Strategy
The Pennsylvania Immunization Program uses program activities and partnerships to increase immunization rates by addressing cultural, educational, and accessibility challenges.
Challenge
Lancaster County, PA, has a diverse population with broad socioeconomic differences and immunization compliance challenges despite provider availability and accessibility across the county. Misinformation is a consistent barrier to immunization in the Plain community (Amish and Mennonite). The Plain community believes the misinformation they have seen and repeats inaccurate information regarding vaccines and vaccine-preventable diseases. Providers offering healthcare to the Plain community consistently respond that they do not provide strong vaccine recommendations to Plain patients due to resistance and not wanting to lose patients. Lancaster County has a total population of 553,652, with a Plain community population of around 40,000. Lancaster County also has a Health Professional Shortage Area (HPSA) score ranging from 12-25 with a Federally Qualified Health Center (FQHC) facility score of 17, demonstrating a high-need population. The population represented in the HPSA is not limited to the Plain population. In addition to the Plain population, Lancaster County has the highest rate of uninsured persons in PA, and increasing school exemption rates leave a large population susceptible to vaccine preventable diseases (VPD).
Solution
Immunization improvement activities in Lancaster County started on July 1, 2022. The immunization goals and objectives specific to Lancaster County include increasing access to immunization services through partnerships, servicing areas with underserved or hesitant populations, and providing community education through trusted resources. The Pennsylvania Department of Health (PDH) utilized Lancaster County as a learning laboratory for immunization improvement activities. PDH established six school-based VFC sites. They engaged in partnerships with the Lancaster County Immunization Coalition, community outreach clinics, the Health Improvement in Plain Population (HIPP) Task Force, Farm Safety Days, and the Pennsylvania State University Hospital pediatric residency collaboration to provide services to the community. PDH partnered with the Lancaster EMS to provide in-home immunizations and the local FQHCs to provide in-home horse and buggy immunization services. PDH collaborated on two research studies with Millersville University and Elizabethtown College.
This intervention required both a time commitment and a financial contribution. PDH dedicated approximately 45 hours to Farm Safety Days. The Community Outreach Clinics required approximately 1,400 hours of staff commitment. There were 780 hours dedicated to home immunizations. Public health experience for Penn State pediatric residency required 23 hours of staff time. The VFC program providers’ sites in Lancaster School District required approximately 45 hours. The back-to-school stadium event held by the PDH took approximately 60 staff hours. Immunization cooperative agreement and supplemental COVID-19 funds were utilized to conduct these activities. Education and outreach cost the department approximately $50,000, and the materials for these interventions cost approximately $78,400.
Outcome
Although the Plain community in Lancaster County had access to providers, stigma and misinformation about vaccines within the community were a significant barrier to immunizations. Individuals of the Plain community are private in their personal perception of VPDs and stance on immunizations. In-home immunization services provided the desired privacy and led to additional families receiving vaccinations. Incorporating vaccine education and immunizations into desired community events provided opportunities to dispel misinformation and improve participation. School-based VFC providers are vaccine advocates, and they were a driving force for educating parents and immunizing students to ensure that youth were not excluded from school.
Supplemental Resources