Vaccination coverage is increasingly an obstacle around the world. From inequity to hesitation, we are working to get people vaccinated against COVID-19. The United States in particular has struggled with the COVID-19 vaccination despite strong major surges.
SNFs in particular are an extremely vulnerable space in which patients and employees have been significantly impacted by the COVID-19 pandemic. Sadly, SNF residents and staff account for 4% of COVID-19 cases and 31% of deaths in the United States in June 2021.
Despite the impressive effectiveness of these vaccines, it often remains difficult to increase vaccination rates. To increase these rates, a randomized clinical trial of 133 SNFs was performed. The research team included 7,496 residents and nearly 18,000 staff. In this trial, over 81% of residents and 53.7% of staff were vaccinated in this trial, which included a 3-month campaign to encourage vaccination.
The research team shared that through the Pharmaceutical Partnership Program (PPP), they were able to collect data on 4 healthcare systems in 16 states. The interventions were each identified at the facility level and included “(1) educational materials and electronic messages for staff; (2) town hall meetings with front-line staff (nurses, orderlies, dietitian, housekeeping); (3) messages from community leaders; (4) giveaways (eg, t-shirts) with socially-concerned messages; (5) use of a specialist to facilitate consent with resident proxies; and (6) funds for additional staff/resident COVID-19 testing.
The goal, of course, of the study was to increase vaccination rates, but the research team referred to the study results as a proportion of residents and staff who received the vaccine, which means a binary result. A detailed breakdown of resident and facility staff noted that “most facilities were for-profit (95; 71.4%) and 1,973 (26.3%) of residents were black. Among residents, 82.5% (95% CI, 81.2% to 83.7%) were vaccinated in the intervention arm compared to 79.8% (95% CI, 78.5% to 81.0%) in the usual care arm (marginal difference 0.8%; 95% CI, -1.9% to 3.7%). Among staff, 49.5% (95% CI, 48.4% to 50.6%) were vaccinated in the intervention group, compared with 47.9% (95% CI, 46.9% to 48.9%) in the usual care group (marginal difference: -0.4%; 95% CI, -4.2% to 3.1%). There was no association of race with the outcome among residents.
Although this vaccination campaign did not quite have the desired result that the research team would have liked, fortunately vaccination rates were high among SNF residents. Vaccination rates among healthcare workers, however, remain a significant challenge. It was reported that just prior to this study (December 2021 to March 2021), approximately 1/3 of healthcare workers in the United States were fully vaccinated. This is deeply concerning and a likely indication of why many hospitals have chosen to mandate vaccines for their healthcare workers. Ultimately, however, we can learn a lot from this study – what works, what doesn’t, and the important work of addressing vaccine hesitancy among healthcare workers, in which we need to invest resources. Easily among the most exposed and vulnerable populations, healthcare workers need to be protected against vaccine-preventable diseases, which in part involves tackling hesitancy and access.