Addressing COVID-19 vaccine hesitancy in rural communities: A case study in engaging trusted messengers to pivot and plan

Abstract

The pandemic declaration of COVID-19 in 2020 presented unique challenges, lessons, and opportunities for public health practice in the United States. Despite clear evidence of COVID-19 vaccine effectiveness, vaccine uptake and vaccine confidence remained low in many regions. Vaccine holdouts, or those who are vaccine hesitant, have been an increasingly difficult population to reach. Several factors influence vaccine hesitancy and behavior in rural areas, including health care access challenges, misinformation, political loyalties, and concerns regarding the perceived lack of trustworthy evidence and knowledge of long-term effects. In March 2021, the Finger Lakes Rural Immunization Initiative (FLRII) engaged stakeholders to address vaccine hesitancy in a nine-county region of rural New York known as the Finger Lakes. Driven by data collected from community partners, physicians, and local health departments regarding their biggest barriers and greatest needs, the FLRII team created an interactive program for trusted messengers (TMs) including a stakeholder panel, called the Trusted Messenger Forum (TMF). The TMF met every 2 weeks from August 2021- August 2022 to engage local TMs and disseminate up-to-date knowledge in real time. During forum sessions, TMs shared detailed accounts of their experiences combating vaccine hesitancy in their communities and supported one another in their efforts through positive interaction and reaffirming conversations. Collaborations between community stakeholders can form a scaffolding to support a rapid response to a variety of public health problems and result in impactful change. For researchers implementing community-based research projects, modeling stakeholder panels after trusted messenger forums can be effective for diversifying the scope of the project and reacting to emergent problems in real-time.

Knowledge and trust of mothers regarding childhood vaccination in Rwanda

“…In our study, 11.9% of respondents had information on vaccines and vaccinations from the social media; this was very low compared to the 22.07 – 49.5% reported elsewhere in Saudi Arabia and Palestine [ 15 , 65 ]. Our finding was also different from that of a study conducted in rural communities to enhance vaccine confidence, wherein trusted messengers had lots of challenges communicating the importance of COVID-19 vaccine importance to the population [ 17 ]. In our study, there was 91.4% trust in childhood vaccination which was very high when compared with the 45.9% and 49.2% COVID-19 vaccine confidence reported amongst Filipinos and Malaysians respectively [ 66 ].…”

“…Mother’s education, has been widely reported as an important determinant of knowledge in childhood vaccination in Ethiopia, Greece, Malaysia, and Palestine [ 15 , 18 , 61 , 71 ]. On the other hand, research studies in the rural communities of the United States of America, showed that the factors affecting vaccine acceptance and knowledge were mistrust and misinformation as well as constantly changing health guidelines [ 17 ]..…”

“…Additionally cited as a concern to pandemic preparedness is vaccine VH [ 22 , 23 ]. VH is the delay in acceptance or refusal of vaccines despite the availability of vaccination services [ 17 , 20 , 24 ]; consequently leading to poor vaccine coverage [ 25 ]. Many researchers have connected VH to differing perspectives, insufficient knowledge and trust about vaccinations, trust of the vaccines, trust of physicians and health provider’s advice [ 1 ], conveniences, cost of vaccines [ 26 ], and perceptions of the threats or advantages of vaccination [ 27 – 31 ].…”

Barriers and enablers to implementation of COVID‐19 vaccine programs in a rural and regional Queensland: A provider perspective

“…Community engagement was identified as an important enabler to COVID‐19 vaccination programs which mirrored other international studies 32–36 . Tjilos et al, 34 a qualitative study of community‐engaged conversations about COVID‐19 vaccinations in New England, USA, found that community leaders suggested utilising existing social networks and trusted community leaders to disseminate credible information.…”

“…Community engagement was identified as an important enabler to COVID-19 vaccination programs which mirrored other international studies. [32][33][34][35][36] Tjilos et al, 34 a qualitative study of community-engaged conversations about COVID-19 vaccinations in New England, USA, found that community leaders suggested utilising existing social networks and trusted community leaders to disseminate credible information. This is particularly important in rural areas where such engagement plays an important role in public health responses 23 and can be utilised to ensure that programs are targeted to specific community needs rather than using a 'one size fits all' approach that often excludes marginalised groups.…”