Protect Your Crew, Get Vaccinated Against The Flu - How to Increase Influenza Vaccine Rates

Influenza is an acute, highly contagious respiratory illness and is a significant cause of morbidity and mortality in Canada. According to the Government of Canada FluWatch annual report, during the 2018-2019 season, a total of 48 818 Canadians were diagnoses with influenza. It is estimated that influenza results in 12 200 hospitalizations and 3 500 deaths each year, meaning that it ranks in the top ten leading causes of death in Canada (Government of Canada, 2020). The good news is, annual flu vaccination reduces the risk of influenza illness, hospitalizations and potentially death.

The influenza vaccine protects against viruses that research predicts will be the most common during the upcoming season (Key Facts About Seasonal Flu Vaccine, 2020). Getting vaccinated is the most effective way to prevent influenza and its complications. However, overall the 2018-2019 influenza season saw a vaccination coverage of 42%, well below the national goal of achieving vaccination coverage of 80% (Vaccine uptake in Canadian adults 2019, 2019).

With the ongoing pressure our health care system faces during the COVID 19 global pandemic, this flu season, more than ever, it is essential for everyone to get the flu vaccine. Using the social-ecological model as a tool, I will explore ways to improve the overall vaccine rates.

The Social-Ecological Model

The Social-Ecological Model (SEM) is a framework for identifying, understanding and addressing the social determinants of health on many levels. The SEM shifts the focus from an individual behaviour approach towards interventions directed at changing individual, interpersonal, organizational, community, and public policy, to influence health outcomes (Max et al., 2015). The model believes that interventions are more likely to be effective when they address all determinants of health.

Kumar et al. (2012) acknowledge that research to date on vaccine uptake has primarily focused on intrapersonal determinants and demonstrates that addressing and targeting all SEM levels has a more significant impact than interventions that only target one specific level. In the following sections, I will use the social-ecological model to discuss how to increase vaccine uptake at each level.

Individual

The individual characteristic that influence behaviour include knowledge, attitudes and beliefs. Studies have shown that lacking general knowledge about influenza and the vaccine has been identified as a barrier to uptake. Many vaccination campaigns target the individual and are geared towards providing reminders that flu season has started and it is time for your flu vaccine. While an excellent reminder for those who get a yearly flu shot, these campaigns do not address the concerns and beliefs individuals may have for not getting the flu shot.

Some of these knowledge gaps and beliefs are:

• Vaccines do not work.

• Vaccines cause the flu.

• You should not be vaccinated when you are pregnant or have an underlying medical problem.

• The vaccine is for the elderly.

The knowledge gaps and misconceptions about the influenza vaccine are common and must be addressed to improve vaccination uptake. When looking at future campaigns, looking for creative ways to provide education and reminders may increase overall vaccination rates.

Interpersonal

The relationships one has with others, including peers, family and social networks, can affect their decisions. Generally, people are influenced by their social network and are more likely to get a yearly flu vaccination if their friends, family or peers are also getting their vaccination (Kumar et al., 2012).

Social media can also play a vital role in the sharing of vaccine information and misinformation. As discussed in my social media blog, an overwhelming majority of online Canadian adults (94%) have at least one social media platform. Studies have shown that people who use the internet and social media compared to traditional resources (e.g. medical professionals) for vaccine information are more likely to be vaccine-hesitant. Overall, negative views of vaccination posted online and through social media recruited more

views and a more extensive network (Kolff et al., 2018).

Many large-scale campaigns have difficulty increasing vaccination rates. Bonnevie et al. (2020) looked to social media influencers' to deliver health messaging about the flu vaccination. Early research shows promise in achieving high levels of digital engagement and positive health outcomes. Given social media's influence, there is also a need to engage healthcare professionals and organizations to use social media as a tool to share information, promote health behaviours, engage with the public and provide positive fact-based information. Public Good Project

Organizational

Rules and regulations of an organization can impact behaviour. The workplace can play a vital role in promoting influenza vaccination and emphasizing its importance. Many healthcare organizations encourage all staff to be immunized yearly. To increase uptake, hospital flu campaigns usually include flu clinics, provide mobile or roving immunization teams to reach smaller sites, and offer prizes or an incentive for getting your flu shot. Some organizations have even implemented policies requiring healthcare workers to either get the flu shot or be required to wear a mask for the influenza season.

A common problem with vaccinations is missed opportunities (Kolff et al., 2018). While hospitals place a great deal of importance on ensuring staff have a chance to receive their flu shot, they typically don't extend this service to patients or clients. The emergency department (ED) presents a unique opportunity to reach many, often high-risk patients who might not otherwise be vaccinated. Taylor et al. (2018) found that if vaccinations were offered in the ED, 53% of patients would accept the influenza vaccination. Therefore, a hospital or clinic visit would be an excellent opportunity for medical professionals to discuss the importance of receiving the flu vaccination.

Community

The availability and location of recourses, such as poverty level, transportation, and access to health care services, can impact vaccination rates. Studies show that communities with an overall higher income are more likely to receive an influenza vaccine than a lower-income neighbourhood (Lucyk et al., 2019). "People living in the poorest neighbourhood are nearly twice as likely as those living in affluent areas to be hospitalized with complications of the flu" (Boylen, 2016). Suggesting that there could be a need to set up community vaccination clinics to target areas with low vaccination uptakes.

Transportation is often considered to be a barrier to healthcare access and can result in poorer health outcomes. Patients living in a rural setting often report more problems with transportation and travel distance to health care providers, and therefore miss their appointment or don't make the appointment at all (Syed et al., 2013). Perhaps providing door-to-door vaccination programs would create an opportunity for health care providers to reach a more significant number of individuals.

Public Policy

Insurance coverage for immunizations is a significant predictor of vaccine uptake (Kumar et al., 2012). In Canada, the influenza vaccine is provided to individuals for free, except for British Columbia and Quebec. After the introduction of universal coverage for the flu shot, most provinces saw an increase in uptake. It would benefit the remaining two to consider this approach.

In 2013, to improve vaccination coverage by increasing accessibility and convenience, legislation passed allowing pharmacists in Nova Scotia to administer immunizations to patients five years of age and older (Isenor et al., 2016). Research shows that after introducing pharmacists administrating the influenza vaccine in Nova Scotia, a 15% increase in total flu shot was given (Isenor et al., 2016). Not all provinces and territories have taken this approach, leaving some missed opportunity to reach a significant number of individuals.

Conclusion

In conclusion, when looking to increase influenza vaccination uptake, you must consider factors at each level of the social-ecological model and work to address any barriers. By recognizing how all levels can influence a person's decision, health care professionals can design plans to target multiple levels to get the most significant increase in influenza vaccine uptake.

References:

Bonnevie, E., Rosenberg, S. D., Kummeth, C., Goldbarg, J., Wartella, E., & Smyser, J. (2020, October 16). Using social media influencers to increase knowledge and positive attitudes toward the flu vaccine. PLOS ONE. https://doi.org/10.1371/journal.pone.0240828

Center for Disease Control and Prevention (n.d.). Key facts about seasonal flu vaccine. https://www.cdc.gov/flu/prevent/keyfacts.htm

Boylen, S. (2016, February 11). CDC: Poverty linked to poor flu outcomes. MedPage Today https://www.medpagetoday.com/pulmonology/uristheflu/56157

Government of Canada (n.d.). Flu (influenza): For health professional. Retrieved from https://www.canada.ca/en/public-health/services/diseases/flu-influenza/health-professionals.html

Government of Canada. (n.d.). Fluwatch annual report: 2018-19 influenza season. https://www.canada.ca/en/public-health/services/publications/diseases-conditions/fluwatch/2018-2019/annual-report.html

Government of Canada. (n.d.). Vaccine uptake in Canadian adults 2019. https://www.canada.ca/en/public-health/services/publications/healthy-living/2018-2019-influenza-flu-vaccine-coverage-survey-results.html

Isenor, J. E., Alia, T. A., Killen, J. L., Billard, B. A., Halperin, B. A., Slayter, K. L., McNeil, S. A., MacDougall, D., & Bowles, S. K. (2016, February 10). Impact of pharmacists as immunizers on influenza vaccination coverage in Nova Scotia, Canada. Human Vaccines and Immunotherapeutics.12(5), 1225–1228.

https://doi.org/10.1080/21645515.2015.1127490

Kolff, C. A., Scott, V. P., & Stockwell, M. S. (2018, May 21). The use of technology to promote vaccination: A social-ecological model based framework. Human Vaccines & Immunotherapeutics, 14(7), 1636–1646. https://doi.org/10.1080/21645515.2018.1477458

Kumar, S., Quinn, S. C., Kim, K. H., Musa, D., Hilyard, K. M., & Freimuth, V. S. (2012, April 1). The social ecological model as a framework for determinants of 2009 H1N1 influenza vaccine uptake in the United States. Health Education and Behavior, 39(2), 229–243. https://doi.org/10.1177/1090198111415105

Lucyk, K., Simmonds, K. A., Lorenzetti, D. L., Drews, S. J., Svenson, L. W., & Russell, M. L. (2019, July 17). The association between influenza vaccination and socioeconomic status in high income countries varies by the measure used: a systematic review. BMC Medical Research Methodology, 19(1), Article 153. https://doi.org/10.1186/s12874-019-0801-1

Max, J. L., Sedivy, V., & Garrido, M. (2015, March). Increasing our impact by using a social-ecological approach. Washington, DC: Administration on Children, Youth and Families, Family and Youth Services Bureau. https://teenpregnancy.acf.hhs.gov/sites/default/files/resourcefiles/Increasing_Our_Impact%20508.pdf

Syed, S. T., Gerber, B. S., & Sharp, L. K. (2013). Travelling towards disease: Transportation barriers to health care access. Journal of Community Health. 38(5), 976–993. https://doi.org/10.1007/s10900-013-9681-1

Taylor, J. A., Vu, E., Angelica, M., Elizalde, L., & Li-Brubacher, J. (2018, March). Influenza and pneumococcal disease vaccinations: Is there a role for prevention in the emergency department? British Columbia Medical Journal. 60(2), 116-120. https://bcmj.org/articles/influenza-and-pneumococcal-disease-vaccinations-there-role-prevention-emergency-department