Using Data and Effective Messaging to Support Strong Vaccine Policy
July 06, 2023 | Heather Tomlinson
Over the past three years, state legislatures have considered at least 2,000 vaccine-related bills: 809 in 2021, 594 in 2022, and more than 690 this year. Some bills sought to expand access to routine vaccination through broadened scopes of practice, allowing minors to give consent, and strengthening Immunization Information Systems (IIS). There were also many proposals to prohibit vaccine requirements and loosen requirements for routine childhood immunization. While states largely dismissed weakening policies, legislatures are likely to continue considering vaccine-related bills, which may allow public health leaders to work collaboratively toward improving vaccination rates and further bolster the positive impact vaccines have on population health.
The pandemic response didn’t just unite many communities in distributing and administering the COVID-19 vaccine. It also provided an opportunity to consider new approaches to increasing access to routine vaccines, such as influenza. Recently enacted legislation in Virginia (HB 1511 and HB 2429) and West Virginia (HB 2754) expands the scope of practice for healthcare professionals including pharmacists, pharmacy technicians, midwives, and emergency medical technicians to administer recommended and approved vaccines. Increasing vaccinators in geographic areas can improve vaccine accessibility and boost community vaccination rates.
Additionally, HHS recently extended the Public Health and Emergency Preparedness (PREP) Act immunity from liability coverage through December 2024 for pharmacists, pharmacy interns, and pharmacy technicians to administer COVID-19 and influenza vaccines. This will likely prompt many state legislatures to consider extending the authorized role of pharmacists in administering vaccinations after this extension expires.
As jurisdictions emerge from the pandemic and return to a new normal, utilizing public opinion data, evidence-based policies, and adequately equipping trusted messengers is pivotal to maintaining and promoting strong vaccine policy.
Utilizing Evidence-Based Policy Options
One way that health agencies can support evidence-based immunization policy is to develop an agency policy agenda and prepare key messages that align with strategic goals. Several evidence-based policies are available to states, including maintaining an opt-out Immunization Information System (IIS). Opt-out IISs have more complete patient and vaccination data than in jurisdictions with an opt-in IIS system, resulting in providers having access to more accurate information to ensure that patients in their care receive the appropriate vaccines. Additionally, opt-in systems cost more to operate, with one study finding opt-in systems costing $1.3 million annually compared to $100,714 annually for opt-out systems.
Another evidence-based policy to support higher immunization rates in a community is to link school enrollment to routine childhood vaccinations. All 50 states and Washington, D.C. require children to receive certain vaccines to enroll in school, with all providing a medical exemption to the requirement and most allowing non-medical exemptions based on religious or personal beliefs. To determine which vaccines are required for school enrollment, public health agencies usually follow guidance from the Advisory Committee on Immunization Practices (ACIP), a group of medical and public health experts who develop recommendations for vaccine usage in the United States. Proposed legislation in Indiana (HB 1083) and Missouri (SB 232) would have shifted this responsibility from the state’s public health agency to the state legislature, members of whom may have limited expertise of vaccines or disease prevention. Those measures failed, indicating support of public health expertise in determining which vaccines are included in a jurisdiction’s routine childhood immunization schedule.
Public health leaders have an opportunity to build vaccine confidence among policymakers and communities throughout the year, providing information about evidence-based policies and answering questions about vaccines. The Association of Immunization Managers (AIM) developed a toolkit to build vaccine confidence in policymakers and communities. When providing information to legislators, agencies should ensure the information is relevant to their jurisdiction, highlights potential cost impacts, and is brief and digestible.
Understanding the Vaccine Opinion Landscape
Policymakers weigh many factors when considering legislation, including direct contact from their constituents and broader public opinion. Public health leaders engaging with policymakers can leverage public opinion data (e.g., from the Harvard Opinion Research Program (HORP)) to gain better understanding of public and provider perspectives on trust in public health response and institutions.
For instance, a Harvard study found that trust in public health agencies was stable from September 2019 to October 2022. In a review of public opinion data available from multiple organizations, HORP found that neither views of routine childhood vaccine safety nor trust in public health agencies on this issue declined from September 2019 to October 2022. Also, the vast majority of the public still support school vaccine requirements to protect the health of others and the latest CDC information shows that nationwide over 90% of kindergarteners received school entry vaccines.
It is crucial for health officials to understand public opinion and adapt public health policy actions accordingly. There are several policy actions that public health leaders can promote to maintain high immunization rates despite less public support for school-based vaccine requirements. Additionally, health departments can adapt messaging strategies to account for shifting perceptions.
For example, messaging about the importance of routine childhood vaccinations can remind parents of the individual benefits of these vaccines as well as the benefits of higher immunization rates in schools and encourage parents or guardians to have conversations with pediatricians and other health professionals who are generally well-trusted.
Equipping Trusted Messengers with Effective Messaging
Public health leaders can utilize value-based messaging—clear, short narratives to connect a person’s values to an issue—to steer the discussion to what public health contributes. Using plain, descriptive language ensures all audiences can understand your message. Berkeley Media Studies Group (BMSG) has developed several strategies and resources to champion public health amid legal and legislative threats. Public health leaders can highlight the impact of proposed legislation on their agency’s ability to keep their communities healthy and safe. Lastly, health departments can partner with trusted messengers to amplify their message, share real-life stories, and convey different voices of support or opposition.
Health officials should leverage evidence-based policy, public opinion data, and thoughtful messaging to develop a comprehensive approach to vaccine policy. Should ASTHO members need additional support as they work to address vaccine legislation, ASTHO can help with technical assistance, providing resources, and connecting state and territorial health agencies with subject matter experts. ASTHO will continue to monitor this important public health issue and provide updates as they become available.