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From Hesitation to Vaccination: Reducing Vaccine Hesitancy by Removing Access Barriers in Dallas, TX

Jun 11, 2024

By Joy Henin and Myranda Baumgartner, Dallas County Health and Human Services

Dallas County is home to an economically and racially diverse population of approximately 2.6 million people. As the landscape of public health is continually evolving and our healthcare system faces unique challenges while grappling with post-COVID impacts, Dallas County Health and Human Services (DCHHS) is actively working to improve health outcomes by increasing health awareness and facilitating access to care through data-driven initiatives.

Recent data shows that vaccine hesitancy is becoming an issue of rising concern in Dallas County. Compared to last year, we saw decreased MMR vaccination rates among Dallas County school-aged children. Similarly, our Tdap vaccination compliance rates were lower than the Regional rates, with a notable decline from pre-COVID data. We also found that conscientious exemption utilization was becoming more prevalent, highlighting the impact of vaccine hesitancy and refusal among specific populations. This data was coupled with increased pertussis outbreaks among Dallas County school-aged children as the vaccination rates continue to decline.

DCHHS set out to identify vaccine hesitancy trends and barriers to compliance to most effectively adapt interventions based on the community’s needs. So, we conducted a two-tiered Rapid Community Assessment (RCA) to identify vaccine concerns, the perceived risk in the community, and barriers affecting compliance rates. We partnered with Dallas Independent School District (DISD) and Carrollton Farmer’s Branch Independent School District (CFBISD) to disseminate a 24-question survey to parents in the community and conduct listening sessions with school nurses. We wanted to understand the perceived risk among parents in addition to the school nurses’ perception of vaccine hesitancy and how to improve vaccine compliance and bolster immunity among their communities.

The listening sessions provided a forum for in-depth discussion that allowed for a deeper understanding of the nuances surrounding barriers to vaccination and vaccine hesitancy. Overwhelmingly, the most prominent theme was that nurses in DISD and CFBISD witnessed vaccine hesitancy in parents far less than they witnessed barriers to vaccination for parents. Within this theme of barriers outweighing hesitancy, nurses noted that complex vaccine records, challenging transportation barriers, and a lack of availability for vaccines and vaccine appointments heavily contributed to low vaccine rates in their schools. These findings are enlightening as they indicate that while there may have been vaccine hesitancy for the COVID-19 and flu shots, childhood vaccines were generally not vaccines parents were hesitant to get for their child. Instead, barriers to accessing these childhood vaccinations were far greater considerations for vaccine compliance.

Notable successes during the listening sessions were the clarifications in nuance between hesitancy and barriers, a clearer understanding of the impact COVID-19 had on childhood vaccination compliance, and a collaborative brainstorm for future best practices for how to improve vaccine compliance in schools.

With barriers emerging as the primary contributor to poor childhood vaccine uptake in DISD and CFBISD, a major lesson learned is that hesitancy and barriers are intricately woven into the fabric of daily life. They can build upon and exacerbate one another – when a parent finally is able to take some time off work to vaccinate their child and they are turned away from a free clinic because vaccines are out of stock, you have frustrated and defeated parents who now may feel more hesitant towards the health system as a whole. These are important lessons learned as it is critical for DCHHS to understand how barriers and hesitancy interact with one another to better provide care, education, and support to the communities we serve.


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