Adult Vaccination Healthcare Providers Education ECHO Series

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“The International Federation on Ageing (IFA) is proud to announce another instalment of the Adult Vaccination Healthcare Providers Education ECHO. The program – taking place biweekly from October 18-December 13 aims to strengthen healthcare provider skills and competencies to promote and advocate for adult immunization.  Building on previous programming and experience, IFA will harness the ECHO^TM Model and its proven method of learning for this innovative program to educate and inform diverse healthcare providers on the field of ageing and VPDs. The model allows for participatory dialogue and allows current and future healthcare providers the opportunity to seek recommendations directly from a panel of subject matter experts. For more information and to register, please visit the Vaccines for Life website.”

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Collaborating with Complementary and Alternative Medicines to promote adult vaccination

Complementary and Alternative Medicine (CAM) practices have been growing in popularity around the world and remain a dominant practice in many communities globally. CAM includes the use of homeopathy, acupuncture, massage, naturopathy, chiropractic care, and other practices. The use of CAM practices however is also associated with greater levels of vaccine hesitancy and reduced vaccination rates. However, CAM practices remain a culturally significant form of care for many patients globally and contribute to an individual’s right to choose the form of healthcare that they feel best suits their needs and they trust. Complementary medicine can also be used in conjunction with conventional medicine to provide a holistic and integrative approach to a person’s health and wellbeing.

There are many challenges to contextualizing the use and prevalence of CAM practices globally. Different definitions of CAM practices, and a lack of reporting and data collection relating to use of CAM contribute to the gaps in understanding how these practices are being used in different communities. However, systematic reviews have placed the use of CAM practices between 24-71.3% depending on the countries reviewed (3). This widespread use of some form of CAM practice shows the value of working with trusted CAM practitioners to promote vaccination as a strategy to improve vaccine uptake in a culturally specific and respectful way.

Additionally, there can be approaches to care within CAM practices that all HCPs can learn from. Despite misconceptions from many primary care providers, CAM practices are not inherently vaccine adverse, but instead focus on individualized care plans, understanding patient’s vaccine concerns and risks of VPDs, and taking vaccine concerns seriously (4). These practices can be adopted into all levels of healthcare to provide a patient centered approach.

Collaboration between CAM practitioners and HCPs can work to remove barriers, provide evidence informed recommendations, and align narratives around vaccination. This module explores good practices in multisectoral collaboration and fostering stronger connections as pathways for knowledge sharing between CAM practitioners and healthcare providers to respond to gaps in adult vaccination strategies, including during crisis settings.

Relevant Resources:

Is there an Association Between the use of Complementary Medicine and Vaccine Uptake: Results of a Pilot Study

Collaborating with CAM Providers when Writing HPV Vaccine Review Articles

Naturopathic Medicine on the Frontline of the COVID-19 Pandemic

Learning Objectives:

1. Understand the role of vaccination within complementary and alternative medicine practices.
2. Discuss current and historical concerns that some CAM patients have had with vaccination.
3. Provide HCPs and CAM practitioners with relevant communication and collaboration tools to improve vaccination rates.

Overcoming vaccine hesitancy in a post-pandemic setting 

The Covid-19 Pandemic brought about an increased urgency and focus on adult vaccination, including the prioritization of vaccination and vaccine campaigns for policy makers and healthcare providers. Despite the increased messaging, funding, and prioritization of adult vaccination, the Covid-19 pandemic also saw increases in vaccine hesitancy and misinformation. The quickly evolving nature of the novel disease brought with it rapidly changing health information and vaccine recommendations for individuals globally. With Covid-19 being declared endemic in Spring 2023, there is a new need to address patient concerns around endemic diseases and to continue to advocate for routine immunization and overcoming vaccine hesitancy despite a decreased threat to Covid-19. 

During the Covid-19 pandemic, vaccine priorities became heavily focused on the COVID-19 vaccination. This prioritization, along with closures and difficulty accessing appointments at healthcare centers lead to vaccination for non-Covid-19 infections (such as influenza) declining (5). In a post-pandemic world, it is crucial to address these concerns and work with patients to “catch-up” on missed vaccines and overcome vaccine hesitancy and apathy for all vaccinations – not just for Covid-19. Vaccine apathy can be a particularly difficult barrier to address, as these individuals may view vaccination as a low-risk activity but not feel it is important to prioritize routine vaccination across the life course. Simplifying the pathways to receive vaccination is one way to prevent loss to follow-up due to vaccine apathy but use of messaging that addresses apathy and not just vaccine hesitancy is also critical. 

This module works to address changes to vaccine perceptions that have occurred due to the Covid-19 Pandemic and how HCPs can address these changes following the latest updates to the status of Covid-19 and other VPDs. 

Relevant Resources:

• Is Vaccine Confidence an Unexpected Victim of the COVID-19 Pandemic?
• Vaccine Hesitancy: Lessons Learned and Perspectives for a Post-Pandemic Tomorrow 
• When Vaccine Apathy, Not Hesitancy, Drives Vaccine Disinterest
  

Learning Objectives:

1. Understand how and why vaccine confidence and vaccine hesitancy rates have changed before and after the COVID-19 Pandemic, specifically for older adults.
2. Discuss ways to improve vaccine confidence and vaccine promotion in a post-pandemic context including the use of co-administered vaccines. 
3. Learn how to cope with patient vaccine fatigue and apathy with health messaging and encourage routine immunization uptake for all recommended adult vaccine

The role of non-traditional vaccinators in low- and middle- income environments  

Working within low- and middle- income environments provide additional challenges and barriers for healthcare providers and their patients to overcome. Patients may have fewer resources available to access high-quality and timely information on vaccination, be limited in their ability to travel to vaccination appointments and have larger concerns with paying for vaccines that are not covered under private or public insurance schemes.

As healthcare providers, working with these individuals and communities is crucial to increasing vaccine rates in an equitable way that prioritizes the patients’ experiences. Using non-traditional vaccinators such as pharmacists, can work to reduce barriers to information but all healthcare providers can be used as key champions for adult vaccination and work to improve health literacy and vaccine awareness in these communities.

Building community trust in these non-traditional vaccine pathways is a necessary step to ensuring the most effective usage, this can be done by training non-traditional vaccinators to be equipped to deal with vaccine hesitancy and skepticism, as well as leveraging trusted community leaders to support vaccination efforts within these communities.  Individuals such as faith leaders, educators, and other leaders in their communities can provide valued insights into the needs of LMICs and identify potential barriers to vaccination that are community specific. Having buy-in from these leaders builds trust in the community and ensures that vaccine campaigns are robust and effective, while also provided the necessary care specific to each community.

This module explores opportunities to deliver vaccination campaigns in people-centered ways that include and specifically target older adults in low- and middle- income environments.

Relevant Resources:

• New immunization strategies: adapting to global challenges
• Building vaccine confidence and communicating vaccine value: toolkit   
• COVID-19 Vaccination is Rising in Many Vulnerable African Communities Thanks to EU-funded, WHO-led Project

Learning Objectives:

1. Describe how low- and middle- income settings experience additional burdens to vaccine supply, vaccine storage, and vaccine access.
2. Identify examples of innovative practice that could be adapted and / or scaled in various communities.
3. Highlight the ways that community buy-in and support from local leaders and trusted messengers contributes to vaccine campaign success.

Healthcare providers as advocates for vaccination policy

Health care professionals (HCPs) remain one of the most trusted influencers in the realm of adult vaccination, not only as vaccinators of populations, but also as advocates to policymakers.  This role can include publishing press releases urging government action, such as the Ontario Medical Association’s call to have all healthcare workers receive Covid-19 vaccines during the pandemic. However, policy change can also include working at the organizational level to ensure that there are comprehensive vaccination policies in place at workplaces, schools, etc.

Healthcare providers can influence policy due to their credibility as professionals, and experts in healthcare topics such as vaccination. They are also often invited to be on advisory committees or belong to professional organizations that have strong collective power and ability to campaign policymakers to drive change (6).

Examples of healthcare providers as advocates and drivers of policy change have been well-documented in other health related policies. In lobbying for health policy change, healthcare providers have been crucial in changing regulations around areas such as nicotine and tobacco usage. Learning from these past experiences and how they can be expanded to the role of healthcare providers in influencing adult vaccination policy is a key opportunity. 

This module explores the important role of HCPs in calling for prioritization of older adults and availability of the appropriate infrastructure and resources to drive vaccine equity through policy change.

Relevant Resources:

• WHO: An unwavering voice for vaccine equity
• Engaging Nurses in Health Policy in the Era of Covid-19

Learning Objectives:

1. Share current initiatives of healthcare providers and associations working to advocate for inclusive and equitable vaccination policies.
2. Provide tangible strategies for increasing advocacy efforts of HCPs.
3. Highlight key examples of HCPs changing health policy and explore how these can be extrapolated to the field of adult vaccination