Role of COVID-19 vaccine education in discharge planning to increase community vaccination coverage.

We read with great interest the study by Danchin and Buttery regarding vaccine hesitancy and challenges regarding the challenges of overcoming vaccine hesitance in the community. With the emergent Omicron variant and waning immunity after the second dose, booster doses will become more important for those with comorbid conditions. We hope to provide suggestions to improve further equitable vaccination coverage within our communities.

Vaccine hesitancy – as discussed by Danchin and Buttery – is a major barrier to achieving timely vaccination targets and is driven by many complex internal and external factors, including socioeconomic status (SES), cultural, health literacy and health information sources that are often entrenched in individual experiences and beliefs. Currently, vaccinations are available in vaccination centres, GP and pharmacies, each presenting logistical barriers that many people face that can prevent timely vaccination despite a willingness to be vaccinated. Understanding the key interplay between these barriers, experiences and beliefs is crucial to addressing the underlying challenges to achieving timely, adequate COVID‐19 vaccination and subsequent booster coverage.

Marginalised populations and people from culturally and linguistically diverse (CALD) communities experience greater barriers to vaccination access and may have reduced access to appropriate vaccination information in their preferred language. With historical marginalisation and mistrust developed towards government and law enforcement, these groups are especially vulnerable to barriers in vaccination. Additionally, factors affecting hospital attendances, including being marginally housed, homeless or of low SES, , , can also disproportionately affect CALD communities. Within key populations with historically poor healthcare engagement, hospital attendances represent a crucial opportunity to provide preventive health messaging and support with culturally appropriate services in a trusted health environment. Hospital admissions could provide an opportunity to address barriers to vaccination including booster dose delivery and develop trust during their patient care journey.

Public hospitals provide care to those most vulnerable to COVID‐19, including patients with multiple comorbidities, elderly people, and people of lower SES and CALD backgrounds who have a higher likelihood of being in households where people are at higher risk of infection or are at greater risk of developing severe complications from COVID‐19. Under‐vaccinated subgroups can also potentiate recurring outbreaks and ongoing community transmission, as seen during the measles outbreak from 2018 to 2019. Consequently, hospitals provide a potential solution to delivering equitable care to under‐vaccinated communities at higher risk of outbreak.

Hospital inpatients often see multiple specialty teams who are well placed to provide education around vaccination and reassurance on specific health concerns that patients may have, providing a clear picture of the benefits of being vaccinated and facilitating linkage to vaccination services upon discharge. Beyond the provision of education, hospitals can potentiate continued care in the community by making appointments with culturally appropriate community health and community GP and pharmacists to increase the chances of patients receiving vaccination. Therefore, hospital services could play a vital role in addressing this critical vaccine coverage gap by introducing vaccination education, counselling, and logistical support as part of routine discharge planning. A review of 31 articles found multidisciplinary, hospital‐based opportunistic vaccination is effective in improving inpatient influenza vaccination.

Even brief clinician advice can have a powerful effect on motivation to shift patient mindset from pre‐contemplative to contemplative stage of change in smoking cessation counselling, where brief advice compared with no advice significantly increases the rate of quitting by more than 50%. Access to medical interpretation services can allow clinicians to provide culturally appropriate education and address the concerns of patients from CALD backgrounds. Hospital pharmacists are an additional source of advice and support when reviewing discharge medications with patients, allaying fears regarding drug‐vaccine interactions. More recently, US hospitals have published experiences of inpatient COVID‐19 vaccination programmes in hopes of demonstrating the possibilities of inpatient vaccination.

The pandemic is constantly evolving, and it is expected that our healthcare systems continue to adapt to the changing public health landscape. As the momentum of vaccination slows and need for booster doses rises, hospitals should play a crucial role in addressing the barriers to vaccine uptake by opportunistically supporting vulnerable patient subgroups.