Trusted Messengers: Supporting Physicians in Promoting COVID-19 Vaccination

PROJECT SUMMARY/ABSTRACT The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and associated coronavirus disease 2019 (COVID-19) pandemic have been devastating. In the United States (US), more than 25 million people have been infected, resulting in more than 430,000 deaths. Black and Latino communities have borne a starkly disproportionate impact of COVID-19, compounding existing health disparities. The approval of multiple effective COVID-19 vaccines has raised hope that a return to "normal" life may be at hand, but realizing the full benefits of vaccines will require widespread acceptance and uptake. Our work and that of others indicate a significant proportion of the US population are reluctant to be vaccinated. Overlap between factors associated with COVID-19 disease and COVID-19 vaccine hesitancy, including being of Black or Latino race/ethnicity, and socioeconomic disadvantage, threaten to severely exacerbate existing health disparities. The overarching goal of this proposal is to overcome COVID-19 vaccine hesitancy, particularly among vulnerable populations. Building on strong existing community partnerships, we will refine, implement, and evaluate a multi-faceted intervention to support primary care providers and community organizations as trusted messengers to promote COVID-19 vaccination among vulnerable patients in and near Worcester, MA. Our intervention will include: (1) an online library of videos addressing common vaccine concerns to be disseminated by PCPs and local community organizations; (2) evidence-based text messaging from PCPs to their patients conveying recommendations for and information about COVID-19 vaccination; and (3) concise educational materials for PCPs to support their conversations with patients about the COVID-19 vaccine. We will implement and evaluate the intervention via a large pragmatic clinical trial at two Federally Qualified Health Centers, and the UMass Memorial Health Center. These three clinical systems collectively serve large populations of racial and/or ethnic minority groups (Black, Latino, non-primary English speakers) and socioeconomically disadvantaged patients. Our specific aims are: (1) To refine and adapt tools to support effective PCP recommendations for COVID-19 vaccination and information dissemination by PCPs and community organizations to vulnerable patients; (2) To implement and assess the impact of the intervention on COVID-19 vaccine uptake among initially unvaccinated patients and (3) To evaluate the intervention according to the RE- AIM framework, incorporating the perspectives of patients, primary care providers, and clinic leaders. We will characterize the local community environment before, during and beyond the intervention period and will identify ways the environment supports or inhibits intervention effectiveness. This research will generate crucial evidence of how to effectively promote COVID-19 vaccination among vulnerable populations. Our findings can be applied to promote uptake of other vaccines (including possible COVID-19 vaccine "boosters") among populations at risk of vaccine hesitancy and health disparities.