Overcoming Vaccine Hesitancy in Rural Northern New England for Adolescents and Adults

Vaccinating a significant portion of the American population with the COVID-19 vaccines is critical to achieve herd immunity to end the pandemic. It was recently reported that 20% of rural residents will "definitely not" get vaccinated. Hesitancy is higher among rural Americans for reasons including perceptions about COVID-19 risk, personal and/or religious reservations, distrust of science and government, and misinformation about vaccinations. Across Vermont, Maine and New Hampshire, there is 25% less COVID-19 vaccination in our predominantly rural communities compared with the limited, more densely populated cities and towns. There is an immediate and compelling requirement to overcome vaccine hesitancy for two rural northern New England target populations. Our adult population is 34% fully vaccinated (as of 4/16/21). The adolescent population (13 to 18 years old) is 10% vaccinated with the first dose; rapidly inoculating this younger cohort is necessary to resume pre-pandemic in-school and structured extra-curricular life. We have a unique opportunity and responsibility to address vaccine hesitancy for both cohorts by two complementary strategies that will leverage the capabilities of the NNE-CTR. A community-engaged multidisciplinary approach, consistent with public health objectives, practices, and policies, will immediately impact COVID-19 incidence and accelerate progress toward mitigating the associated health, social and economic consequences. For the 13- to 18-year-old group, we will pursue a parental-informed peer-based social media "influencer" intervention based in a single rural Vermont county intended to increase recipient intention to get the COVID-19 vaccine (Specific Aim 1). Our hypothesis is that electronic word-of-mouth communication utilizing information dissemination through social media networks will promote peer persuasion to overcome vaccination hesitancy. For the 25- to 65-year-old group, we will pursue a shared decision making intervention (Specific Aim 2). Our hypothesis is that the shared and unique dimensions to communication between patients and physicians impacts receptiveness to COVID-19 immunization and overcoming vaccine hesitancy. To facilitate community engagement and maximize participation of rural northern New England primary care practices, program leadership and NNE-CTR infrastructure of the will partner with experts at the University of Vermont (UVM) and in the community. These include the UVM rural health communication researchers and practitioners, the Vermont, New Hampshire and Maine departments of health, the Northern New England Primary Care Practice-Based Research Network, the rural northern New England primary care consortium, and the liaison organization with northern New England schools, Vermont Afterschool Inc. Reducing rural inequities is a public health priority and the overarching commitment of this program. Our approach is nimble and scalable to respond to public health policies and practices, and required modifications in interactions in the immediate and foreseeable future.