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In December 2020, 11 months after identifying the first laboratory-confirmed case of COVID-19 in the United States, the U.S. Food and Drug Administration authorized emergency use of two COVID-19 vaccines. To prepare the public for a large-scale vaccination campaign and build confidence in COVID-19 vaccines, the U.S. Centers for Disease Control and Prevention (CDC) funded more than 200 partners and developed a national Vaccinate with Confidence (VwC) COVID-19 framework to support Americans in their decision to get vaccinated. The evolving nature of the pandemic and highly variable confidence in vaccines across populations has resulted in many unique complexities and challenges to reaching universally high vaccination coverage. Here, we describe how 23 professional health associations and national partner organizations, focused solely on building vaccine confidence, operationalized CDC's VwC COVID-19 framework from February 2021 to March 2022. Capturing how partners deployed and adapted their activities to meet a shifting pandemic landscape, which began with high demand for vaccines that waned over time, is an important first step to understanding how this new strategy was utilized and could be implemented for future surges in COVID-19 cases and other routine immunization efforts. Going forward, evaluation of partner activities should be prioritized to capture learnings and assess VwC program effectiveness. [ABSTRACT FROM AUTHOR]

COVID-19 vaccines mitigate severe disease, yet uptake remains low among people experiencing homelessness (PEH) despite the risk of transmission in congregate settings like homeless shelters. This study evaluated retrospective COVID-19 vaccination intent and decision-making between March 2020-October 2021 to identify modifiable factors to improve vaccine acceptance among PEH. We conducted 31 semi-structured interviews and eight focus group discussions across six homeless shelters in Seattle-King County, Washington. Residents and staff aged ≥18 years were recruited through purposive sampling for interviews and convenience sampling for focus groups. Thematic analysis was conducted. Participants reported that too much contradictory and changing information about COVID-19 vaccines led to confusion. Information deemed trustworthy contributed to individual's knowledge and in some cases changed their vaccination intent. While many intended to get vaccinated without external motivators, others were motivated by incentives and requirements. Despite intention to vaccinate, participants reported barriers to COVID-19 vaccine access including availability of vaccine doses, timely eligibility for vaccination, and availability of appointments. Participants presented recommendations to improve COVID-19 information content and dissemination, access, and use of incentives in shelter settings. Future research should test recommended vaccination strategies rooted in the voices and experiences of PEH to determine feasibility and effectiveness in shelter settings. [ABSTRACT FROM AUTHOR]

Injury and violence prevention strategies have greater potential for impact when they are based on scientific evidence. Systematic reviews of the scientific evidence can contribute key information about which policies and programs might have the greatest impact when implemented. However, systematic reviews have limitations, such as lack of implementation guidance and contextual information, that can limit the application of knowledge. “Technical packages,” developed by knowledge brokers such as the federal government, nonprofit agencies, and academic institutions, have the potential to be an efficient mechanism for making information from systematic reviews actionable. Technical packages provide information about specific evidence-based prevention strategies, along with the estimated costs and impacts, and include accompanying implementation and evaluation guidance to facilitate adoption, implementation, and performance measurement. We describe how systematic reviews can inform the development of technical packages for practitioners, provide examples of technical packages in injury and violence prevention, and explain how enhancing review methods and reporting could facilitate the use and applicability of scientific evidence. [ABSTRACT FROM AUTHOR]

Purpose: The study purpose was to learn and describe 1) where homeless shelter residents receive health care, 2) what contributes to positive or negative health care experiences among shelter residents, and 3) shelter resident perceptions toward health care., Methods: Semi-structured interviews (SSIs) utilizing purposive sampling and focus group discussions (FGDs) utilizing convenience sampling were conducted at 6 homeless shelters in Seattle-King County, Washington, during July-October 2021. All residents (age ≥18) were eligible to participate. SSIs were conducted with 25 residents, and 8 FGDs were held. Thematic analysis was conducted using Dedoose., Results: Participants received health care in settings ranging from no regular care to primary care providers. Four elements emerged as contributing positively and negatively to health care experiences: 1) ability to access health care financially, physically, and technologically; 2) clarity of communication from providers and staff about appointment logistics, diagnoses, and treatment options; 3) ease of securing timely follow-up services; and 4) respect versus stigma and discrimination from providers and staff. Participants who felt positively toward health care found low- or no-cost care to be widely available and encouraged others to seek care. However, some participants described health care in the United States as greedy, classist, discriminatory, and untrustworthy. Participants reported delaying care and self-medicating in anticipation of discrimination., Conclusions: Findings demonstrate that while people experiencing homelessness can have positive experiences with health care, many have faced negative interactions with health systems. Improving the patient experience for those experiencing homelessness can increase engagement and improve health outcomes., Competing Interests: Conflicts of Interest Dr. Chu reports consulting with Ellume, Abbvie, Pfizer, and The Bill and Melinda Gates Foundation. She has received research funding from Gates Ventures and Sanofi Pasteur and support and reagents from Ellume and Cepheid outside the submitted work. There are no other conflicts of interest to report., (© 2023 Advocate Aurora Health, Inc.)

Vaccination is critical to controlling the COVID-19 pandemic, and health care providers play an important role in achieving high vaccination coverage (1). To examine the prevalence of report of a provider recommendation for COVID-19 vaccination and its association with COVID-19 vaccination coverage and attitudes, CDC analyzed data among adults aged ≥18 years from the National Immunization Survey-Adult COVID Module (NIS-ACM), a nationally representative cellular telephone survey. Prevalence of report of a provider recommendation for COVID-19 vaccination among adults increased from 34.6%, during April 22-May 29, to 40.5%, during August 29-September 25, 2021. Adults who reported a provider recommendation for COVID-19 vaccination were more likely to have received ≥1 dose of a COVID-19 vaccine (77.6%) than were those who did not receive a recommendation (61.9%) (adjusted prevalence ratio [aPR] = 1.12). Report of a provider recommendation was associated with concern about COVID-19 (aPR = 1.31), belief that COVID-19 vaccines are important to protect oneself (aPR = 1.15), belief that COVID-19 vaccination was very or completely safe (aPR = 1.17), and perception that many or all of their family and friends had received COVID-19 vaccination (aPR = 1.19). Empowering health care providers to recommend vaccination to their patients could help reinforce confidence in, and increase coverage with, COVID-19 vaccines, particularly among groups known to have lower COVID-19 vaccination coverage, including younger adults, racial/ethnic minorities, and rural residents., Competing Interests: All authors have completed and submitted the International Committee of Medical Journal Editors form for disclosure of potential conflicts of interest. Noel T. Brewer reports consulting fees from Merck and Novartis. No other potential conflicts of interest were disclosed.