What is the role of primary care in the COVID-19 vaccine roll-out and the barriers and facilitators to an equitable vaccine roll-out? A rapid scoping review of nine jurisdictions

Abstract

ObjectivesThis study aimed to: (1) examine the experience of nine global jurisdictions that engaged primary care providers (PCPs) to administer COVID-19 vaccines during the pandemic; (2) describe how vaccine hesitancy and principles of equity were incorporated in the COVID-19 vaccine roll-out strategies and (3) identify the barriers and facilitators to the vaccine roll-out.DesignRapid scoping review.Data sourcesSearches took place in MEDLINE, CINAHL, Embase, the Cochrane Library, SCOPUS and PsycINFO, Google, and the websites of national health departments. Searches and analyses took place from May 2021 to July 2021.ResultsSixty-two documents met the inclusion criteria (35=grey literature; 56% and 27=peer reviewed; 44%). This review found that the vaccine distribution approach started at hospitals in almost all jurisdictions. In some jurisdictions, PCPs were engaged at the beginning, and the majority included PCPs over time. In many jurisdictions, equity was considered in the prioritisation policies for various marginalised communities. However, vaccine hesitancy was not explicitly considered in the design of vaccine distribution approaches. The barriers to the roll-out of vaccines included personal, organisational and contextual factors. The vaccine roll-out strategy was facilitated by establishing policies and processes for pandemic preparedness, well-established and coordinated information systems, primary care interventions, adequate supply of providers, education and training of providers, and effective communications strategy.ConclusionsEmpirical evidence is lacking on the impact of a primary care-led vaccine distribution approach on vaccine hesitancy, adoption and equity. Future vaccine distribution approaches need to be informed by further research evaluating vaccine distribution approaches and their impact on patient and population outcomes.

Strengthening access to and confidence in COVID-19 vaccines among equity-deserving populations across Canada: An exploratory qualitative study

“…This study examined the strategies used by the provincial authorities of six Canadian jurisdictions to expand COVID-19 vaccination uptake and confidence in populations recommended for vaccine prioritization by NACI (i.e., FNIM, Black communities, essential workers, people experiencing homelessness, and people with disabilities). While research into COVID-19 vaccine equity in Canada has gained great momentum (3, 33, 34), the scientific literature documenting the strategies and interventions for equity in COVID-19 vaccination and the factors influencing their implementation remains scarce, as indicated in a recent scoping review (35). Our work, therefore, makes an important contribution to this knowledge gap.…”

“…Furthermore, vaccine hesitancy was described as an intricate issue rooted in a lack of trust in the public health system and government authorities. (3,33,34), the scientific literature documenting the strategies and interventions for equity in COVID-19 vaccination and the factors influencing their implementation remains scarce, as indicated in a recent scoping review (35). Our work, therefore, makes an important contribution to this knowledge gap.…”

Evaluation of COVID-19 vaccine implementation in a large safety net health system

“…A key facilitator of implementation seen in some safety net health system studies is an emphasis on advance planning for implementation ( 5 , 6 ). However, health systems did not have the luxury of advance planning with COVID-19 vaccine implementation during the pandemic.…”

“…Implementation of safety net initiatives has been associated with challenges including limited staffing, lack of organizational financial investment, and the need to address patients' biopsychosocial complexities. Facilitators to implementation have included advance planning, redundancy in communication, knowledge of patient needs, desire to perform well, personnel commitment to reducing health inequities, and multidisciplinary teams to drive implementation (3)(4)(5)(6). More research is needed to understand the role of implementation factors in the safety net, particularly for primary care-led vaccine distribution approaches (7).…”