Healthcare Researchers: Use Digital Health Strategies to Boost Vaccine Education, Distribution

Could the use of digital health strategies improve the health equity of the process around the current nationwide effort to vaccinate the U.S. population to protect our citizens and residents from the COVID-19 virus? A team of healthcare policy leaders has published an article in the Health Affairs Blog arguing exactly that proposition.

“Accelerating Digital Health To Achieve Equitable Delivery Of The COVID-19 Vaccine” was published on Friday, Jan. 29 by Shantanu Nundy, M.D., Kavita K. Patel, M.D., and Mark Sendak, M.D.. Shantanu Nundy, M.D., MBA, is a practicing primary care physician and chief medical officer at Accolade Inc., a population health company that provides personalized health and benefits solutions for employers. He also serves as a professorial lecturer at the George Washington University Milken Institute of Public Health. Kavita K. Patel, M.D., MSHS, is a nonresident fellow at the Brookings Institution and a primary care physician. Mark Sendak, M.D., MPP, is the population health and data science lead at the Duke Institute for Health Innovation, where he leads interdisciplinary teams of data scientists, engineers, and clinicians to develop and implement new care delivery models. In March, he helped launch the Pandemic Response Network.

As the authors note that “The COVID-19 pandemic has spurred a dramatic acceleration in digital health including telemedicine, remote monitoring for chronic conditions, and mobile apps for contact tracing, as well as school and small-business safety monitoring. Perhaps the best-known example is the use of telemedicine to facilitate safe and effective means of triaging and accessing COVID-19 testing—including for individuals who have traditionally been poorly served by the health system. The National Association of Community Health Centers determined that approximately 49 percent of visits in federally qualified health centers were conducted virtually in May 2020 during the first peak of the pandemic.”

Meanwhile, they note that, “With the promise of new vaccines, there has been great speculation around how to distribute the vaccine in historically marginalized communities, including racial and ethnic minorities and individuals living in poverty, who have been disproportionately affected by COVID-19. With the advent of multiple vaccine options that have early evidence of high efficacy, a pressing question for policy makers is the role, if any, of digital health in delivering vaccines equitably.” The researchers believe that “digital health has the potential to facilitate a more widely distributed model of vaccine delivery that can help reach traditionally underserved populations.” Indeed, they write, “Health information technology systems and deeply engaged networks of community-based and faith-based organizations will be critical.”

Nundy, Patel, and Sendak point out “three key challenges of vaccine delivery”: “lack of trust,” “lack of access to care,” and “lack of efficacy data.” Among other issues, they note that in many communities, there is a lack of trust in healthcare institutions; a lack of sources of trusted information about vaccines; and a lack of regular primary care physician coverage of vulnerable populations. Indeed, they note that “One-quarter of U.S. adults and higher proportions of Latino and Black individuals lack an identified source of primary care, which woud be the most natural place for them to receive the COVID-19 vaccine. Vulnerable health populations also face logistical and financial barriers to access, including distance, lack of transportation, and inflexible wrk or family obligations.”

The authors note that “Digital health can help spread accurate and personalized health information about the vaccine to the community. One model to consider is the public-private partnership Text4Baby, which provides expectant mothers with reminders, health information, and information about community resources through text messages and a mobile app–based system. By texting BABY in English or BEBE in Spanish or downloading a free mobile app, women subscribe to the service and receive evidence-based information timed to their stage of gestation through their mobile phone.” Such mechanisms, they argue, could help inform members of the public, especially in vulnerable communities, to access information on where to get vaccinated and when to receive follow-up doses.

The authors write that, “In addition, many patients require help in navigating the health system. At Accolade (where one of the authors works), we provide population health services for US employers using telephone and mobile-based support. What we found in the initial months of the pandemic is that 90 percent of calls for COVID-19 were not for symptom triage or testing, but for transportation, logistics, and financial issues. Such contextual barriers are well-known drivers of health care disparities.” Another mechanism might be “WeMUNIZE, a mobile health registry developed in Nigeria. WeMUNIZE is an automated scheduling, GPS-enabled software as a service that uses a mobile app to increase uptake of routine immunization,” they note. “One particularly relevant feature is the use of robocalls featuring voice recordings from influential community leaders to encourage immunization. Given the importance of trust to the delivery of the new COVID-19 vaccine, a similar feature could be used to amplify the voices of local leaders who historically disadvantaged communities already trust.”

They note that, “To equitably distribute the vaccine in disadvantaged communities, it will likely be necessary to move vaccination out of traditional health care facilities and into the community. Potential sites of vaccination include schools, churches, barbershops, mobile vans, and homes. The benefits of “meeting patients where they are” are well known but also come with new challenges. One of the challenges with out-of-facility care is that it shifts the logistical burden of care from health systems to smaller entities that must quickly learn how to navigate the administrative burden associated with vaccine delivery. Taking care out of the clinic where there are billing and documentation systems also creates challenges with supply-chain management and tracking.”