As Crystal Reeck researched how cities created registration platforms for residents to receive COVID-19 vaccines, she found that for many people, signing up to get a shot is not a simple process.
“It’s a struggle,” said Reeck, a supply chain management professor. “You have to be really committed to wanting to get that shot in order to make it through the system in a lot of places.”
Two Temple University professors, Reeck and Heather Gardiner, are conducting separate studies to research how health care providers can make the COVID-19 vaccination sign-up process more accessible to residents and increase the number of people receiving vaccines.
Reeck published “Do Nudges Reduce Disparities? Choice Architecture Compensates for Low Consumers for Low Consumer Knowledge,” in the Journal of Marketing on April 29, 2021, which identifies how the format and information on vaccination sign-up platforms can reduce socioeconomic disparities in accessing vaccines. Gardiner, a social and behavioral sciences professor and director of the Health Disparities Research Lab, is leading the community engagement work for the RapidVax project, a city-funded initiative at the College of Public Health aiming to expand vaccine accessibility for underserved communities.
As of May 20, more than 865,000 Philadelphia residents have received at least one dose of a Pfizer’s COVID-19 vaccine, and more than 652,000 residents are fully vaccinated, The Temple News reported.
All Philadelphia residents aged 12 years and older are eligible to receive the Pfizer-BioNTech COVID-19 vaccine as of May 13, and about 37 percent of residents 16 and older are currently fully vaccinated according to the Philadelphia Department of Public Health.
The city must vaccinate approximately 70 to 80 percent of residents in order to reach herd immunity according to former health commissioner Thomas Farley, 6ABC reported.
Herd immunity is achieved when a majority of a population are immune to a disease which disrupts infection rates and protects the community, according to Mayo Clinic.
Reeck and three Columbia Business School professors researched how vaccine providers convey vaccine choices to people on vaccination sign-up websites and how different ways of displaying these choices impact consumer decisions about whether to get vaccinated or not, Reeck said.
Based on results from six studies, Reeck concluded people who come from lower socioeconomic backgrounds, struggle with digital literacy or have less health care knowledge have difficulty signing up to receive vaccines because the process is too complicated, she said.
Elderly individuals, who are at higher risk for suffering worse outcomes from contracting COVID-19, often can’t easily use the Internet, which presents challenges to signing up to receive the vaccine, she added.
“The way the choices were set up wasn’t taking into account the need for the most vulnerable consumers,” Reeck said. “If we set up the choice to give people better information, the people who benefited the most were low socioeconomic people.”
Health professionals can decrease the barriers created by online sign-up portals by using patient lists from local health care providers to contact patients directly who qualify for the vaccine and help them set up appointments, Reeck said.
Even if residents complete sign-up pages, those without access to cars can struggle getting to vaccination sites, Reeck said. Making clinics available to more neighborhoods can help reduce barriers for residents to get vaccinated, she added.
Philadelphia provides transportation information for city-run clinics, like the Federal Emergency Management Agency clinic at the Pennsylvania Convention Center and the Esperanza Community Vaccination Clinic on their COVID-19 information page, wrote James Garrow, communications director for the Philadelphia Department of Health, in an email to The Temple News.
Sarah Bass, a social and behavioral sciences professor and and director of the Risk Communication Lab is leading the community messaging work for the RapidVax project. Bass is conducting surveys to assess how barriers like difficulty traveling to vaccination sites impact people’s willingness to get vaccinated, and is surveying Philadelphians about why they may feel hesitant to get a vaccine as a part of the RapidVax project, Gardiner said.
The COVID-19 vaccines approved by the U.S. Food and Drug Administration for emergency use were tested in clinical trials and are safe and effective, according to the Centers for Disease Control and Prevention. People are recommended to get the vaccine as soon as possible.
Gardiner and the RapidVax team partnered with 13 organizations including Prevention Point Philadelphia, an organization providing harm-reduction services and the Indo-Chinese American Council, an education service for refugee immigrants to learn how people using these services feel about health care.
Partnering with the organizations helped Gardiner understand why people feel hesitant about trusting vaccines and health care, and also how to persuade people to get COVID-19 vaccines, she said.
As of May 3, roughly 30 percent of Americans are hesitant about receiving the COVID-19 vaccine if offered which could pose challenges to reaching herd immunity in the U.S., The New York Times reported.
One in four predominantly nonwhite communities is estimated to have a 25 percent rate or higher of vaccine hesitancy, which is double the estimate for white communities, despite nonwhite communities being disproportionately impacted by the pandemic, according to vaccination data from the CDC, ABC News reported.
For some minority groups, distrust in health care may stem from historical instances of medical experimentation like the Public Health Service Syphilis Study at Tuskegee Institute, which studied Black men with syphilis but did not offer treatment, and have fueled distrust in vaccines in Black communities, NBC News reported.
Another barrier that may prevent individuals from signing up online to be vaccinated is that many sign-up websites are only available in English and are not translated into other languages, Gardiner said. This is a challenge because communicating vaccine information in various languages and having conversations with leaders in local communities can increase the likelihood of an individual getting vaccinated, Gardiner added.
“We have to make things less burdensome for people so it’s really straightforward to sign up and it’s not this huge, complex process,” Gardiner said.
The Philadelphia Department of Health vaccination form is available in five different languages, and appointments can be set up through the Health Centers 311 call line, community providers like Philadelphia Corporation for Aging and the Black Doctors COVID-19 Consortium, Garrow wrote.
Additionally, the city’s FEMA site at the Convention Center provides access to interpreters and LanguageLine, an interpretation and translation service, Garrow wrote.
Gardiner and the RapidVax team hopes to use Bass’s survey results to address Philadelphia residents’ concerns about getting vaccinated.
“It goes back to trust, and if people trust the organization and leadership of the organization, then they’re going to be more likely to sign up,” Gardiner said.
Gardiner feels she can fight vaccine hesitancy by working directly with people who do not trust the safety of the COVID-19 vaccine with an approach based on people’s experiences and reasoning, which will not be a one-size-fits-all solution, she said.
Unless health care providers work to reduce vaccine hesitancy, the city will likely struggle to reach herd immunity, she added.
“This work is important and it’s really going to be some of the only ways we can get enough people vaccinated so that life can return to normal,” Gardiner said.
CORRECTION: A previous version of this article incorrectly attributed Sarah Bass’s research as well as Heather Gardiner’s association with the RapidVax project.