This Notice of Special Interest (NOSI) highlights the need for research strategies and interventions to address vaccine hesitancy, uptake, and implementation among populations who experience health disparities in the US.* Research is needed to understand and address misinformation, distrust, and hesitancy regarding vaccines (e.g., SARS-CoV-2, pneumococcal, influenza, hepatitis B, human papilloma virus (HPV), and herpes zoster) among adults in the United States and territories, especially in populations at increased risk for morbidity and mortality due to long-standing systemic health and social inequities and chronic medical conditions. The purpose of this NOSI is to solicit community-engaged research to: 1) evaluate intervention strategies (e.g., expand reach, access) to facilitate vaccination uptake in clinical and community contexts; and 2) address the barriers to increasing reach, access, and uptake of vaccinations among health disparity populations at high risk and likely to experience vaccine hesitancy.
United States Food and Drug Administration (FDA)-authorized/approved vaccines, along with effective prevention strategies, are critical for reducing rates of infection and slowing the spread of viruses. Recent viral outbreaks of preventable diseases, such as SARS-CoV-2 (COVID-19) and increasing levels of vaccine hesitancy among populations with health disparities, highlight the need to develop and evaluate strategies to increase vaccine completion. NIH is committed to advancing scientific knowledge on methods to increase access to and uptake of vaccinations to prevent life-threatening illnesses.
There is evidence of disparities in the acceptance and uptake of vaccinations among adults from racial and ethnic minority populations, including vaccines for influenza and HPV. Recent research on influenza vaccination uptake shows a pattern of racial and ethnic minorities being less likely to receive the vaccine, with socioeconomic and clinician/health care system factors (e.g., not offering) playing a role. Research on HPV vaccination uptake shows a similar pattern of racial/ethnic minorities being less likely to initiate or complete the series. Vaccine hesitancy, which includes both a delay in acceptance, or declining immunizations despite the availability of adequate services, is higher for populations experiencing health disparities. The reasons for hesitancy are varied, but may include concerns about perceived safety, skepticism about the trustworthiness of the source(s) of vaccination recommendations, misinformation, considering immunization a low priority, perceived low risk of illness, limited knowledge about the disease or the benefits of vaccination, limited health literacy, difficulty accessing services, clinician bias, cost, or personal, and cultural or religious beliefs discouraging vaccination.
The overall goal of this NOSI is to apply scientific methods to promote the uptake of vaccination among groups that experience health disparities. This NOSI is focused on adults 18 years and older with the exception of HPV-related topics, which may include minors 9 years and older. Effective measures and trusted sources are essential to address and reduce misinformation, build community trust, and to promote widespread vaccine dissemination, population level uptake, and adherence to vaccination protocols. Applications are encouraged to consider upstream factors (e.g., interpersonal, community, health system, policy), as well as relevant cultural and historical factors associated with individual beliefs, risk perceptions, and behavior across multiple levels (e.g., individual, community, etc.). The intervention research development for reducing barriers to access, acceptance, and uptake of vaccines in groups that experience health disparities should undertake or leverage community-engaged methods. Applications on urgent vaccination topics such as the uptake and/or series completion of the SARS-CoV-2 vaccine are encouraged.
Key questions to be addressed include but are not limited to:
- What interventions and strategies are most effective to increase the reach, access, acceptance, and vaccine completion among populations that experience health disparities?
- How can evidence-based interventions that have reduced vaccine hesitancy and increased both access and uptake of other vaccinations (e.g., influenza and HPV) be adapted and/or adopted to increase the uptake of the SARS-CoV-2 vaccine?
- How can social media, digital marketing, and other innovative technologies (such as smart phone applications) be integrated into vaccine promotion interventions to identify and address the sources of misinformation regarding vaccination?
- How can vaccine-related communications on coronavirus, HPV, influenza, and other vaccines be generated and promoted by clinicians and healthcare systems to be community and culturally appropriate?
- What are effective culturally specific and/or community competent approaches for reducing barriers and increasing the vaccination uptake and completion?
- What service delivery or organizational level policies are effective in facilitating broad vaccination uptake and reducing barriers such as stigma, distrust, fear, discrimination, and exposure to misinformation?
- What are effective dissemination and implementation strategies related to vaccination in clinical and community settings?
- What rapid data collection methods (e.g., rapid ethnographic assessments) can be used to identify and prioritize vaccine interventions in communities?
This funding opportunity encourages studies that move away from an exclusively “top-down” public health vaccination approach by emphasizing collaborative partnerships with key stakeholders such as community partners, leaders, and knowledge holders, leveraging community resources and local service delivery settings to enhance vaccine access, delivery, uptake, and ultimate community benefit. Approaches to engage community stakeholders through the research process, such as team science, community-engaged research, participatory action research, empowerment evaluation approaches, community asset mapping, citizen science, and community health workers are strongly encouraged.
Applicants are expected to be able to leverage existing partnerships, such as with Tribal governments and agencies, academic and community medical centers or health systems, safety-net health clinics such as federally qualified health care centers (FQHCs), social service systems, state and local public health departments, community and faith-based organizations, and schools, workplaces, or child care settings, to complete the study aims. Applicants should have a history of successful recruitment and retention of participants within the populations of focus. Projects are expected to incorporate research strategies to: a) address individual and structural social determinants of health (SDOH) (See: PhenX SDOH toolkit: https://www.phenxtoolkit.org/collections/view/6) that present barriers to vaccine access and uptake; b) create sustainable collaborations and implementation in communities disproportionately affected by illnesses for which vaccination is an option; and c) conduct effective communication, co-creation, and dissemination activities to inform communities about the project and its findings. Applicants are expected to have established partnerships with community organizations with whom they will work and projects must have clearly defined the roles for all partners. As appropriate, study budgets should include funds for community collaborations and partnerships to be fully engaged in research design and implementation.
Design, Analysis, and Sample Size for Studies to Evaluate Group-Based Interventions: Investigators who wish to evaluate the effect of an intervention on a health-related biomedical or behavioral outcome may propose a study in which (1) groups or clusters are assigned to study arms and individual observations are analyzed to evaluate the effect of the intervention, or (2) participants are assigned individually to study arms but receive at least some of their intervention in a real or virtual group or through a shared facilitator. Such studies may propose a parallel group- or cluster-randomized trial, an individually randomized group-treatment trial, a stepped-wedge design, or a quasi-experimental version of one of these designs. In these studies, special methods may be warranted for analysis and sample size estimation. Group randomization may not be feasible in some circumstances for community-based interventions among populations who experience health disparities. Applicants should use methods that are appropriate given their plans for assignment of participants and delivery of interventions. Additional information is available at https://researchmethodsresources.nih.gov/.
Applications should also delineate outcomes (such as receipt of target vaccine) and how the intervention or strategies can be sustained and scaled-up to improve population health.
Primary outcomes: Vaccine uptake and/or vaccine series completion per recommendations by the CDC’s Advisory Committee on Immunization Practices (https://www.cdc.gov/vaccines/acip/index.html) as applicable.
Secondary outcomes (include, but are not limited to): Vaccine hesitancy and distrust; community/social vaccine beliefs, misconceptions, misinformation, norms, and risk perceptions; adherence to vaccine protocols; vaccine distribution and implementation across various sectors/settings; implementation of policies to increase individual access and uptake; access to immunization services; service delivery improvements; trust in science supporting vaccine research; trust in government and health organizations providing vaccine recommendations; and anxiety and stigma.
Projects must include a focus on one or more NIH-designated populations who experience health disparities in the United States, which include racial and ethnic minority groups (Blacks or African Americans, Hispanics or Latinos, American Indians and Alaska Natives, Asian Americans, Native Hawaiians and other Pacific Islanders), less privileged socioeconomic status, sexual and gender minorities, and underserved rural populations. Projects that examine or address factors at multiple levels are strongly encouraged (see the NIMHD Research Framework for examples of determinants of health at different levels: https://www.nimhd.nih.gov/about/overview/research-framework/nimhd-framework.html). Research is encouraged among distinct sub-populations based on the country of origin (e.g., Koreans, Vietnamese, Cambodian, etc., rather than Asian Americans).
Projects are also strongly encouraged to support early-stage investigators including those from backgrounds underrepresented in the biomedical workforce to enhance diversity.
URLs for more information:
Submit applications for this initiative using one of the following funding opportunity announcements (FOAs) or any reissues of these announcement through the expiration date of this notice.
Filed Under: Research Announcements