Vaccine hesitancy is in the Vanderburgh County Health Department's crosshairs

Erin Reese, the Vanderburgh County Health Department's lead immunization nurse, told the health board in May she had been "feeling kind of like I was spinning my wheels." So last summer, the health department commissioned a survey meant to dig up the roots of vaccine hesitancy among parents and find ways to respond.

The problem was evident in overall immunization rates for a series of recommended vaccines — including the "DTaP" vaccine against tetanus, diphtheria and pertussis and the "MMR" vaccine to prevent measles, mumps, and rubella — for children 19-35 months of age.

Reese pulled the data from the state's Children and Hoosier Immunization Registry Program (CHIRP). It didn't look so good.

"We were doing really well until we hit COVID," Reese told the health board.

The 19-35 immunization rate was 79% in 2020, according to a report Reese presented to the health board. Then it fell to 74% in 2021. It was in the midst of falling further to 71.7% last year, when the survey commenced.

Reese and her team also found that vaccination rates for children 5-10 years old were below recommended herd immunity thresholds — the vaccination coverage rate required to provide adequate protection for the entire population.

The threshold for pertussis — the formal name for the extremely contagious and easily spread respiratory illness commonly known as whooping cough — is 92-94%. But Vanderburgh County's rate for DTaP, which protects against pertussis, was 79%. The threshold for measles is 95%, but Vanderburgh County's MMR vaccination rate was 86.3%.

Point of survey was to identify barriers to vaccination

The health department put its "Immunization Needs Assessment provider survey" online, making it available in English, Spanish, Marshallese and Haitian Creole. The survey was sent electronically to doctor's offices and family practitioners to get their input as well.

It was open to anyone, but directed to parents of children under 17 years old. As an inducement to answer, participants could enter to win a $50 Amazon gift card.

The point was identifying the barriers to getting more kids vaccinated.

"Your insights are critical for us to understand perceptions and barriers to vaccinations in our community," stated a promotion for the survey.

When it was all over, the health department had collected 774 responses, about 44% of which came from parents.

For all the translations into other languages, only about 30 responses came from non-English speaking populations.

The survey fleshed out parents' concerns

Still, the survey provided insights.

Overall trust in healthcare providers was high — 90% — but trust in their vaccine recommendations was a little lower. Large majorities of parents and others agreed that vaccines are important for individuals and the public.

But 18% of parents were neutral about the statement, "Vaccines are safe," a number Reese found startling. Overall, 15% of respondents were neutral on that question. 15% of parents and 11% overall were neutral when asked whether they receive enough information about vaccine side effects from their provider.

"Free comments were mixed, but many indicated concern about side effects, COVID-19 vaccines, and an increase in concern since COVID," stated Reese's report to the health board.

"One of the most interesting things, I thought, was I posed two questions on the survey about social media, one within the general perception portion," Reese told the health board. "'Have you had concern about something you read on social media?' And we saw that almost a third (29% of parents) agreed and then, 18% (of parents) were neutral."

Ten precent of parents answered that things they read on social media about vaccines had been a barrier to them getting their children immunized.

The survey identified other barriers to vaccination — finances, transportation or lack thereof, clinic hours and being too busy among them.

"Some people said they didn't have a provider, or they don't know where to go," Reese told the health board. "So I thought that was something we can work on — awareness."

A rise in school-based mobile vaccination clinics — the health department did 13 clinics that fully vaccinated 203 children this past fall — has made a big difference, Reese reported.

"(Doing clinics) meets all six barriers for our school-aged kids," she said. "If you can get your kid done — transportation, finances, being too busy, clinic hours — all of that is met by a school-based clinic, including language barriers."

The health department recently had its vaccination consent form for parents translated into six languages.

Reese introduced data supporting the notion that it's all working.

That 19-35 immunization rate that was 79% in 2020 but down to 71.7% last year? The latest data, as of April 1, put it at 74.6%.

How is the health department responding?

Chief among health department interventions — actions it is taking in response — is the agency's mobile vaccination clinic for adults, which goes out two or three times weekly.

"Right now they're mostly seeing people with no insurance, but we are working on some plans to add some Medicaid and private insurance because some of the places (clinics) go, people do have Medicaid," Reese said. "They are signed up. And (we are) working on processes to see if we can add some pediatric vaccines over the summer or in some way make that process work."

Monthly reminder and recall messages to the health department's clients of all ages — those whose data is included in CHIRP — are a key strategy. In 2024, Reese said, the health department showed ECHO Community Healthcare how to employ the reminder recall function. The agency works with other healthcare providers on reminder recall functions as well, specifically on measles cases.

The health department sends a welcome packet book and brochure with vaccine information to families with new babies, although Reese said that likely will not continue after budget cuts this year.

Joe Gries, the health department's administrator, said the survey gave the health department actual data to help clarify the potential reasons parents don't get their children vaccinated — apprehension about side effects and safety, a lack of information.