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Running Head: INCREASING VACCINE USE 1

Group 6: Increasing the Use of Vaccinations for Underserved Patients Through Public Policy

Initiatives

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Problem Statement

Widespread vaccination efforts have led to the eradication of several infectious diseases.

However, underserved populations continue to have the lowest nationwide vaccination rates.

What local initiative would best increase access for underserved populations?

Options

Based on the responses from a variety of stakeholders, the following options are proposed

as solutions to address the lower vaccination rates in underserved populations. Educational

health programs, mobile clinics, a mobile app, and incentive programs could all be used as

means to address the health disparities in an effort in bridging the gap in vaccination rates

between underserved populations and other populations. Each of these options has several

benefits as well as possible difficulties that must be addressed before proceeding with the chosen

option.

Option 1: Implement Parent and Student Education Programs in Cameron County Schools

Focused on Vaccinations

This option focuses primarily on the initiation of informative classes in Cameron County

schools and parent-teacher meeting programs that educate parents about the purpose of

vaccinations. This program is an initiative to encourage the vaccination of more children in

underserved communities. The vaccine information program can be presented to parents at the

beginning of each grade level year and the parents will be asked to attend as an admission

requirement for their children. The teachers in the school with medical experience and

credentials will create the presentations. Several program classes will be offered since children

should receive vaccinations at various ages. There will be different program classes depending

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on what grade levels are eligible to receive which vaccines. Each vaccination information class

will be presented in English and Spanish options. The courses will discuss the lifesaving benefits

of vaccinations, the side effects of vaccinations with valid research data, and locations that offer

the vaccines mentioned. The feasibility of this school vaccine information program is moderate

since it will only occur at the beginning of each school year and will not require an everyday

expense or effort. This program may have a disadvantage of it being difficult to find individuals

educated enough to hold vaccine informative sessions with completely accurate data and sources.

Additionally, parents may be resistant to such classes if they do not feel the school should

mandate vaccinations or classes on vaccinations. The financial burden incurred by the school

district may be of concern as well. Monies will have to be allocated for the time of the educator

to research, compile, and present the data for the courses. Funding sources for this option are

federal or state funds. Time and space constraints within the school must also be considered and

could be inhibitory to successful implementation of an education initiative. A one year trial

period is proposed to assess the impact of such a program.

Option 2: Mobile Clinics

Offering people in underserved populations the chance to get low-cost or free

vaccinations through a mobile clinic would be a significant advantage for underserved

populations. “Mobile Health Clinics (MHCs) are an innovative model of healthcare delivery that

could help alleviate health disparities in vulnerable populations” (Yu, Hill, Ricks, Bennet, &

Oriol, 2017). The clinic would require several staff members and a large vehicle. This option

would require a collaborative approach on behalf of the local health department mobile clinic

coordinators and health care providers. Although cost must be a consideration in options

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analysis, a mobile clinic could provide low to no cost vaccines at a convenient location and time.

The mobile clinic could provide basic health care, focusing on vaccines. Although a large

expense would have to be made to start the mobile clinic and to keep it running, this could

potentially reduce long-term health costs. Patient in the underserved population would have easy

access to health care and would not need to wait until their condition gets worse before seeking

medical attention. The cost of the vaccines themselves could be covered through the CDC’s

Vaccines for Children program (VFC) (CDC, 2016). Several states such as New York, offer free

vaccinations for adults under a Vaccines for Adults (VFA) program (New York State

Department of Health, n.d.). These programs target the vaccination of underserved populations

by offering free vaccines if the patient qualifies as uninsured or underinsured. A clinic may

register as a provider to receive these vaccines for distribution. Funding and adequate staffing are

significant challenges of this option. The local health department would be responsible for

arranging and implementing this option, as they hold an advantageous position for contacting the

underserved population and are already approved for VFC or VFA programs. Funding sources

for this option include federal or state monies. A two year trial period is proposed for this option

with renewal of the program contingent on funding and positive impact on the underserved

populations.

Option 3: Mobile Application for Reminders and Education

A mobile application could be a way to target underserved populations. The app could

provide reminders for when a vaccination is due for each member of the family. The mobile app

could provide educational videos or articles about vaccines to increase awareness and provide

information on where vaccines are offered. Additionally, misconceptions and frequently asked

questions could be addressed and discussed by professionals in another section of the app. The

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mobile app could deliver updates on vaccine information and connect to the popular social media

sites. This approach to addressing the low vaccination rates in underserved populations could be

relatively cost effective since a profit will not be required from the app, however startup costs

vary. According to Muoio (2018), “Thirty-six percent of mobile health app publishers spent less

than $25,000 on their apps up until launch, while 12 percent reported budgets exceeding

$500,000”. This could be paid for with county funds or with federal grants if necessary. One

major problem with a mobile app is that the vaccines themselves will not be provided through

this app. The app will be educational and will raise awareness on the importance of vaccines, but

people in these underserved populations will still need to go to a doctor’s office or clinic to get

the necessary vaccines. Other issues include that the design and implementation of a mobile app

assume that the population has access to a cellular telephone and have an awareness that the app

exists. Outreach campaigns may be necessary to raise awareness of the app. Additionally, the

usefulness of the app must be made clear to the target population as well, otherwise they may not

use it. Funding for this option includes county funds or a federal grant. Startup and maintenance

for the program will be organized by the largest local healthcare network in the region.

Option 4: Vaccination Incentive Reward Program

Most people are willing to participate in health initiatives if there are additional benefits

for themselves aside from the expected health benefits. This option focuses primarily on the

community establishing a vaccination reward program for its participants. For all participants

that complete the vaccination reward program, they will receive the gift card and be entered in

the main prize raffle. If individuals and their immediate families follow adhere to the CDC’s

recommended vaccine schedule, they will receive a Visa gift card worth $50 for groceries.

Furthermore, there will be a main prize raffle of a free health check up every 3 months for a year.

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The method of the community tracking the completion of the vaccinations will be a vaccination

tracking log that is signed and dated by the medical facility administering the vaccination. These

logs will be mailed to the members of the community and the incentive program will be

explained to the community members in a vaccine incentive reward brochure. The feasibility of

this vaccine incentive program is high since a visa gift cards are easily obtained and the

investment from the program is not significant. Additionally, since the main prize is only for 1

participant it won’t be a series of varying costly expenses. The advantages of this program will

be that when people of the community discover that they will benefit through an indirect mode of

compensation, they will be more likely to complete the vaccination for their family and

themselves. The disadvantage of this option is that if there are many participants that receive the

gift card, the costs may become too high to manage this incentive program. The recipients of the

Visa gift cards may also use the gift card for something other than its intended purpose,

groceries, without any supervision of how the money is spent. The winner of the free health

checks may pose an issue if this individual has major health complications that could a pose a

high cost as well. The funding course for this option includes federal or state allocated monies.

Implementation of the program would be administered by the local health department, who

would be responsible for issuing promotional materials and rewarding the incentives. Renewal of

this option would be contingent on the measured impact of the program and continued funding.

Side by side options analysis are provided in Table 1 and Table 2.

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Table 1.

Benefit Analysis for Increasing Vaccination Rates in Underserved Populations

Benefit Option 1 Option

2 Option

3 Option

4

Long term sustainability ✓ ✓ ✓ ✓

Empowers target audience to take role in personal health

✓ ✓ ✓ ✓

Engages local healthcare providers ✓ ✓ ✓

Easily accessible patient tracking ✓ ✓ ✓

Cost effective ✓ ✓

Provides vaccine education and awareness ✓ ✓

Easy access to vaccines ✓

Provides vaccine itself ✓

Available at any time ✓ ✓

Goes beyond addressing vaccines ✓

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Table 2. Summarized Side by Side Options Analysis

Option Option Description Affected Parties Option Length Funding Source

Option 1: School Vaccine Education Program

Implement Parent and Student Education Programs in Cameron County Schools focused on a Vaccine Informative

Underserved community individuals, students, parents and teachers

One year school trial period, annual renewal dependent on school funds

Federal or state

Option 2: Mobile Heath Clinic (MHC)

Mobile Health Clinics would patrol medically underserved communities with low cost effective or free vaccinations

Underserved community individuals in vicinity of MHC

Two year test trial period, renewal depending on budget needs

Federal or state

Option 3: Mobile App

Mobile app that can help underserved families and individuals with a vaccine reminder. The app can also serve as a FAQ and health data forum regarding vaccinations

Worldwide Mobile App users

Indefinite, dependent on app funding

County funds or Federal Grant

Option 4: Vaccine Incentive Program

Vaccination programs that can promote members of underserved communities to vaccinate themselves and their children through a benefit reward program.

Underserved community individuals

One year trial period, annual renewal depending on productivity and community participation

Federal or state