INTRODUCTION

The COVID-19 pandemic has disproportionately affected rural communities in the United States, leading to significantly higher infection and mortality rates than their urban counterparts. Extensive research has consistently highlighted the stark contrast in COVID-19 prevalence and fatalities between rural and urban areas 1 . Adding to this inequality is a significant disparity in vaccination coverage, with rural areas lagging in vaccination rates, irrespective of age and gender. In Missouri, where 99 out of 115 counties are classified as rural, the impact of COVID-19 has been particularly pronounced. In mid-2020, rural counties started witnessing a steady surge in positive COVID-19 cases, surpassing the number of cases reported in urban counties. Throughout 2020, rural areas consistently exhibited higher 7-day positivity rates compared to urban areas. By the end of the year, rural counties reached a peak 7-day positivity rate of 25.8%, while urban counties peaked at 20.6% 2a.

The statewide data from 2020 shows the average 7-day positivity rate was 11.6%. Further examination revealed that rural counties had an average of 13.3%, slightly higher than the 11.0% average observed in urban counties 2b. These findings underscore the disparities in COVID-19 positivity rates between rural and urban areas, necessitating targeted interventions and strategies to address the impact of the virus on different communities.

As we continue to navigate the pandemic, it is crucial to revamp mitigation strategies to effectively combat the spread of COVID-19 in rural communities, particularly in Missouri.  Tailored interventions that prioritize COVID-19 mitigation efforts in rural counties must be prioritized. To achieve this, it is essential to identify the barriers and opportunities for improvement in COVID-19 vaccination. By understanding the unique challenges rural communities face, we can implement targeted measures to bridge the vaccination gap and protect vulnerable populations.

Addressing the impact of COVID-19 in rural America requires a concerted effort from healthcare providers, policymakers, and community leaders. By adopting a comprehensive approach that considers the specific needs and circumstances of rural communities, we can ensure equitable access to vaccination and mitigate the impact of the virus. Only by working together can we effectively safeguard the health and well-being of all our citizens, regardless of their geographic location.

To better understand ways to promote COVID-19 vaccination services, it is important to understand that prominent concerns around vaccine uptake, hesitancy, and barriers exists3,4. These multi-layered concerns should be addressed at various levels, through programming and improved COVID-19 communication strategies to promote COVID-19 vaccination. It is essential to understand where there is overlap in these concerns and where there are standalone barriers to prioritize interventions that will address them. To achieve this goal, the Missouri Immunization Coalition has leveraged findings from a December 2022 online survey of healthcare organizations to understand better prioritization of COVID-19 messaging, target audiences, and key communication campaign strategies to deploy to improve COVID-19 vaccination rates as part of continued efforts to update MIC’s COVID-19 vaccine promotion campaigns to serve Missouri communities best.

The survey looked at the following indicators:

  1. Funding size of the respondents’ organization.
  2. Ideal target audience for COVID-19 vaccine promotion messaging.
  3. Primary motivations for choosing COVID-19 vaccination.
  4. Priority messages to promote COVID-19 vaccination.
  5. Primary barriers to vaccine access.

RESULTS

  • 23.1% of the organizations had a funding size between $1 million to $3 million, and 20% indicated that their organization’s funding size was less than $1 million.
  • 81.6 % indicated that their ideal target audience for COVID-19 vaccination is 55-year-olds and above. 76.3% indicated that 25–54-year-olds were their preferred target audience.
  • 91.4% of the respondents agreed that their clients are motivated to get the COVID-19 vaccine to protect themselves and their loved ones. In comparison, 80% of the respondents agreed that their clients are motivated to get the COVID-19 vaccine due to the healthcare provider’s recommendation.
  • 41% and 24%, respectively, of respondents expressed that their top priority regarding COVID-19 vaccination promotion messages in their community is addressing vaccine hesitancy and facilitating first-time vaccination for adults.
  • The data revealed that both myths and misconceptions surrounding the vaccine, as well as the attitudes and beliefs about the COVID-19 virus posed substantial barriers to vaccination. One barrier specifically mentioned was the vaccine distribution strategy in their community discouraged vaccine uptake due to the initial prioritization of large-scale National Guard clinics over local vaccination plans. While this response falls beyond the scope of the current report, it underscores the importance of prioritizing policies and programming that ensure adherence to local vaccination plans during public health emergencies.

These findings provide valuable information that can guide efforts to promote COVID-19 vaccination and ensure successful vaccination programs.

 RECOMMENDATIONS

Based on our survey findings, it is evident that funding size, target audience preferences, motivations for vaccinations, priority messages, and identifying/addressing barriers all play a significant role in organizations’ approach to COVID-19 vaccination efforts. To leverage these insights and maximize the impact of vaccination campaigns, the following recommendations are proposed:

  1. Funding Allocation: Increased funding for organizations with funding sizes between $1 million to $3 million should be considered. This will enable organizations to allocate a portion of their resources toward COVID-19 vaccination initiatives. In addition, this will enable organizations to expand outreach efforts, enhance communication strategies, and support targeted interventions aimed at reaching their preferred target audiences.

 

  1. Support for Smaller Organizations: Recognizing that 20% of organizations that responded have funding sizes below $1 million, it is crucial to provide additional support and resources to these organizations. This goal can be achieved through collaborations with larger organizations, partnerships with local health departments, or securing funding from external sources, like state and federal funding. The collective impact of vaccination efforts can be strengthened by bolstering the capacity of smaller organizations.

 

  1. Intentional Messaging: COVID-19 communication strategies should prioritize messaging that addresses vaccine hesitancy and promotes first-time COVID-19 vaccination for adults. Survey respondents identified these as top-priority messages they would like access to. This strategy, if adopted, can effectively help address vaccine hesitancy and encourage vaccination uptake by tailoring messaging to address specific concerns and doubts surrounding vaccines.

 

  1. Age-specific Messaging: Communication strategies should stratify messaging based on age groups to increase vaccination rates. Survey respondents indicated that COVID-19 vaccine promotion messaging should primarily target the age group of 55 and above (81.6%), followed by the age group of 25–54-year-olds (76.3%). However, messaging should not neglect other age groups, and efforts should be made to reach all demographics with appropriate and relevant information. Given that most organizations identified 55-year-olds and above as their ideal target audience, it is recommended to prioritize messaging that specifically addresses the concerns, benefits, and accessibility of COVID-19 vaccination for this age group. Simultaneously, organizations should also allocate resources towards targeting the 25–54-year-old population to ensure comprehensive coverage across different age demographics. Tailoring messaging to the specific needs and motivations of each group will help increase vaccine acceptance and uptake.

 

  1. Highlighting Key Vaccination Motivators: Communication strategies should emphasize the key motivators behind individuals choosing to receive a COVID-19 vaccination or booster. Survey findings indicate that strategies and messaging focusing on people’s desire to protect themselves and their loved ones, as well as recognizing strong provider recommendations can effectively motivate vaccine uptake.

 

  1. Addressing Barriers: Barriers to accessing COVID-19 vaccines must not be overlooked. The survey identified myths and misconceptions about the COVID-19 vaccine, as well as attitudes and beliefs about the virus as the top barriers to vaccination. It is essential to identify and implement strategies and programming to address these barriers, along with other identified obstacles in conjunction with communication campaigns. Engaging frontline stakeholders, such as Local Public Health Agencies (LPHAs) and Federally Qualified Health Centers (FQHCs), is crucial in developing effective strategies to overcome these barriers and gain stakeholder buy-in. By prioritizing these identified opportunities for intervention, communication campaigns can effectively address vaccine hesitancy, tailor messaging to different age groups, highlight key motivators, and mitigate barriers to vaccination. This comprehensive approach will contribute to increasing COVID-19 vaccination rates, improving vaccine confidence, and fostering community engagement in Missouri and beyond. Moving forward, it is crucial to address the myths, misconceptions, and attitudes surrounding COVID-19 vaccines to foster greater acceptance and uptake. Doing so can enhance the effectiveness of vaccination campaigns and maximize the public health impact. Additionally, efforts should be made to review and refine vaccine distribution strategies, emphasizing local plans to ensure equitable access and community engagement during times of crisis.

 

  1. Collaboration and Knowledge Sharing: Organizations should actively engage in knowledge sharing and collaboration within their networks to exchange best practices, successful strategies, and lessons learned. This approach can be facilitated through virtual forums, webinars, or conferences. By leveraging collective expertise and experiences, organizations can refine their approaches and improve the effectiveness of their COVID-19 vaccination campaigns.

 

  1. Continuous Monitoring and Evaluation: Establishing mechanisms for ongoing monitoring and evaluation of vaccination efforts is crucial. This will allow organizations to assess the impact of their strategies, identify areas for improvement, and make data-driven adjustments. Regular data collection and analysis will enable organizations to adapt their approaches based on emerging trends and changing community needs.

 

By implementing these recommendations, organizations can optimize resources, target priority populations effectively, and enhance their COVID-19 vaccination promotion efforts. Collaboration, tailored messaging, and a focus on continuous improvement will contribute to increased vaccine acceptance and ultimately help control the spread of the virus in communities.[1]

 

  1. Murthy, B. P., Sterrett, N., Weller, D., Zell, E., Reynolds, L., Toblin, R. L., Murthy, N., Kriss, J., Rose, C., Cadwell, B., Wang, A., Ritchey, M. D., Gibbs-Scharf, L., Qualters, J. R., Shaw, L., Brookmeyer, K. A., Clayton, H., Eke, P., Adams, L., Zajac, J., … Harris, L. Q. (2021). Disparities in COVID-19 Vaccination Coverage Between Urban and Rural Counties – United States, December 14, 2020-April 10, 2021. MMWR. Morbidity and mortality weekly report, 70(20), 759–764. https://doi.org/10.15585/mmwr.mm7020e3
  2. a, b Missouri Department of Health and Senior Services: Office of Rural Health and Primary Care. health.mo.gov/living/families/rural health/publications.php[1]
  1. Robinson, R., Nguyen, E., Wright, M. et al. Factors contributing to vaccine hesitancy and reduced vaccine confidence in rural underserved populations. Humanity Soc Sci Communication 9, 416 (2022). https://doi.org/10.1057/s41599-022-01439-3
  2. Majee, W., Anakwe, A., Onyeaka, K., & Harvey, I. S. (2023). The Past Is So Present: Understanding COVID-19 Vaccine Hesitancy Among African American Adults Using Qualitative Data. Journal of racial and ethnic health disparities, 10(1), 462–474. https://doi.org/10.1007/s40615-022-01236-3