In early 2023, the National Association of County and City Health Officials (NACCHO) surveyed local health department (LHD) immunization programs on their activities, challenges, and priorities during 2022. The survey was fielded to a stratified random sample of 1,018 LHDs. This survey provided new insights on many aspects of LHD immunization programs in the post-COVID world.

LHDs were asked about the challenges they experienced in 2022. Over 80% of LHDs reported experiencing challenges with patient/parent vaccine hesitancy. Additionally, over 30% reported vaccine hesitancy among healthcare providers. These both increased compared to a similar survey NACCHO conducted in 2017, prior to the pandemic. In this survey, 56% of LHDs reported vaccine hesitancy among patients/parents and 20% reported vaccine hesitancy in healthcare providers.

LHDs were also asked about their top three priorities for the next three years. Unsurprisingly, around 40% of LHDs said that addressing vaccine hesitancy for both routine youth and childhood vaccines were their top priorities. Other top priorities include conducting outreach and education with community partners, establishing partnerships with under-vaccinated populations, and securing additional funding.

Over the past four years, NACCHO, in partnership with CDC, has funded selected LHDs to participate in the Equipping Local Health Departments to Address Vaccine Hesitancy project. Through this opportunity, LHDs were provided funding to work with an identified vaccine hesitant population, conduct CDC’s Rapid Community Assessment (RCA), and develop a workplan and tools to address the concerns and barriers expressed by this community. Through the projects, LHDs partnered with various community organizations within the identified populations and brought them into the research process. LHDs focused on a variety of populations and vaccines – from parents to high school students and COVID to routine vaccines – the RCA process and project was flexible enough to accommodate whichever population the LHD needed to focus on. Each of the participating LHDs provided more information on their project and the tools they developed. This year’s stories include:

From Hesitation to Vaccination: Reducing Vaccine Hesitancy by Removing Access Barriers in Dallas, TX: Dallas County worked with two of their school districts that had low MMR and Tdap vaccination rates to assess their hesitancy toward routine childhood vaccines. They conducted a survey with parents and listening sessions with school nurses to identify barriers to vaccine uptake. They then created PSAs in both English and Spanish informing parents of the importance of back-to-school vaccines.

Fighting the Rising Tides of Vaccine Hesitancy Among Students: Perspectives on how to return to normal immunization levels post-pandemic: Wyandotte County, KS also conducted their RCA with their school districts through a parent survey and a school nurse listening session. They learned that the community doesn’t understand herd immunity and the importance of keeping the vaccination rates high to protect everyone. The health department is holding back to school immunization clinics and developing a communications toolkit addressing the reasons for hesitancy identified through their RCA.

Engaging Youth in the Survey Process: A Unique Approach to Addressing Vaccine Hesitancy in Rural Appalachia: Martin County, KY worked with some of their high school students to develop and field a survey to understand vaccine hesitancy among their peers. The barriers identified led them to organizing educational events and pop-up clinics. They also developed a social media toolkit for the health department and partners to use when posting about vaccines.

Stories from LHDs that participated in the past as well as the tools they all developed can be viewed on NACCHO’s Addressing Confidence, Hesitancy, and Uptake webpage under the Local Health Department Developed Resources heading.

LHDs interested in conducting an RCA to better understand vaccine hesitancy in their community can view the guide and addendums for specific populations on CDC’s website. Those with questions on how other LHDs have conducted these assessments can reach out to NACCHO’s Immunization Team at [email protected].