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Partnering with disabilityled organizations to prepare and respond to public health emergencies
Abstract
Over a quarter of adults in the United States live with a disability, increasing their risk for severe outcomes from coronavirus disease 2019 (COVID-19). Additionally, people with disabilities face continuous barriers in accessing COVID-19 vaccinations. Disability-led organizations are catalytic partners for public health departments to reach and provide services to and build partnerships with people with disabilities. For this reason, the Centers for Disease Control and Prevention Foundation funded three disability-led organizations, two nationally focused and one locally focused, to partner with state and local public health agencies to identify and address barriers to COVID-19 vaccination and emergency response planning in their communities. These partners identified key strategies for inclusion in emergency response and vaccination planning, including creating accessible materials and messaging, ensuring the accessibility of vaccination sites, and addressing the historical mistrust between people with disabilities and health systems. Through this funding, 59 partnerships between disability-led organizations and disability or public health partners were formed with 26 memorandums of understanding being executed. This project provides actionable recommendations and illustrates that disability-led organizations are key public health partners in planning for and implementing strategies that benefit people with disabilities and the community more broadly.
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On August 31, 2022, the Food and Drug Administration (FDA) authorized bivalent formulations of BNT162b2 (Pfizer-BioNTech) and mRNA-1273 (Moderna) COVID-19 vaccines; these vaccines include mRNA encoding the spike protein from the original (ancestral) strain of SARS-CoV-2 (the virus that causes COVID-19) and from the B.1.1.529 (Omicron) variants BA.4 and BA.5 (BA.4/BA.5). These bivalent mRNA vaccines were authorized for use as a single booster dose ≥2 months after completion of primary series or monovalent booster vaccination; Pfizer-BioNTech bivalent booster was authorized for persons aged ≥12 years and Moderna for adults aged ≥18 years.*,† On September 1, 2022, the Advisory Committee on Immunization Practices (ACIP) recommended that all persons aged ≥12 years receive an age-appropriate bivalent mRNA booster dose.§ To characterize the safety of bivalent mRNA booster doses, CDC reviewed adverse events and health impacts reported after receipt of bivalent Pfizer-BioNTech and Moderna booster doses during August 31-October 23, 2022, to v-safe,¶ a voluntary smartphone-based U.S. safety surveillance system established by CDC to monitor adverse events after COVID-19 vaccination, and the Vaccine Adverse Event Reporting System (VAERS),** a U.S. passive vaccine safety surveillance system managed by CDC and FDA (1). During August 31-October 23, 2022, approximately 14.4 million persons aged ≥12 years received a bivalent Pfizer-BioNTech booster dose, and 8.2 million adults aged ≥18 years received a bivalent Moderna booster dose.†† Among the 211,959 registrants aged ≥12 years who reported receiving a bivalent booster dose to v-safe, injection site and systemic reactions were frequently reported in the week after vaccination (60.8% and 54.8%, respectively); fewer than 1% of v-safe registrants reported receiving medical care. VAERS received 5,542 reports of adverse events after bivalent booster vaccination among persons aged ≥12 years; 95.5% of reports were nonserious and 4.5% were serious events. Health care providers and patients can be reassured that adverse events reported after a bivalent booster dose are consistent with those reported after monovalent doses. Health impacts after COVID-19 vaccination are less frequent and less severe than those associated with COVID-19 illness (2).
Objectives:
Our study aimed to (1) identify barriers to equitable access to COVID-19 vaccines for Canadians with disabilities and (2) present recommendations made by study participants to improve immunization programs in terms of inclusivity and equitable access.
Methods:
We invited Manitobans living with disabilities to participate in online focus groups. Focus groups were conducted across multiple disability experiences, although one focus group was advertised explicitly as offering simultaneous American Sign Language interpretation to encourage people who are d/Deaf or hard of hearing to participate. Participants were asked about their perspectives on the management of COVID-19 public health measures and vaccination program rollout. Participants were also asked about barriers and facilitators of their vaccination experiences and if they had recommendations for improvement.
Results:
The participants identified three areas where they encountered routine barriers in accessing the COVID-19 vaccines: (1) vaccine information and appointment booking, (2) physical access to vaccination clinics, and (3) vaccination experience. While participants identified specific recommendations to improve vaccine accessibility for people with disabilities, the single most crucial advice consistently identified was to involve people with disabilities in developing accessible immunization programs.
Conclusion:
Meaningful engagement with people living with disabilities in immunization program planning would help ensure that people with disabilities, who already face significant challenges due to COVID-19, are offered the same protections as the rest of the population. These recommendations could be easily transferred to the administration of other large-scale immunization campaigns (e.g., influenza vaccines).
Background
The COVID-19 pandemic has exacerbated historical inequities for people with disabilities including barriers in accessing online information and healthcare appointment websites. These barriers were brought to the foreground during the vaccine rollout and registration process.
Objective
This cross-sectional study aimed to examine accessibility of U.S. state and territory COVID-19 information and registration centralized websites.
Methods
The Johns Hopkins Disability Health Research Center created a COVID-19 Vaccine Dashboard compiling COVID-19 information and vaccine registration web pages from 56 states and territories in the United States (U.S.) reviewed between March 30 through April 5, 2021 and analyzed accessibility using WAVE Web Accessibility Evaluation Tool (WAVE). WAVE identifies website accessibility barriers, including insufficient contrast, alternative text, unlabeled buttons, total number of errors, and error density. Web pages were ranked and grouped into three groups by number of errors, creating comparisons between states on accessibility barriers for people with disabilities.
Results
All 56 U.S states and territories had COVID-19 information web pages and 29 states had centralized state vaccine registration web pages. Total errors, error density, and alert data were utilized to generate accessibility scores for each web page, the median score was 259 (range=14 to 536 and IQR=237) for information pages, and 146 (range=10 to 281 and IQR=105) for registration pages.
Conclusions
These results highlight barriers people with disabilities may encounter when accessing information and registering for the COVID-19 vaccine, which underscore inequities in the pandemic response for the disability community and elevate the need to prioritize accessibility of public health information.
Objective: Tailored communication is necessary to address COVID-19 vaccine hesitancy and increase uptake. We aimed to understand the information needs, perceived benefits and barriers to COVID-19 vaccination of people prioritised, but hesitant to receive the vaccine.
Method: In this qualitative study in Victoria, Australia (February-May 2021), we purposively sampled hesitant adults who were health or aged/disability care workers (n=20), or adults aged 18-69 with comorbidities or aged ≥70 years (‘prioritised adults’; n=19). We thematically analysed interviews inductively, then deductively organised themes within the World Health Organization Behavioural and Social Drivers of vaccination model. Two stakeholder workshops (n=12) explored understanding and preferences for communicating risks and benefits. We subsequently formed communication recommendations.
Results: Prioritised adults and health and aged care workers had short- and long-term safety concerns specific to personal circumstances, and felt like “guinea pigs”. They saw vaccination as beneficial for individual and community protection and travel. Some health and aged care workers felt insufficiently informed to recommend vaccines, or viewed this as outside their scope of practice. Workshop participants requested interactive materials and transparency from spokespeople about uncertainty.
Conclusions and public health implications: Eleven recommendations address communication content, delivery and context to increase uptake and acceptance of COVID-19 vaccines.
Background
Previous research has indicated that demographic differences affect COVID-19 vaccination rates. Trust, in both the vaccine itself and institutional trust, is one possible factor. The present study examines racial differences in institutional trust and vaccine status among a nationally representative sample of adults in the United States.
Methods
Data for the current study was collected as part of Wave 8 Omnibus 2000 survey conducted by RAND ALP and consisted of 2080 participants. Responses were collected through the online RAND ALP survey in March 2021.
Results
Trust in the scientific community was the strongest predictor for already receiving at least one dose of the COVID-19 vaccine at the time of study. Asians had a significantly higher trust in the scientific community compared to all other groups. Results also showed a significant difference in level of trust of the government’s response to the COVID-19 pandemic with Indian/Alaskan Natives reporting lower trust compared to Whites, Blacks and Asians. Asians also had a significantly higher level of trust when compared to those who identified as racial Other. Those who identify as American Indian/Alaskan Natives had the lowest levels of institutional trust. Trust in the government’s response was not indicative of vaccination within the sample.
Conclusions
Strategies to increase trust of the scientific community can be employed to address vaccine hesitancy through community-based initiatives and building of partnerships between the scientific community and local community stakeholders.
Estimates from the 2019 American Community Survey (ACS) indicated that 15.2% of adults aged ≥18 years had at least one reported functional disability (1). Persons with disabilities are more likely than are those without disabilities to have chronic health conditions (2) and also face barriers to accessing health care (3). These and other health and social inequities have placed persons with disabilities at increased risk for COVID-19-related illness and death, yet they face unique barriers to receipt of vaccination (4,5). Although CDC encourages that considerations be made when expanding vaccine access to persons with disabilities,* few public health surveillance systems measure disability status. To describe COVID-19 vaccination status and intent, as well as perceived vaccine access among adults by disability status, data from the National Immunization Survey Adult COVID Module (NIS-ACM) were analyzed. Adults with a disability were less likely than were those without a disability to report having received ≥1 dose of COVID-19 vaccine (age-adjusted prevalence ratio [aPR] = 0.88; 95% confidence interval [CI] = 0.84-0.93) but more likely to report they would definitely get vaccinated (aPR = 1.86; 95% CI = 1.43-2.42). Among unvaccinated adults, those with a disability were more likely to report higher endorsement of vaccine as protection (aPR = 1.29; 95% CI = 1.16-1.44), yet more likely to report it would be or was difficult to get vaccinated than did adults without a disability (aPR = 2.69; 95% CI = 2.16-3.34). Reducing barriers to vaccine scheduling and making vaccination sites more accessible might improve vaccination rates among persons with disabilities.
This qualitative study analyzes department of health websites for all 50 US states for accessibility and usability in obtaining COVID-19 vaccine eligibility information and appointments.
The success of mass COVID-19 vaccination campaigns rests on widespread uptake. However , although vaccinations provide good protection, they do not offer full immunity and while they likely reduce transmission of the virus to others, the extent of this remains uncertain. This produces a dilemma for communicators who wish to be transparent about benefits and harms and encourage continued caution in vaccinated individuals but not undermine confidence in an important public health measure. In two large pre-registered experimental studies on quota-sampled UK public participants we investigate the effects of providing transparent communication-including uncertainty about vaccination effectiveness on decision-making. In Study 1 (n = 2097) we report that detailed information about COVID-19 vaccines, including results of clinical trials, does not have a significant impact on beliefs about the efficacy of such vaccines, concerns over side effects, or intentions to receive a vaccine. Study 2 (n = 2217) addressed concerns that highlighting the need to maintain protective behaviours (e.g., social distancing) post-vaccination may lower perceptions of vaccine efficacy and willingness to receive a vaccine. We do not find evidence of this: transparent messages did not significantly reduce perceptions of vaccine efficacy, and in some cases increased perceptions of efficacy. We again report no main effect of messages on intentions to receive a vaccine. The results of both studies suggest that transparently informing people of the limitations of vaccinations does not reduce intentions to be vaccinated but neither does it increase intentions to engage in protective behaviours post-vaccination.
A strong relationship exists between disability and poor health. This relationship could exist as a result of disabilities emerging from chronic conditions; conversely, people with disabilities may be at increased risk of developing chronic conditions. Studying health in relation to age of disability onset can illuminate the extent to which disability may be a risk factor for future poor health.
We used data from the 2006-2012 National Health Interview Survey and conducted weighted logistic regression analyses to compare chronic conditions in adults with lifelong disabilities (n = 2,619) and adults with no limitations (n = 122,395).
After adjusting for sociodemographic differences, adults with lifelong disabilities had increased odds of having the following chronic conditions compared with adults with no limitations: coronary heart disease (adjusted odds ratio [AOR] = 2.92; 95% confidence interval [CI], 2.33-3.66) cancer (AOR = 1.61; 95% CI, 1.34-1.94), diabetes (AOR = 2.57; 95% CI, 2.10-3.15), obesity (AOR = 1.81; 95% CI, 1.63-2.01), and hypertension (AOR = 2.18; 95% CI, 1.94-2.45). Subpopulations of people with lifelong disabilities (ie, physical, mental, intellectual/developmental, and sensory) experienced similar increased odds for chronic conditions compared with people with no limitations.
Adults with lifelong disabilities were more likely to have chronic conditions than adults with no limitations, indicating that disability likely increases risk of developing poor health. This distinction is critical in understanding how to prevent health risks for people with disabilities. Health promotion efforts that target people living with a disability are needed.
Background:
Systemic inequities may place people with disabilities at higher risk of severe COVID-19 illness or lower likelihood to be discharged home after hospitalization. We examined whether severity of COVID-19 hospitalization outcomes and disposition differ by disability status and disability type.
Methods:
In a retrospective analysis of April 2020-November 2021 hospital-based administrative data among 745,375 people hospitalized with COVID-19 from 866 US hospitals, people with disabilities (n = 120,360) were identified via ICD-10-CM codes. Outcomes compared by disability status included intensive care admission, invasive mechanical ventilation (IMV), in-hospital mortality, 30-day readmission, length of stay, and disposition (discharge to home, long-term care facility (LTCF), or skilled nursing facility (SNF).
Results:
People with disabilities had increased risks of IMV (aRR: 1.05; 95%CI: 1.03-1.08) and in-hospital mortality (1.04; 1.02-1.06) compared to those with no disability; risks were higher among people with intellectual and developmental disabilities (IDD) (IMV [1.34; 1.28-1.40], mortality [1.31; 1.26-1.37]) or mobility disabilities (IMV [1.13; 1.09-1.16], mortality [1.04; 1.01-1.07]). Risk of readmission was increased among people with any disability (1.23; 1.20-1.27) and each disability type. Risks of discharge to a LTCF (1.45, 1.39-1.49) or SNF (1.78, 1.74-1.81) were increased among community-dwelling people with each disability type.
Conclusions:
Severity of COVID-19 hospitalization outcomes vary by disability status and type; IDD and mobility disabilities were associated with higher risks of severe outcomes. Disparities such as differences in discharge disposition by disability status require further study which would be facilitated by standardized data on disability. Increased readmission across disability types indicates a need to improve discharge planning and support services.
Background
It is important for people with disabilities to be vaccinated against COVID-19 because, as a group, they are at increased risk of severe outcomes. While there are multiple vaccines available to prevent COVID-19, a considerable proportion of Americans report some hesitancy to becoming vaccinated, including people with disabilities.
Objective
We conducted a study to explore what factors may contribute to COVID-19 vaccination hesitancy among Americans with disabilities.
Methods
We used Amazon's Mechanical Turk to survey 439 people with disabilities (ages 18+) about their concerns of the COVID-19 disease, vaccines, and hesitancy toward vaccination to learn more about factors that influence vaccination hesitancy. Concerns about vaccines were analyzed as a composite variable representing different dimensions such as: side effects, too new, developed too quickly, influenced by politics, and effectiveness.
Results
Results from a logistic regression indicate that concern about vaccines was the most significant predictor of hesitancy, even after considering demographic, economic, and geographic factors. Concerns about getting COVID-19, getting tested for COVID-19, trust in experts, education, and being a Democrat were negatively associated with hesitancy.
Conclusions
These findings indicate that some groups of individuals may be more vaccination hesitant because they are more concerned about vaccine safety than COVID-19 infection. Public health messaging that focuses on the risks of vaccines relative to the risks of COVID-19 might be one strategy to reduce hesitancy and increase vaccination uptake. Messaging should also be tailored to specific disabilities (i.e. physical, mental, sensory), written in plain language, and disseminated in accessible formats.
Examine the factors that promote vaccine hesitancy or acceptance during pandemics, major epidemics and global outbreaks. A systematic review and thematic analysis of 28 studies on the Influenza A/H1N1 pandemic and the global spread of Ebola Virus Disease. We found seven major factors that promote vaccine hesitancy or acceptance: demographic factors influencing vaccination (ethnicity, age, sex, pregnancy, education, and employment), accessibility and cost, personal responsibility and risk perceptions, precautionary measures taken based on the decision to vaccinate, trust in health authorities and vaccines, the safety and efficacy of a new vaccine, and lack of information or vaccine misinformation. An understanding of participant experiences and perspectives toward vaccines from previous pandemics will greatly inform the development of strategies to address the present situation with the COVID-19 pandemic. We discuss the impact vaccine hesitancy might have for the introduction and effectiveness of a potential COVID-19 vaccine. In particular, we believe that skepticism toward vaccines can still exist when there are no vaccines available, which is contrary to contemporary conceptualizations of vaccine hesitancy. We recommend conducting further research assessing the relationship between the accessibility and cost of vaccines, and vaccine hesitancy.
This exploratory study investigated the web accessibility of 54 official COVID-19 vaccine registration websites in the US and their concordance with the WCAG 2.0 and 2.1 guidelines. We employed AChecker, WAVE, and SortSite web accessibility evaluation tools to conduct automated analyses of these websites. The results showed suboptimal compliance with WCAG 2.0 and 2.1 guidelines, as determined using the AChecker, WAVE, and SortSite tools. These shortcomings in compliance may pose difficulties to users with disabilities as they access information on the websites. Based on our findings, we offered recommendations for states and other authorities to improve the accessibility of their websites to ensure that users with disabilities can independently schedule vaccination appointments.
Background
Trust of information shapes adherence to recommended practices and speed of public compliance during public health crises. This is particularly important for groups with higher rates of high-risk health conditions, including those aged 65 and over and people with disabilities.
Objective
We examined trust in information sources and associated adherence to COVID-19 public health recommendations among people with disabilities living in metropolitan, micropolitan, and noncore counties.
Methods
We recruited participants using Amazon’s Mechanical Turk (MTurk) and screened for disability status (n = 408). We compared sociodemographic groups with t-tests, Pearson’s correlations, and Chi-square, as appropriate. We used linear regression to examine factors associated with trust in information and compliance with CDC recommended COVID-19 practices.
Results
Nonmetro respondents had the lowest trust ratings among all demographic groups, and reported significantly less trust in most information sources. Respondents aged 65 and over reported the highest compliance with CDC recommended practices, while those from nonmetro areas reported the lowest. A regression model for adherence to CDC recommended practices was significant (F = 11.87, P ≤ .001), and explained 33% of the variance. Specifically, increased adherence was associated with being over 65, female, and higher general trust scores. Decreased practices were associated with being nonwhite, nonmetro, higher trust scores in President Trump, and having a communication disability.
Conclusions
Trust in information sources is associated with action. It is important to provide clear, consistent, and non-polarizing messages during public health emergencies to promote widespread community action.
Brief summary of findings on the association between disabilities and severe COVID-19 outcomes
- A B Ryerson
- M Yeargin-Allsopp
- Ken Clark
Ryerson AB, Yeargin-Allsopp M, Clark KEN, et al.: Brief summary of findings on the association between disabilities and severe
COVID-19 outcomes.
Americans with Disabilities Act of 1990. As amended
- Ada Gov
Preventing discrimination against people with disabilities in COVID-19 response
- U N News
The Rehabilitation Act of 1973
- Us Eeoc
Disability and health data system (DHDS). 2022
Centers for Disease Control and Prevention (CDC): Disability
and health data system (DHDS). 2022. Available at https://www.
cdc.gov/ncbddd/disabilityandhealth/dhds/index.html. Accessed
January 31, 2023.
ACL: Strategies for helping older adults and people with disabilities access COVID-19 vaccines. 2021. 17. UN News: Preventing discrimination against people with disabilities in COVID-19 response
- J R Kerr
- Alj Freeman
- T M Marteau
Kerr JR, Freeman ALJ, Marteau TM, et al.: Effect of information about COVID-19 vaccine effectiveness and side effects on
behavioural intentions: Two online experiments. Vaccines (Basel).
2021; 9(4): 379. DOI: 10.3390/vaccines9040379.
15. SAGE Working Group: Report of the SAGE Working Group on
Vaccine Hesitancy. Thousand Oaks, CA: SAGE Working Group, 2014.
16. ACL: Strategies for helping older adults and people with disabilities access COVID-19 vaccines. 2021.
17. UN News: Preventing discrimination against people with disabilities in COVID-19 response. 2020. Available at https://news.
un.org/en/story/2020/03/1059762. Accessed January 31, 2023.
18. CDC: Ensuring equitable COVID-19 vaccine access for older
adults and people with disabilities. 2022. Available at https://www.
cdc.gov/vaccines/covid-19/clinical-considerations/older-adults-anddisability/access.html. Accessed January 31, 2023.
Available at https:// www.eeoc.gov/statutes/rehabilitation-act-1973
- Us Eeoc
US EEOC: The Rehabilitation Act of 1973. Available at https://
www.eeoc.gov/statutes/rehabilitation-act-1973. Accessed August 14,
2023.
National Council on Independent Living: About independent living
- Ada Gov
ADA.gov: Americans with Disabilities Act of 1990. As amended.
Available at https://www.ada.gov/law-and-regs/ada/. Accessed
August 14, 2023.
21. National Council on Independent Living: About independent
living. 2012. Available at https://ncil.org/about/aboutil/. Accessed
August 14, 2023.
22. ACL: Centers for independent living. Available at https://acl.
gov/programs/aging-and-disability-networks/centers-independentliving. Accessed February 6, 2023.