Opinion

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How collaboration can help counteract vaccine fatigue

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Being an eternal optimist (or suffering cognitive dissonance, depending on who you speak to), one of the silver linings I found during the COVID-19 pandemic has been the breaking down of silos that we work in and the increased collaboration throughout the primary healthcare system.
 
Hence, I am always keen to report on innovative and successful programs to help improve the health outcomes of our community.
 
One of these initiatives I recently participated in is the South Western Sydney Primary Health Network (SWSPHN) COVID Small Grants Program, which sought to improve COVID-19 vaccination rates in vulnerable communities in southwest Sydney.
 
This region, with its significant diversity and low underlying socioeconomic determinants of health outcomes, suffered quite significantly during the pandemic in regards to infection rates and hospitalisations, including the social challenges of living under strict curfews.
 
The program aimed to support general practices and pharmacies to ensure continuity of COVID-19 vaccinations for vulnerable groups and to increase health literacy among vaccine-hesitant patients.  
 
Funding was directed for the healthcare team and not specifically for face-to-face GP time, which was of particular relevance to our practice as is allowed other team members to spend time discussing COVID vaccines with patients in an attempt to increase vaccination uptake.
 
As part of the program, participating practices and pharmacies carried out conversations about the benefits of vaccination with patients identified as vaccine hesitant and, where possible, helped them to access the vaccine. We were also supported to spend time identifying a vulnerable population group using clinical software and those who were under-vaccinated, to recall and discuss vaccination and to connect vulnerable populations to COVID-19 vaccine providers.
 
Ninety practices participated across the seven LGAs and the split was fairly even across general practice and pharmacies, with 42 general practices and 48 pharmacies participating.
 
During the first month of the program, 3722 conversations were undertaken by the participating practices – leading to 1739 extra vaccination doses. 
 
In the second month of the program a further 3494 conversations with vulnerable patients took place and this culminated in an additional 1304 vulnerable and high-risk patients being vaccinated.
 
There were many good news stories during the primary care program relating to improved health literacy, and these are highlighted by participating practice staff below.
 

• ‘Patients didn’t think they needed it, but were vaccinated after discussions.’
• ‘We were fortunate enough to have a family of anti-vaccinators who were then vaccinated, and we found this very rewarding after two years of trying to convince them.’
• ‘Patients didn’t know there was a fourth dose [second booster] and were vaccinated after explanation. They were mostly not aware as the media had ceased broadcasting the boosters.’
• ‘One of our elderly patients was completely unaware that they had to get more than one vaccination to be fully protected. He thought he was doing the right thing, but as he did not have a mobile phone for SMS reminders none of the reception staff at the vaccination clinic followed up with him to book him in for subsequent doses. He was directed to reception and was able to get vaccinated on the same day.’
• ‘An older gentleman who was severely immunocompromised believed he was fully immunised, but on further conversation it was explained that he wasn’t. The patient really was pleased to be informed and proceeded to getting vaccinated that same day.’
• ‘A patient was travelling overseas and was not aware they were eligible for a COVID booster dose. Considering they were travelling to a high-risk country, they were happy to be informed and booked in for a booster.’

 
Further good news stories were highlighted by the following examples showing how vulnerable populations were encouraged to get vaccinated.
 

• ‘One conversation resulted in a family of three being vaccinated.’
• ‘A 16-year-old Aboriginal girl had a third dose following a conversation with her doctor.’
• ‘A pregnant woman was strongly anti-vax until she gave birth. After having extended discussions with the doctor and practice nurse post-delivery and witnessing COVID symptoms’ impact variations on vaccinated versus non-vaccinated people, she was finally convinced to take the vaccine.’
• ‘We assisted a young pregnant woman seeking a vaccination before travelling back home to South East Asia.’
• ‘The GPs played an important role to provide home visits to people with disabilities and special needs who otherwise may not have had a chance to get COVID vaccines and the booster doses.’
• ‘We had a customer who was the head of the family, and when I was speaking to him in his own language he decided to get vaccinated and was going to speak to the doctor about how safe it was to vaccinate his four children as well.’
• ‘The good news story that stands out to me was being able to help and vaccinate a patient with mental health issues who lives in an isolated part of our region.’
• ‘A 73-year-old with prostate and lung cancer was completely against the booster vaccine. However, after a conversation with him about the importance of the booster, I organised with the medical centre next door for him to take the booster.’

 
Overall, the findings on evaluating programs and the good news stories mentioned, as well as practice reports, indicate that the COVID Small Grants Program had many benefits for both the participating practices and patients.
 
Noted strengths included:

 

• significant increase in vaccination uptake in vulnerable populations
• development of SWSPHN relationships with practices and pharmacies who were previously disengaged
• that the program was able to be implemented within the deadlines met.

 
Limitations of the program were noted as:
 

• limited engagement from general practices in languages other than English
• confusion from practices around invoicing and reporting
• the fact that not all approved practices participated and were lost to follow up.

 
While the program had its limitations, overall it was certainly successful in achieving the stated objectives in increasing COVID vaccine boosters in vulnerable members of southwest Sydney’s community. The feedback from GPs and the pharmacists involved, as well as the number of vaccinations administered, indicated that the program had been an effective way to support GPs and practices within the COVID-19 response.
 
Moving forward, any limitations to the program could be addressed with solutions such as:
 

• directed outreach to Aboriginal and Torres Strait Islander and culturally and linguistically diverse services
• invoice templates
• more structured interaction with participating practices to attract engagement and give support where needed.

 
Overall, an extra 3043 southwestern Sydney residents who were unvaccinated or under-vaccinated benefited from this program by obtaining relevant immunisation.
 
I certainly found the assistance from the SWSPHN a beneficial and innovative way to use the most cost effective and efficient component of our health system – primary care – to deal with overcoming some of the issues relating to pandemic vaccination fatigue.
 
Certainly, it has highlighted the health benefits shown when adequate general practice funding is available, particularly in relation to the most vulnerable members of our community.
 
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COVID-19 vaccination health literacy southwest Sydney vaccine hesitancy vulnerable patients

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