Beyond Influenza Vaccination: Expanding Infrastructure for Hospital-based Pediatric COVID-19 Vaccine Delivery

Abstract

Controlling the spread of COVID-19 will rely on increasing vaccination rates in an equitable manner. The main reasons for under-vaccination are varied among different segments of the population and include vaccine hesitancy and lack of access. While vaccine hesitancy is a complicated problem that requires long-term solutions, enhancing access can be achieved through evidenced-based delivery strategies that augment traditional approaches. Hospital-based COVID-19 vaccination programs hold particular promise for reaching populations with decreased vaccine access and those at higher risk for adverse outcomes from COVID-19 infection. Hospitals have the necessary equipment and storage capabilities to maintain cold chain requirements, a common challenge in the primary care setting, and can serve as a central distribution point for delivering vaccines to patients in diverse hospital locations, including inpatient units, emergency departments, urgent care centers, perioperative areas, and subspecialty clinics. They also have the capacity for mass vaccination programs and other targeted outreach efforts. Hospital-based vaccination programs can leverage existing infrastructure such as electronic health record tools that have been successful approaches for influenza and other routine vaccinations. With the possibility of COVID-19 becoming endemic, much like seasonal influenza, these programs will require flexibility as well as planning for long-term sustainability. The goal of this review is to highlight existing vaccine delivery to children in hospital-based settings, including key advantages and important challenges, and outline how these systems could be expanded to include COVID-19 vaccine delivery.

Vaccines Administration in the Perspective of Patient Safety and Quality of Healthcare: Lesson from the Experience of an Italian Teaching Hospital for Pandemic Preparedness

“…Our experience could be discussed and integrated with other similar ones in order to achieve an effective, efficient, and resilient model. It has been shown that a successful hospital immunisation programme should consider five key elements: a multidisciplinary team that holds regular meetings, the use of automated IT tools, the use of data collection, review and dissemination tools, education and communication programmes, and the involvement of hospital leadership and patients [52]. In addition, it could also be considered in the context of a public health macro-perspective.…”

Increasing COVID-19 Immunization Rates through a Vaccination Program for Hospitalized Children

“…Unlike inpatient influenza vaccination programs, additional system-based challenges specific to COVID-19 vaccination included limited shelf life, navigating state-managed supply and strategic conservation to avoid wasted doses, defining and raising awareness for eligible patients, and the necessity for subsequent doses after discharge. 8 Potential clinician-related factors contributing to low vaccination rates included clinician hesitancy based on available data, logistic barriers including competing priorities, time constraints, and the clinician perception that inpatient providers may lack the skills and longitudinal relationship with families to discuss vaccination, especially in vaccine-hesitant encounters. 11 Both system- and clinician-related factors were significantly exacerbated by ongoing staffing shortages related to the pandemic.…”

“…Prior studies evaluating the implementation of inpatient influenza vaccination programs in children's hospitals demonstrated several advantages of inpatient immunization. [8][9][10] These included reaching populations without outpatient medical homes, increased access for those with transportation or financial constraints, and vaccine delivery to populations at risk of adverse outcomes. Other advantages included access to an interprofessional care team to educate patients and families, opportunities for coordination with subspecialists, and access to a robust inpatient pharmacy network for vaccine storage and delivery.…”

“…Other advantages included access to an interprofessional care team to educate patients and families, opportunities for coordination with subspecialists, and access to a robust inpatient pharmacy network for vaccine storage and delivery. 8 Despite these advantages, it is imperative that inpatient vaccination programs effectively address previously identified barriers to vaccination in this setting, including accurately identifying and targeting eligible patients as well as empowering inpatient clinicians to address vaccine hesitancy. 11 The Food and Drug Administration granted emergency use authorization (EUA) for the Pfizer-BioNTech COVID-19 vaccination for individuals 16 and older in December 2020.…”

Influenza Vaccine Utilization: A Comparison between Urban and Rural Counties in Florida

“…Future studies that assess the utilization of the influenza vaccine after the launch of the ACA may help indicate the success of the new federal policies. Additionally, using and expanding the existing infrastructure and recently implemented policies during the COVID-19 pandemic can help to address the underutilization of influenza vaccines, especially in the underserved areas [ 15 , 16 ].…”