Misinformation and Healthy Information Environment: A Call to Action, reminds us that vaccine hesitancy is not new. Likewise, misinformation spreads about all kinds of scientific discoveries, and mistrust cultivates among patients who have experienced discrimination and shortcomings in their care. Because of these various phenomena, Joseph says we cannot expect everyone to automatically trust the COVID vaccine.

Mistrust between patients and providers is a separate and wider-reaching problem than resistance to COVID vaccines, according to Joseph and Kline. Focusing on restoring trust with patients opens the door for all forms of treatment recommendations, not just the COVID vaccine. Joseph and Kline share examples of their own experiences and strategies for building trust.

For example, Kline says relationship-building often happens in “non-sterile settings” like schools. As a school-based nurse, she keeps an open-door policy so staff and parents know they can come to her with questions. “It's always having that ability to be open and have those conversations and try and hold that space without judgment, which can be very hard,” says Kline.

Joseph is a proponent of motivational interviewing. She says that behind every piece of misinformation, there is a reason why the person believes it over their provider. Ask about the person’s previous healthcare experiences, or about the trusted friends and role models in the person’s life; this signals to the patient that you share an interest in what is best for them.

Both Kline and Joseph suggest letting the patient decide when they are ready to make a change. Kline compares it to smoking cessation. In a routine wellness visit, a provider asks, “do you smoke?” and uses that opportunity to tell the patient about the risks of smoking. One day, the patient might ask what they can do to stop smoking. Vaccines can be treated the same way. Using every encounter to ask, “are you vaccinated?” and to provide some quick facts about the benefits of vaccines can be enough for the patient to change their behavior over time.

The conversation ends with some recommendations for nurses, such as taking care of mental health, staying aware of current recommendations, such as the CDC’s booster calendar, and taking the proper precautions by social distancing and masking when appropriate.

Nurses and other health professionals across the country are using innovative methods to vaccinate their communities against COVID-19. Our four-part Vaccine Confidence Series has explored several professionals’ stories. Listen to the entire series on At the Core of Care.

Listen to all the episodes in the Vaccine Confidence Series:

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This project was funded in part by a cooperative agreement with the Centers for Disease Control and Prevention (grant number NU50CK000580). The Centers for Disease Control and Prevention is an agency within the Department of Health and Human Services (HHS). The contents of this resource center do not necessarily represent the policy of CDC or HHS, and should not be considered an endorsement by the Federal Government.

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This is the second episode of our new Vaccine Confidence series on At the Core of Care. Over the course of four episodes, we will dive into different facets of the COVID-19 vaccination effort, including education, advocacy, and community partnership.

You can listen to At the Core of Care on the Pennsylvania Action Coalition’s website, or wherever you listen to podcasts. Stay tuned for the rest of the series in the coming weeks by following us on Twitter and subscribing to our newsletter.

In this episode, Annette Gadegbeku, M.D., Associate Professor and the Associate Dean of Community Health at the Drexel University College of Medicine, joins us for a conversation on community health, including her role in vaccination and testing initiatives at Drexel University.

Annette shares some key community health lessons learned after rolling out these initiatives at Drexel’s Dornsife Center for Neighborhood Partnerships. “There's so many things that are involved in this work,” she shares. “At the very top is hearing voices and building trust.” She details ways that health facilities can earn trust, including being consistent and demonstrating a long-term interest in the community’s wellbeing.

Two examples of this strategy in action were the Dornsife Center’s weekly “Ask the Doc” and “Community Health Chats,” that were offered both in-person and virtually before the pandemic. These were spaces for community members to learn more about their health conditions, medications, and various wellness topics. It was also an opportunity for people to get familiar with the Dornsife staff and “see a familiar face,” Annette says.

The Dornsife Center started running mobile vaccination clinics across Philadelphia in 2021 to improve the vaccine rollout in underserved communities. According to Annette, these mobile clinics offered the best chance to address and reduce COVID-related health disparities in Philadelphia because they went further to overcome access issues. Patients returned consistently to receive mandatory COVID tests for work, and her team of volunteer Drexel students were eager to work with them at a time when it was difficult for students to get patient contact. The mobile clinics benefited everyone; the patients gained trust in the staff whom they saw consistently, and the staff got steady opportunities to build confidence in the COVID vaccines.

Funding for these mobile vaccine clinics has now ended, and with the announcement of the end of the public health emergency on May 11th, Annette is worried that there will be fewer opportunities across the country to maintain community-based programs that formed during the pandemic. Annette believes that consistency and sustainability are vital to building a community’s trust in a healthcare facility. Thus, the sudden discontinuation of programs might send the wrong message to communities.

Annette says that we now need to look at providing vaccine education and encouraging COVID vaccinations as part of routine care, and as a part of advancing health equity. “Our goal every year is to help all achieve their best health. That's what health equity is. So, the best, best health that they can achieve. And this is a part of it.”

Nurses and other health professionals across the country are using innovative methods to vaccinate their communities against COVID-19. Follow along as we explore other professionals’ stories as part of our Vaccine Confidence Series.

Listen to all the episodes in the Vaccine Confidence Series:

----------

This project was funded in part by a cooperative agreement with the Centers for Disease Control and Prevention (grant number NU50CK000580). The Centers for Disease Control and Prevention is an agency within the Department of Health and Human Services (HHS). The contents of this resource center do not necessarily represent the policy of CDC or HHS, and should not be considered an endorsement by the Federal Government.

This episode and blog post are Part 2 of the final special report of our Vaccine Confidence Special Reports series on At the Core of Care. Over the course of three, two-part Special Reports, we have done a deep dive into three different facets of the COVID-19 vaccination effort: Workforce Development, Burnout, and nurse-led Vaccine Confidence programs. You may now listen to all 6 episodes on the PA-Action Coalition’s website, or wherever you listen to podcasts.

We are joined this episode by Dr. Garrett Chan, the President and CEO of HealthImpact, an organization that drives workforce development innovations within nursing. Dr. Chan also holds a PhD in Palliative Care and Emergency Nursing from the University of California San Francisco. Before joining HealthImpact, he was overseeing a new graduate residency program at Stanford Healthcare. Utilizing Dr. Chan’s background in both emergency preparedness and workforce development,  HealthImpact has led two major nurse-led vaccine confidence initiatives during the pandemic: VaxForce and Trust a Nurse, Ask a Nurse.

In discussing the creation of these programs, Dr. Chan notes that he anticipated three main barriers to overcoming the COVID-19 pandemic through vaccinations. He says, “The first one was going to be availability. There's something like 400 million people in the United States; not everybody's going to be able to get the vaccine immediately.” The second obstacle was not having enough personnel to administer the vaccine, and the third was vaccine hesitancy.

When vaccines became available in California, Dr. Chan led HealthImpact in launching VaxForce to address staffing challenges. VaxForce recruited an interdisciplinary team of skilled volunteers who could administer vaccinations. Dr. Chan says that many healthcare volunteers were drawn to the opportunity to have physical closeness to community members. Today, VaxForce has administered over 8,000 vaccines and has been especially successful in diverse communities. While they have scaled back their efforts, VaxForce still offers about three vaccination events per week.

Shortly after establishing VaxForce, HealthImpact started the Trust a Nurse, Ask a Nurse program. This program, which is also staffed by volunteer nurses, provides a telehealth platform where nurses discuss questions about the vaccine with community members and other healthcare providers. You can hear from one of the nurse volunteers who founded Trust a Nurse, Ask a Nurse, Lizett Leandro, in Part 1 of this Special Report.

Dr. Chan says that Trust a Nurse, Ask a Nurse began as a tool against vaccine hesitancy, the third major hurdle in the vaccine rollout. “For the people who are truly anti-vax, who really subscribe to the misinformation or disinformation, that was not the population that we were trying to reach. We were trying to reach the people who just had questions and were unsure and needed reassurance.” This virtual model has been highly successful, especially among breastfeeding parents and Spanish speaking patients.

HealthImpact is currently exploring ways to expand the Trust a Nurse, Ask a Nurse program beyond COVID vaccines. There are endless opportunities to provide telehealth education, but Dr. Chan is particularly interested in aging and dementia support, substance use disorder, and suicidality. Trust a Nurse, Ask a Nurse might even provide screening and pre-screening tests in the future. This unique fusion of emergency preparedness and workforce development can and will have diverse implications for the nursing workforce at large.

Nurses and other health professionals across the country are using innovative methods to vaccinate their communities against COVID-19. Learn more about their work by following us on Twitter and subscribing to our newsletter.

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This project was funded in part by a cooperative agreement with the Centers for Disease Control and Prevention (grant number NU50CK000580). The Centers for Disease Control and Prevention is an agency within the Department of Health and Human Services (HHS). The contents of this resource center do not necessarily represent the policy of CDC or HHS, and should not be considered an endorsement by the Federal Government.

ALSO AVAILABLE ON

This is the first episode of our new Vaccine Confidence series on At the Core of Care. Over the course of four episodes, we will dive into different facets of the COVID-19 vaccination effort, including education, advocacy, and community partnership. 

You can listen to At the Core of Care on the Pennsylvania Action Coalition’s website, or wherever you listen to podcasts. Stay tuned for the rest of the series in the coming weeks by following us on Twitter and subscribing to our newsletter.

In this episode, we hear from Nurses Who Vaccinate founder Melody Butler, RN, who works as an infection preventionist at Good Samaritan Hospital Medical Center on Long Island. Melody also joined us in 2021 for our first Vaccine Confidence series. This time, she’s back to talk about where we are in the pandemic, and to weigh in on whether we are more prepared to prevent cases of infectious disease than in previous years.

Melody starts by addressing the “tripledemic.” This winter, we have seen a simultaneous surge of COVID, RSV, and flu. Melody confirms that we are seeing higher-than-normal rates of infection. At the time of the recording—January 24th, 2023—there had been 85 pediatric deaths from flu this season, nearly double the number of deaths from last winter.

Meanwhile, COVID vaccination rates have plateaued. “Last we spoke, the vaccination rates for United States at the end of 2021 were about 73 percent for people having had received at least one dose of the COVID vaccine. And here we are in 2023 and we're at a whopping 81 percent of people having at least one vaccine dose. So, I'm very disappointed to see where we are right now” Melody says. The vaccination rate in children under five is only 11 percent.

The conversation shifts to the bivalent booster rollout. Melody sees several reasons why not enough people are up-to-date with their vaccinations. First, many people do not know they’re eligible for a new vaccine, or forget they need a booster. People may be too busy to take off work to get the booster. When primary care doctors don’t provide the shot in their office and recommend going to a pharmacy, people may not schedule that extra appointment. Some people are afraid of the side effects, which can necessitate time off work. Many employers are being less lenient with giving time off than they were earlier in the pandemic.

The end of the Public Health Emergency Declaration is another threat to the vaccine rollout. Many services that are currently free, such as COVID tests, will no longer be free starting in May 2023. Millions of people may lose their Medicaid coverage this year, meaning lost pathways to free testing, vaccines, and treatments. Hospitals will no longer receive reimbursement for treating uninsured patients with COVID-19.

Overall, there is less support and more barriers keeping people from taking action against the spread of COVID-19. As Melody says, we are getting away from the “all hands on deck” mentality that we learned in the early days of the pandemic. The long-term management of COVID-19 and other infectious diseases is going to require employers and healthcare organizations to “highly encourage self-care.”

As the country moves on, nurses and other health professionals will have an uphill battle to prevent COVID cases. They will have to push against misinformation, especially as social media platforms change how they regulate misinformation. Nurses are also warding off “hopelessness” among patients, Melody claims. “People are very disappointed that the COVID vaccine does not prevent illness. We have to stress how amazing it is that the vaccine keeps you out of the hospital just like the flu shot…. that's such an important point that we need to stress to the public, to our patients, to our communities.”

Melody is the founding member of Nurses Who Vaccinate, an organization for nurses and healthcare workers who are passionate about vaccines. You can follow Nurses Who Vaccinate on Twitter or attend one of their upcoming events.

Nurses and other health professionals across the country are using innovative methods to vaccinate their communities against COVID-19. Follow along as we explore other professionals’ stories as part of our Vaccine Confidence Series.

Listen to all the episodes in the Vaccine Confidence Series:

----------

This project was funded in part by a cooperative agreement with the Centers for Disease Control and Prevention (grant number NU50CK000580). The Centers for Disease Control and Prevention is an agency within the Department of Health and Human Services (HHS). The contents of this resource center do not necessarily represent the policy of CDC or HHS, and should not be considered an endorsement by the Federal Government.