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Biosecurity BriefingNew Study Examines Ways to Raise Influenza Vaccination Rates Among Hard-to-Reach Populations By Molly D’Esopo, August 24, 2007 In July 2007, the Journal of Urban Health published a study that finds that while “considerable attention has been devoted to achieving high levels of influenza immunization” in pandemic preparedness activities, most plans fail to consider the specific challenges of distributing influenza drugs and vaccines to hard-to-reach (HTR) populations. Because such individuals may be at “increased risk of morbidity and mortality” for flu-related illnesses due to “increased incidence and prevalence of medical conditions for which influenza vaccine is recommended…and reduced immune system activity caused by lifestyle factors,” the article highlights the importance of reaching HTR communities and suggests innovative strategies for improving outreach to those communities.1 The authors acknowledge that “while no uniform definition of HTR populations exist,” people typically included among this group are those removed from the healthcare setting—i.e. they “do not seek treatment in traditional healthcare settings such as provider offices or clinics” for a variety of reasons, including “poor access to immunization services, difficulties in negotiating the health care system, cost, lack of education leading to misconceptions about vaccine risks and benefits, and lack of clear, strong recommendations from health care providers.” In their article, the authors include among the hard-to-reach: “the housebound elderly, disenfranchised groups, people living in disadvantaged urban communities, undocumented immigrants, and substance abusers.” The article points out that the numbers of people included among these constituent groups are considerable. In the United States there are an estimated 11.5-12 million undocumented immigrants, 1.5 million IV drug users (in 96 large urban areas), and 744,000 homeless persons.1 The researchers stress the importance of developing outreach activities that are targeted, community-based, and culturally sensitive. The study also recommends that the community and target population be involved in designing immunization distribution services, and in developing and pilot testing educational materials.1 Additionally, researchers emphasize the importance of improved access to vaccines by considering “unconventional sites” for distribution—sites such as urban needle exchange programs which have preexisting networks that already provide services to a segment of the HTR population. Findings further suggest that location of vaccination sites matters: “people are more likely to go to familiar locations in their neighborhoods that they know and trust, and one study found that most vaccine recipients returned to the same sites where they were immunized the previous year . . .” Locations suggested by the study include pharmacies, grocery stores, public schools, daycare centers, churches, migrant worksites, soup kitchens, homeless shelters, gathering places for day laborers, community-based clinics, senior centers, etc.1 The study concludes that “immunizing HTR populations is a humanitarian effort of great public health importance.” In a related article published by Medical News Today, the study’s lead author David Vlahov notes that “The current federal recommendations for annual and pandemic vaccine do not prioritize the issue of HTR populations. . .” Dr. Vlahov maintains that “This problem is an epidemiologic, clinical, and ethical issue.”2 References
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