Low Vaccination Rates Research Articles

The COVID-19 Vaccination Problem and Its Solutions in the United States

With COVID-19 coming to an end, the challenges faced in its epidemic prevention process will undoubtedly play an exemplary role in the large-scale public health crisis that may be faced in the future. Among them, the promotion of vaccination is the first to bear the brunt. As one of the most effective means to curb the spread of the COVID-19 epidemic, the complete vaccination rate is not satisfactory in some countries, such as the United States. This is because, as a complex issue, the reasons for its emergence involve conflicts and trust between government credibility, race, culture, and religion. This article provides a detailed analysis of the reasons for the low complete vaccination rate in the United States and corresponding solutions. At the same time, it is expected that when other countries encounter similar government credibility crises or large-scale public health crises in the future, the example of the United States can be used as an effective reference.

The Ukrainian war and the pandemic: the impact on public health and the need for new health digital tools and the next level of intelligence

Against the background of the war in Ukraine, the COVID-19 pandemic has waned from public consciousness as the threat of the virus to health is outweighed by safety concerns during the war. Pandemic restrictions in the European region are being lifted despite low vaccination rates in Central and Eastern European countries and a lack of effective containment strategies. However, Central and Eastern European countries are influenced most by the flow of refugees from neighboring Ukraine where a triple health crisis occurs: an overloaded health system, an ongoing COVID-19 pandemic, and the war. The aim: to review the progress regarding viral surveillance technologies that use genomics, digital, and informational tools, to find the gap in the literature and formulate policy recommendations for continuing surveillance in the context of permacrisis. Unstructured search was conducted through scientific (PubMed and Google Scholar databases) and grey literature using the keywords. The paper highlights aspects of war-related problems of infectious diseases control in Europe, new challenges in healthcare connected with COVID-19 pandemic and war in Ukraine and provides discussion on the role of innovative surveillance systems in tackling infection outbreaks (with COVID-19 pandemic as an example). The paper overviews perspectives of the implementation of the discussed measures. Future COVID-19 outbreaks and new variants are possible. Complex adaptive system models, new tools, and the next level of health and digital intelligence are needed to provide timely and valuable insights. Combining lessons learned from the COVID-19 pandemic, the threat of war, and the need for continuous outbreaks surveillance, new public health and digital intelligence tools must be designed and implemented at regional, European, and global levels.

Evaluating Influenza Vaccination Practices among COPD Patients.

Chronic Obstructive Pulmonary Disease (COPD) stands as a global health concern linked to considerable morbidity and mortality. In Jordan, the prevalence of COPD is substantial, but research in this area is limited. Exacerbations of COPD can lead to severe outcomes, including hospitalization and increased cardiovascular risk. Influenza is a significant trigger of exacerbations in COPD patients, and vaccination is recommended. However, studies have shown negative attitudes towards the influenza vaccine. This cross-sectional study aimed to investigate the knowledge, attitudes, practices, and intentions of COPD patients in Jordan regarding influenza vaccination. Data were collected through a custom-designed questionnaire from 300 COPD patients. The study revealed low influenza vaccination rates, with forgetfulness and lack of knowledge about vaccine effectiveness being the main barriers. Higher knowledge and positive attitudes were associated with greater intention to vaccinate. To tackle these challenges, it is recommended to implement customized health education campaigns, foster collaborations with healthcare providers, and engage in community-focused initiatives to enhance acceptance of the influenza vaccine among COPD patients in Jordan. These findings underscore the importance of addressing knowledge gaps and negative attitudes to enhance vaccine uptake and improve health outcomes for COPD patients.

DEMOGRAPHIC VARIATION IN BARRIERS TO VACCINATION AMONG OLDER ADULTS: LINKS TO VACCINATION BEHAVIORS

Abstract As older adults face increased infectious disease risks, understanding barriers to vaccination is vital. The current study examines associations between vaccination barriers, demographics, and vaccination behaviors among older adults (65+) in North Dakota, a rural state with low vaccination rates. A mailed survey, including closed- and open-ended questions regarding vaccine beliefs and behaviors was conducted with 901 older adults. Potential vaccine barriers (Disliking shots, Concerns about cost, Lacking doctor recommendation, Lacking transportation, and Uncertainty how to schedule) were rated on a four-point Likert-type scale (1=Strongly Disagree; 4=Strongly Agree). Vaccine behaviors were assessed with measures of uptake for influenza, shingles, pneumonia, and SARS-CoV-2 immunizations. While endorsement of perceived barriers was relatively low, the greatest perceived barriers were cost and disliking shots. Regarding demographic variation: lower income was associated with cost concerns, lower education and rurality were associated with lacking doctor recommendation, and lower education was associated with uncertainty how to schedule. Disliking shots was significantly associated with uptake for shingles and pneumonia. Cost concerns was associated with lower shingles uptake, whereas lacking doctor recommendation was associated with lower uptake for pneumonia and SARS-CoV-2 booster. No barriers were associated with influenza or SARS-CoV-2 initial immunization uptake. While perceived vaccination barriers were low, certain populations of older adults are more at-risk of experiencing barriers, suggesting intervention opportunities. Moreover, the relevance of barrier type varied by disease, suggesting the need for disease-specific interventions. These findings suggest that practitioners should consider the diverse factors influencing barriers to older adults’ vaccination receipt.

COVID-19 Vaccine Communications on Instagram and Vaccine Uptake in Young Adults: A Content Assessment and Public Engagement Analysis

In Canada, during the pandemic, young adults (18–29 year-olds) represented one of the least-vaccinated age groups against COVID-19. These low vaccination rates, and high infection rates, left young people vulnerable to severe infections and created a risk for transmission to immunocompromised populations. Given young adults’ unique characteristics, to encourage vaccination among this demographic, public health and government officials must adopt an audience-centred approach to communication. We sought to understand if the vaccine messages from 8 Canadian federal government Instagram accounts met the needs of young adults based two frameworks: Guiding Principles for Crisis Communication (compassion and empathy, conversational tone, transparency, clarity, call to action and correction of misinformation), and the 5C Model for Vaccine Hesitancy (confidence, complacency, constraints, collective responsibility, and risk calculation). Across 159 posts that mentioned COVID-19 vaccines, there was limited incorporation of best practices, suggesting the government’s communication strategy did not meet the needs of young people.

Epidemiology of COVID-19 in Infants in the United States: Incidence, Severity, Fatality, and Variants of Concern.

The clinical spectrum of infant COVID-19 ranges from asymptomatic infection to life-threatening illness, yet epidemiologic surveillance has been limited for infants. Using COVID-19 case data (restricted to reporting states) and national mortality data, we calculated incidence, hospitalization, mortality and case fatality rates through March 2022. Reported incidence of COVID-19 was 64.1 new cases per 1000 infant years (95% CI: 63.3-64.9). We estimated that 594,012 infants tested positive for COVID-19 nationwide by March 31, 2022. Viral variant comparisons revealed that incidence was 7× higher during the Omicron (January-March 2022) versus the pre-Delta period (June 2020-May 2021). The cumulative case hospitalization rate was 4.1% (95% CI: 4.0%-4.3%). For every 74 hospitalized infants, one infant death occurred, but overall COVID-19-related infant case fatality was low, with 7.0 deaths per 10,000 cases (95% CI: 5.6-8.7). Nationwide, 333 COVID-19 infant deaths were reported. Only 13 infant deaths (3.9%) were the result of usually lethal congenital anomalies. The majority of infant decedents were non-White (28.2% Black, 26.1% Hispanic, 8.1% Asian, Indigenous or multiracial). More than half a million US infants contracted COVID-19 by March 2022. Longitudinal assessment of long-term infant SARS-CoV-2 infection sequelae remains a critical research gap. Extremely low infant vaccination rates (<5%), waning adult immunity and continued viral exposure risks suggest that infant COVID-19 will remain a persistent public health problem. Our study underscores the need to increase vaccination rates for mothers and infants, decrease viral exposure risks and improve health equity.

Impact of COVID-19 on HPV Vaccination Rates in New York City and Long Island.

In the United States, uptake of human papillomavirus (HPV) vaccination has been exceptionally low as compared with other vaccines. During the coronavirus disease (COVID-19) pandemic, routine vaccinations were deferred or delayed, further exacerbating HPV vaccine hesitancy. The specific effect of the pandemic on HPV vaccination rates in the United States has not been yet described. We aimed to determine the percentage of children achieving full HPV vaccination (2 doses) by age 15 years and to compare prepandemic to pandemic rates of HPV vaccination at pediatric practices across our institution. A retrospective chart review was performed to compare HPV vaccination rates in the "prepandemic" and "pandemic" periods for all children 9 through 14 years of age. Additionally, peaks in COVID-19 positivity were compared with HPV vaccination rates. Of children aged 9-14 years, 49.3% received at least 1 dose of HPV vaccine in the prepandemic period, compared with 33.5% during the pandemic (P < 0.0001). Only 33.5% of patients received the full 2-dose series of HPV prepandemic, compared with 19.0% of patients during the pandemic (P < 0.0001). When COVID-19 positivity rates peaked, HPV vaccination also declined. The issue of low HPV vaccination rates was amplified due to the COVID-19 pandemic, as illustrated by the correlation between peaks in COVID-19 positivity and low rates of HPV vaccination.

Hepatitis B in Healthcare Personnel: An Update on the Global Landscape.

Despite the outstanding progress that has been made in the prevention, detection, and management of hepatitis B during the past decades, hepatitis B remains a problem among healthcare personnel (HCP) in many countries. We reviewed studies on all aspects of hepatitis B in HCP published from 2017 through April 2023. They revealed wide variations on the prevalence of infection among HCP, ranging from 0.6% in Europe to >8.7% in Africa, almost always in association with very low vaccination rates. Many studies found a significant association between HCP's knowledge about hepatitis B and hepatitis B vaccines, their vaccination status, and practices. This research also discloses global inequities regarding vaccination policies against hepatitis B, free-of-charge vaccinations, and access to post-exposure prophylaxis (PEP). Strategies to prevent and manage accidental exposures are needed in order to reduce the burden of hepatitis B on HCP, while written policies for all aspects of infection prevention, protective equipment, and PEP should be available. Lastly, HCP should be accordingly educated. These are all imperative given the decline of routine vaccinations in the COVID-19 era, particularly in countries with fragile vaccination programs, and the disruptions of interventions for hepatitis B that are expected to provide a pool of virus transmission to future generations.

Spatiotemporal variability in socioeconomic inequalities in COVID-19 vaccination in Catalonia, Spain

ObjectivesSocioeconomic inequalities have played a significant role in the unequal coverage of the COVID-19 vaccine. The objectives of this study were to (1) assess the socioeconomic inequalities in COVID-19 vaccination coverage in Catalonia, Spain; (2) analyse the spatial variation over time of these inequalities; and (3) assess variations in time and space in the effect of vaccination on inequalities in COVID-19 outcomes. Study designA mixed longitudinal ecological study design was used. MethodsCatalonia is divided in to 373 Basic Health Areas. Weekly data from these Basic Health Areas were obtained from the last week of December 2020 until the first week of March of 2022. A joint spatio-temporal model was used with the dependent variables of vaccination and COVID-19 outcomes, which were estimated using a Bayesian approach. The study controlled for observed confounders, unobserved heterogeneity, and spatial and temporal dependencies. The study allowed the effect of the explanatory variables on the dependent variables to vary in space and in time. ResultsAreas with lower socioeconomic level were those with the lowest vaccination rates and the highest risk of COVID-19 outcomes.In general, individuals in areas that were located in the upper two quartiles of average net income per person and in the lower two quartiles of unemployment rate (i.e., the least economically disadvantaged) had a higher propensity to be vaccinated than those in the most economically disadvantaged areas. In the same sense, the greater the percentage of the population aged ≥65 years, the higher the propensity to be vaccinated, while areas located in the two upper quartiles of population density and areas with a high percentage of poor housing had a lower propensity to be vaccinated.Higher vaccination rates reduced the risk of COVID-19 outcomes, while COVID-19 outcomes did not influence the propensity to be vaccinated. The effects of the explanatory variables were not the same in all areas or between the different waves of the pandemic, and clusters of excess risk of low vaccination in the most disadvantaged areas were detected. ConclusionsCOVID-19 vaccination inequalities in the most disadvantaged areas could be a result of structural barriers, such as the lack of access to information about the vaccination process, and/or logistical challenges, such as the lack of transportation, limited Internet access or difficulty in scheduling appointments. Public health strategies should be developed to mitigate these barriers and reduce vaccination inequalities.

Do Not Leave Your Patients in the Dark-Using American College of Rheumatology and European Alliance of Associations for Rheumatology Recommendations for Vaccination in Polish Adult Patients with Autoimmune Inflammatory Rheumatic Diseases.

(1) Introduction: Patients with autoimmune inflammatory rheumatic diseases (AIIRD) face a higher infectious risk compared to the general population. As per the ACR and EULAR recommendations, vaccinations against influenza, COVID-19, pneumococci, and tetanus are recommended for most patients with AIIRD. (2) Objectives: This study aimed to assess vaccination coverage among Polish AIIRD patients and identify factors influencing it. (3) Patients and Methods: This study was conducted at the reference rheumatological center in Poland between May 2023 and October 2023. The study participants completed a questionnaire covering their knowledge of vaccination recommendations, actual vaccination status, factors affecting their decision to vaccinate, and their perspectives on immunization. (4) Results: This study involved 300 AIIRD patients and 60 controls. Both groups exhibited comparably low vaccination rates for all diseases (the highest for COVID-19-52% in both groups and the lowest for pneumococci-7.7% and 10%, respectively). Knowledge about recommended vaccinations was limited among patients in both groups. AIIRD patients were also not aware that they should avoid live vaccines. The primary motivators for vaccination among AIIRD patients were fear of infection (up to 75%) and medical advice (up to 74.6%). Conversely, the predominant reasons for non-vaccination were a lack of knowledge that vaccination is recommended (up to 74.7%) and concerns about potential adverse effects (up to 48.6%). Many patients reported not receiving vaccination recommendations from either primary care physicians or rheumatologists. (5) Conclusions: To enhance vaccination coverage among AIIRD patients in Poland, it is essential to educate them about vaccinations during routine medical consultations, emphasizing the increased risk of infection, informing them about recommended vaccinations, and clarifying doubts about adverse effects.

Assessing the prevalence and patterns of COVID-19 vaccine side effects among Syrian adults: A cross-sectional study

AimThis study aimed to assess the prevalence and patterns of COVID-19 vaccine side effects among Syrian adults, with a focus on the AstraZeneca and Sputnik Light vaccines, in light of the low vaccination rate in Syria (below 18%) attributed to fear of side effects. MethodA cross-sectional study was conducted between January and May 2022, using probability-based and convenient sampling strategies. Data was collected through online, paper, and face-to-face questionnaires that included demographic and vaccine-related questions. ResultOut of 3,766 participants, the majority were female (56.7 %) and aged 18–24 years (53.3 %). Most participants had a university-level qualification (71.2 %) and were related to the medical sector (53.2 %). A significant proportion (47.0 %) received AstraZeneca, Sputnik Light (22.1 %) and Sinopharm (14.7 %). Common side effects included sleepiness and lethargy (50.0 %), fever and chills (45.0 %), and pain/swelling at the injection site (35.9 %). Multivariate logistic regression analysis revealed that male (OR: 0.57, CI: 0.48–0.68) and participants aged 45–65 years (OR: 0.53, CI: 0.40–0.70) were less likely to experience side effects. Participants who believed COVID-19 posed a high threat to their personal life had higher odds of side effects (OR: 1.74, CI: 1.22–2.46). Vaccine type was also associated with side effects, with Sputnik Light (OR: 2.52, CI: 1.85–3.46) and AstraZeneca (OR: 1.61, CI: 1.26–2.05) having increased odds. ConclusionOur study found that COVID-19 vaccines are well tolerated among the Syrian population, with short-term side effects that typically resolve within three days. These findings are expected to bolster vaccination rates through enhanced public confidence and acceptance.

COVID-19 vaccination prevents a more severe course and treatment with complement inhibitors reduce worsening hemolysis during the Omicron pandemic in patients with PNH: a single-center study

Objective Paroxysmal nocturnal hemoglobinuria (PNH) is a rare acquired disease characterized by chronic complement-mediated hemolysis. The concentrated outbreak of coronavirus disease 2019 (COVID-19) in China after 6 December 2022, provided an opportunity to observe the disease course of PNH during an active Omicron infection epidemic. Patients and method Patients diagnosed with PNH at Peking Union Medical College Hospital (PUMCH) before 6 December 2022, were followed up until 10 April 2023. Clinical data related to coronavirus infection and hemolysis were recorded. Factors influencing the infection and severity rate of Omicron, as well as hemolysis provocation, were analyzed. Results In total, 131 patients with PNH were included in this retrospective analysis; 87.8% were infected with Omicron. Among them, 15.7% met the criteria for severity, and 1 patient died (0.87%). No protective factors were identified against Omicron infections. However, patients with severe Omicron infection (n = 18) had a lower vaccination rate than those with non-severe infection (n = 97; p = 0.015). Among those infected (n = 115) with Omicron, there was a significant increase in lactate dehydrogenase (LDH) levels compared with those in the uninfected group (n = 16, p = 0.000). Patients with severe infections (n = 18) had even higher LDH increase rates than those without severe infections (n = 97; p = 0.002). 10 (37.0%) patients treated with complement inhibitors developed breakthrough hemolysis (BTH). Patients treated with complement inhibitors (n = 27) exhibited less severe hemolysis than treatment-naïve patients (n = 104; p = 0.003). Conclusions Omicron infection exacerbates hemolytic attacks in patients with PNH. Vaccination helps mitigate the severity of Omicron infection, and using complement inhibitors reduces hemolysis exacerbation.

Geospatially clustered low COVID-19 vaccine rates among adolescents in socially vulnerable US counties

COVID-19 vaccinations are widely available across the United States (U.S.), yet little is known about the spatial clustering of COVID-19 vaccinations. This study aimed to test for geospatial clustering of COVID-19 vaccine rates among adolescents aged 12–17 across the U.S. counties and to compare these clustering patterns by sociodemographic characteristics.County-level data on COVID-19 vaccinations and sociodemographic characteristics were obtained from the COVID-19 Community Profile Report up to April 14, 2022. A total of 3,108 counties were included in the analysis. Global Moran’s I statistic and Anselin Local Moran’s analysis were used, and clustering patterns were compared to sociodemographic variables using t-tests. Counties with low COVID-19 vaccinated clusters were more likely, when compared to unclustered counties, to have higher numbers of individuals in poverty and uninsured individuals, and higher values of Social Vulnerability Index (SVI) and COVID-19 Community Vulnerability Index (CCVI). While high COVID-19 vaccinated clusters, compared to neighboring counties, had lower numbers of Black population, individuals in poverty, and uninsured individuals, and lower values of SVI and CCVI, but a higher number of Hispanic population. This study emphasizes the importance of addressing systemic barriers, such as poverty and lack of health insurance, which were found to be associated with low COVID-19 vaccination coverage.

Potential contribution of vaccination uptake to occupational differences in risk of SARS-CoV-2: analysis of the ONS COVID-19 Infection Survey

ObjectivesTo assess variation in vaccination uptake across occupational groups as a potential explanation for variation in risk of SARS-CoV-2 infection.DesignWe analysed data from the UK Office of National Statistics COVID-19...

Analysis of adult vaccination in Shandong Province from 2018 to 2022

Objective: To analyze the utilization of adult vaccination among people aged 18 and above in Shandong Province from 2018 to 2022. Methods: Data on vaccination units in 2022 and individual cases of vaccination information for people aged 18 and above were extracted from the Shandong Immunization Information System. A descriptive analysis was conducted on the distribution of adult vaccination units and adult vaccination varieties. The total vaccination amount and vaccination rate were calculated. Results: By the end of 2022, there were 3 948 vaccination units providing adult vaccination in Shandong Province, with 0.36 adult vaccination clinics per 10 000 people. Adult vaccination including RabV(rabies vaccine for human use), InfV(influenza vaccine), HPV(human papillomavirus), HepB(hepatitis B vaccine), PPV23(23-valent pneumococcal polysaccharide vaccine), MenACYW135(meningococcal polysaccharide vaccine group ACYW135), MMR(measles, mumps and rubella combined attenuated live vaccine), HEV(hepatitise E vaccine), RZV(recombinant zoster vaccine), TV(tetanus vaccine) and HF(haemorrhagic fever with renal syndrome vaccine) vaccines were administered, with a cumulative dose of 40.056 9 million and an average of 0.1 doses per person per year from 2018 to 2022. The top three vaccines were RabV, InfV and HPV, accounting for 31.48%, 22.57%, and 15.93% of the total vaccination amount, respectively. The annual vaccination dose for adults increased from 3.477 3 million in 2018 to 13.308 6 million in 2022, with an average annual growth rate of 56.55%. The cumulative 5-year doses of RabV and TV were 15.90 doses per 100 people and 0.21 doses per 100 people. The average annual vaccination rate of InfV was 2.28%. The cumulative full vaccination rates of HPV, HepB, PPV23 and RZV were 12.44%, 1.61%, 0.52% and 0.17%, respectively. The cumulative 5-year doses of RabV and TV were 29.19 doses per 100 people and 0.43 doses per 100 people in the age group of 20 to<30 years old. The vaccination rates of InfV and PPV23 were 9.08% and 1.27% in the age group of 70 to<80 years old. The vaccination rate of RZV was 0.11% in the age group of 50 to<60 years old. The HPV vaccination rate was 18.09% in the age group of 20 to<30 years old, and the HepB, MenACYW135, MMR and HEV vaccination rates were 6.21%, 9.55%, 2.65%, and 2.83% in the 18-19 age group, respectively. Conclusion: There are relatively few types of adult vaccination in Shandong Province, with narrow coverage and low vaccination rates.

Knowledge, Attitude and Practice Regarding Hepatitis B among population of Sector O-9 Islamabad, A descriptive Cross Sectional Study

Background: Hepatitis B (HBV) remains a significant public health challenge globally, with varying prevalence and awareness levels across different regions. Understanding the Knowledge, Attitudes, and Practices (KAP) regarding HBV among different populations is crucial for effective public health interventions. Objective: This study aimed to assess the KAP regarding HBV among residents of Sector O-9, Islamabad, and to identify areas for potential health education and intervention. Methods: A descriptive, cross-sectional study was conducted involving 372 participants from Sector O-9, Islamabad. Data were collected using a prevalidated questionnaire covering demographic characteristics, and KAP related to HBV. The response rate was 87.94%. Data analysis included descriptive statistics and chi-square tests using SPSS software. Results: The majority of participants (73%) were aware of HBV, but specific knowledge gaps were evident, with 58% not recognizing HBV as a viral disease. Attitudinally, over 80% did not perceive themselves at risk for HBV. Regarding practices, while a high insistence on new blades for shaving was noted (100%), vaccination rates were low (26.4%), and consistent use of new syringes was reported by only 56.4%. The primary source of HBV information was through media and family/friends. Conclusion: The study revealed a reasonable level of general awareness about HBV among participants. However, specific knowledge gaps, low vaccination rates, and inconsistent preventive practices indicate the need for targeted health education and improved healthcare services. Public health interventions should focus on filling these gaps to enhance overall HBV management and control.

Barriers to HPV vaccination in marginalized Roma communities in Slovakia.

Limited access to healthcare services leads to lower vaccination rates in marginalized Roma communities (MRCs). This study aimed to explore health system barriers to HPV vaccination faced by people from MRCs from multiple perspectives. The qualitative study was conducted in Slovakia in 2021/22 with 43 community members and health professionals. Data were analyzed using a combination of content analysis and consensual qualitative research. A substantial barrier to vaccination is limited coverage of vaccination expenses for certain age categories by health insurance. Moreover, Slovakia faces a significant shortage of healthcare personnel, leading to work overload and a lack of capacity and motivation to address HPV vaccination. Impaired relationships between health care providers and people from MRCs lead to the avoidance of healthcare services, which contributes to insufficient delivery of information and a lack of awareness regarding HPV-related diseases and vaccination. Strengthening the capacities of health care providers, expanding the age group covered by health insurance and providing tailored information to people from MRCs are necessary prerequisites to increase the availability of HPV vaccination and enable people to make informed decisions about HPV vaccination.

Distance to vaccine sites is tied to decreased COVID-19 vaccine uptake

Abstract COVID-19 remains a leading cause of mortality in the United States, despite the widespread availability of vaccines. Conventional wisdom ties failure to vaccinate primarily to vaccine-skeptic beliefs (e.g. conspiracy theories, partisanship). Yet in this research, we find that vaccination is also hindered by travel distance to vaccine sites (a form of friction, or structural barriers). In study 1, Californians living farther from vaccine sites had lower vaccination rates, and this effect held regardless of partisanship. In study 2, Chicago zip codes saw an uptick in vaccination following vaccine site opening. These results proved robust in multiverse analyses accounting for a wide range of covariates, outcomes, and distance indicators. COVID-19 vaccination is hampered not only by vaccine hesitancy but also by structural barriers like distance. Efforts to boost vaccination could benefit from minimizing friction.

Abstract A058: "That’s our culture...”: A qualitative study on factors that influence cervical cancer stigma in the Caribbean

Abstract Background: Cancer stigma, which encompasses the negative responses of nations, communities, families, and individuals towards those affected by cancer, presents a growing challenge in low-resourced societies and various parts of the world. In particular, cervical cancer (CCA) stigma has become increasingly prevalent in numerous cultures and societies. This stigma is fueled by the fact that nearly 99% of CCA cases and pre-cancerous cervical lesions are attributed to infection with the sexually transmitted human papillomavirus (HPV). Despite the substantial burden CCA stigma and the availability of widely accessible, cost-effective services, Caribbean women exhibit alarmingly low rates of appropriate CCA screening practices and HPV vaccination for their children, both in the U.S. and the Caribbean. To enhance the effectiveness of CCA prevention efforts in the U.S, it is imperative to include studies involving Caribbean nations with significant immigration to the U.S. Objective: This study aimed to explore the manifestations of cancer stigma among men and women aged 18-85 in Grenada, Jamaica, and Trinidad &amp; Tobago, and its potential impact on CCA prevention behaviors. Design and Methods: Employing a community-based participatory research approach, academic institutions collaborated with community leaders in each country to conduct a cross-sectional qualitative study using focus groups. Thematic analysis was performed using MAXQDA data analysis software to examine the role of stigma in CCA prevention behaviors. Results: Three focus groups were conducted in each country, with a total of 69 participants. Major themes emerged regarding the influence of stigma on CCA cancer prevention efforts, including fatalism, cultural views, and confidentiality. Participants demonstrated knowledge of the sexually transmitted nature of HPV, which causes CCA, contributing to the stigmatization of the disease. Stigma was associated with unwarranted assumptions of female promiscuity. The stigmatization of CCA was characterized by blame and the belief that women with the disease should feel ashamed, creating significant barriers to HPV vaccination and pap testing. Cancer was often regarded as a death sentence and rarely discussed among family and friends, further deterring women from seeking screening, early detection, and support. Fear and misinformation surrounding the pap testing procedure, as well as concerns about medical confidentiality, also hindered screening. Conclusion: Generalized cancer stigma (viewing cancer as a death sentence) and specific CCA cancer stigma (shame and blame) have adverse effects on CCA prevention efforts. Further research is needed to assess the multifaceted dimensions of cancer stigma and inform interventions aimed at improving CCA cancer screening and HPV vaccination in the Caribbean. Investigating and addressing the various dimensions of cancer stigma within the non-patient population are required to inform strategies to reduce stigma’s influence; and thus improve CCA screening and HPV vaccination to prevent cancer and save lives. Citation Format: Kamilah B. Thomas-Purcell, Diadrey-Ann Sealy, Althea Bailey, Sherry-Ann Joseph, Kimlin Ashing. "That’s our culture...”: A qualitative study on factors that influence cervical cancer stigma in the Caribbean [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr A058.

Abstract C067: Evaluation of data from a new mobile HPV vaccination program in South Carolina, U.S.

Abstract Purpose: Human papillomavirus (HPV) infections are linked to at least six different types of cancer. The Medical University of South Carolina (MUSC) Hollings Cancer Center (HCC) and Department of Pediatrics leaders identified less-than-optimal HPV vaccination rates in rural and medically underserved communities in South Carolina (SC) (80% in urban cities vs. 62% in rural areas). Forty-three percent of SC’s 46 counties include areas classified as rural by the U.S. Census, and 14% of the state’s population lives in rural areas. SC’s population demographics are typical of the Deep South region of the U.S. and primarily comprise non-Hispanic White (69%) and non-Hispanic Black (27%) residents, with a small but growing Hispanic/Latinx population (6.0%). SC compares unfavorably with the U.S. averages in educational levels and per capita and median household incomes. These social determinants of health-related factors contribute to lower levels of knowledge about, and access to, the HPV vaccine. Methods: To address the major public health issue of low HPV vaccination rates in rural SC, the MUSC HCC and Department of Pediatrics created a statewide community engagement-focused HPV Vaccination Van Program with funding from the HealthyMe/HealthySC (HMHSC) program and MUSC HCC. The Program launched in October of 2021. It provides HPV and other childhood vaccinations in school districts, HMHSC health clinics, and other community settings throughout SC, focusing on children aged 9–18 years who are eligible for the U.S. Centers for Disease Control and Prevention’s Vaccines for Children Program. The prioritization of the selection of counties for inclusion in the Program is based on geospatial analyses highlighting the current HPV vaccination rates in each county. Results: As of 5 June 2023, the Program has administered childhood vaccinations to 734 participants in 28/46 counties (60%) of SC. Three-hundred and forty-six of the participants received HPV vaccinations. They were predominantly female (56.4%), aged 4–18 years (97.1%), and self-identified as non-Hispanic White (46.0%), non-Hispanic Black (31.9%), Hispanic/Latino (14.9%), Asian American (1.2%), Multiracial (3.3%), or Other (2.4%), with 0.3% of the participants not reporting their racial/ethnic identification. Slightly more than half of the participants (52.9%) had Medicaid insurance and 25.1% reported having no insurance coverage. Conclusions: The number of children receiving the HPV vaccine through the Program, and the number of counties served, is expected to expand as the Program’s relationship with SC’s school districts and other community-based organizations grows. The Program provides a model for delivering mobile HPV vaccinations to rural children, thus reducing their cancer risk. Citation Format: Marvella E. Ford, Kathleen B. Cartmell, Angela M. Malek, Nhi Phuong Le, Chloe Keeve, I'Ayana Sanders, Jerlinda Ross, Melanie Slan, Joan McLauren, Mina Platt, Ellen Gomez, Jessica Zserai, Beth Poore, Christina Cody, Victoria Ladd, Mary S. Beattie, J. David Suddoth, Kapri Kreps, James R. Roberts. Evaluation of data from a new mobile HPV vaccination program in South Carolina, U.S. [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr C067.