Methods of Current Practice: Qualitative Analysis of Intervention Strategies Utilized by Vaccine Waiver Educators in Michigan.

By enacting administrative rule 325.176 (12), Michigan added a vaccine education component as a precondition to granting vaccine waivers to vaccine-hesitant parents wishing to file a nonmedical vaccine exemption for their school-aged child. The purpose of the study was to identify best practices for reaching vaccine-hesitant parents during face-to-face vaccine education sessions conducted by vaccine waiver educators in Michigan. This study utilized qualitative descriptive content analysis of semi-structured phone interviews with vaccine waiver educators from local health departments (LHDs) in Michigan. Participants were vaccine waiver educators who were employed by a local health department in Michigan and had conducted at least 30 vaccine waiver education sessions. Strategies, resources, and techniques identified by educators as beneficial included using and providing information from a variety of sources, compiling their own educational materials, creating a positive experience, holding personalized sessions, and streamlining exemption and vaccination sessions. However, unexpected themes that emerged from the interviews revealed that vaccine waiver educators need additional training in discussing vaccine ingredients with parents, handling religious vaccine exemption requests, and assessing the role of schools. Implementing successful vaccine education interventions targeting vaccine-hesitancy is crucial to public health. Charging LHDs with overseeing vaccine education via a face-to-face discussion is a novel intervention strategy, the effective implementation of which may inform vaccine education intervention nationwide and may even be translated into international contexts and prove useful to current COVID-19 vaccination efforts.

COVID-19 vaccine hesitancy in rural South Africa: Deepening understanding to increase uptake and access.

Background: To date, COVID-19 vaccine coverage in the African region falls far too short of global goals. Increasing vaccination rates requires understanding barriers to vaccination so that effective interventions that sensitively and effectively address barriers to vaccination can be implemented. Methods: To assess COVID-19 vaccination levels and identify major barriers to vaccine uptake we conducted a population-based, cross-sectional survey among 1662 adults 18 and older from August 25 to October 29 2021 in the Agincourt Health and Socio-Demographic Surveillance System (AHDSS) area, Mpumalanga, South Africa. Results: Half of participants reported receiving a COVID-19 vaccine (50.4%) with 41.1% being fully vaccinated and 9.3% being partially vaccinated; 49.6% were unvaccinated. More women than men were vaccinated (55.5% vs 42.8%, P < 0.001), and older age groups were more likely to be vaccinated than younger age groups (P < 0.001). Among the unvaccinated, 69.0% planned to get vaccinated as soon as possible, while 14.7% reported definitely not wanting the vaccine. Major barriers to vaccination included lacking information on eligibility (12.3%) or where to get vaccinated (13.0%), concerns about side effects (12.5%), and inconvenient hours and locations for vaccination (11.0%). Confidence in the safety and efficacy of COVID-19 vaccines was higher among those vaccinated than unvaccinated (75.3% vs 51.2%, 75.8% vs 51.0%, both P < 0.001, respectively). Conclusions: Increasing vaccination in South Africa beyond current levels will require a concerted effort to address concerns around vaccine safety and increase confidence in vaccine efficacy. Clarifying eligibility and ensuring access to vaccines at times and places that are convenient to younger populations, men, and other vulnerable groups is necessary.

Geographic hot spot analysis of vaccine exemption clustering patterns in Michigan from 2008 to 2017.

OBJECTIVE: This study explored vaccine exemption clustering in Michigan and examined whether vaccine exemptions clustered by exemption type (medical, religious, and philosophical). Furthermore, the study investigated whether Michigan's nonmedical vaccine exemption policy change had an impact on type-specific vaccine exemption clusters following its implementation. METHODS: The study used the ArcGIS optimized hot spot analysis tool to visually examine vaccine exemption clustering by type in Michigan. The study analyzed secondary kindergarten vaccine exemption data from 2301 elementary school buildings in Michigan for years spanning 2008 to 2015 and 2016 to 2017 post policy change. RESULTS: Clustering of vaccine exemptions by type was present both before and after implementation of the policy with fewer statistically significant features and differences regarding the distribution of hot spot clusters following the policy change. CONCLUSION: Considering the heterogeneity in vaccine exemption hot spot clustering by type can help to inform public health officials to areas/communities at high risk for vaccine preventable disease outbreaks. Such analysis can allow for the implementation of vaccine exemption interventions that are exemption type specific and tailored for a given area, thus maximizing impact and making best use of limited public health resources. This analysis was also able to showcase the impact of Michigan's nonmedical vaccine exemption policy on vaccine exemption hot spot clusters.

The Impact of Michigan's Nonmedical Vaccine Exemption Rule Change on Philosophical Exemption Rates.

To examine school factors associated with philosophical exemption rates among kindergarteners in Michigan from 2014, before Michigan's implementation of administrative rule 325.176 (12), to 2015, after the rule change revising the process for receiving nonmedical exemptions from school entry vaccines. The study explored the extent to which the factors-school type, geographical location, and socioeconomics-were associated with philosophical exemptions among kindergarteners before and after the rule change, using negative binomial regression and Spearman's Rho correlation. Philosophical exemptions decreased from 2014 to 2015 for all school types but remained highest among rural private schools. Urban private schools had the second highest exemptions with rates 2.22 times higher than those of urban public schools. Exemption rates among rural charter schools were double those of urban public schools, while rural public schools' rates were 1.22 times higher than those of urban public schools. Free and reduced school lunch eligibility had a strong inverse association with philosophical exemptions for both 2014 and 2015, with higher philosophical exemptions being associated with higher socioeconomic schools. Philosophical exemption rates decreased in the wake of the rule change; however, high philosophical exemptions, post rule change, were still associated with private schools, rural locations, and high socioeconomic status schools.