If you didn’t get your second Shingrix, will you get your second Covid-19 Vaccine?
Vaccine Compliance among older adults. Why and why not?
As we all know, the Coronavirus vaccine rollout is happening and priority groups are receiving their doses. Up first are the front line workers, medical professionals, and next are older adults with no autoimmune disorders. This all sounds great but there’s a problem: the vaccine comes in two doses and people will be fully vaccinated after about six weeks of waiting. Staying on the vaccine timeline between first and second dose is essential for it to be effective, so if you wait too long in between, you may have wasted the 1 of 100,000 doses available, and your first dose will be null in void.
So will people follow through on the 2-stage vaccination process?
The Kaiser Family Foundation looked at a similar population with a similar vaccine process: Shingrix, the Shingles vaccine. Shingles primarily affects older adults so this was a good sample group. The Shingrix vaccine also requires two stages of shots, with the second dose administered 2-6 months after the first. The question is: if people didn’t get their second Shingrix vaccine, can we trust that they will follow the Covid vaccine rules?
And less about the individual simply not following the guidelines of the vaccine, are there reasons that they aren’t? Who is affected? These answers will help us to roll out a Covid vaccination process that will make sure inequity is not disproportionately changing the outcome of vaccination in different communities.
According to Kaiser Family Foundation: “The majority of Medicare beneficiaries who received an initial dose of the Shingrix vaccine received the second dose within six months, but follow-up rates were lower among beneficiaries in communities of color, those who are younger than age 65 with long-term disabilities, and low-income beneficiaries.” The numbers look like this: 1 in 4 beneficiaries (26%) who received an initial dose of Shingrix between January and June 2018 did not receive the second dose within the recommended timeframe. An additional 6% of beneficiaries received the second dose after the 6-month timeframe but no later than the end of 2018.” - KFF
Further research shows that those who do not receive the second dose of the vaccine “on time” encounter other issues such as cost, transport, proper communication, etc. These reasons are all tied to health equity or perhaps inequity, that dictates who gets what and when, from the health system. Now let’s keep in mind the Shingrix vaccine can cost up to $57 with the average covered (having insurance/Medicare) individual paying $5. Cost is still cost and this does create barriers. Luckily the Coronavirus vaccine will be for people who already qualify for Medicare and Medicare is required to cover the cost of vaccination. But those other issues still remain: proper communication on the dosage guidelines, transportation, etc.
So how do we make a plan to mitigate these things? KFF suggests several methods that helped with Shingles, but it’s important to note that the Shingrix vaccine has a long time period in between doses (up to 6 months) whereas the Coronavirus vaccine will have a maximum of 3-4 weeks between doses. Pharmacist reminders were one effective tool, online medical portals are another, but if you are not “in the system” it’s going to be difficult for you to receive a reminder unless the patient themselves are proactive.
Additionally, the language of education is something that the health system needs to examine. People need to hear the correct directions for care in their own language. This isn’t something to scoff at because there are only 100,000 total doses of the vaccine and each person needs two, leaving us with 50,000 vaccines. Meaning that if you simply didn’t understand the nurse providing the vaccine, you will not comply and you will not know how to ask your questions to make sure you can comply.
It is projected that compliance will be higher with the Coronavirus vaccine because of the hellish death tolls we’ve seen for months and how much daily life has changed. People will want to comply simply for their own life improvement, lack of fear, and ability to return to some level of normalcy.
The takeaway here is that the healthcare system needs to make a point to learn from the lessons we’ve all seen come to light over the past year: the health system is unequal. People of color have experienced higher death tolls and greater overall economic impact due to the virus. The healthcare systems in predominantly black communities are so overburdened that preventative care or proper communication are an afterthought. Looking forward, the healthcare system can use the desperate state of affairs that the pandemic created to rise from the ashes and start making changes toward looking at our multiracial healthcare system as a whole and not in parts.
Source:https://www.kff.org/medicare/issue-brief/who-didnt-get-a-second-shingrix-shot-implications-for-multidose-covid-19-vaccines/