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New NACCHO Study Shows Over a Doubling of Local Health Department Immunization Spending with Increases in Innovative Service Delivery and Outreach

The National Association of County and City Health Officials (NACCHO), the voice of over 3,300 local health departments across the country, recently released its 2023 Immunization Profile Study, showing that average expenditures more than doubled between fiscal year 2020 and fiscal year 2021, and remained constant throughout fiscal year 2022. Immunization activities have also increased, including a 34% uptick in local health departments conducting immunization-related outreach efforts over the past five years. Local health departments reported shifts in how they provide immunization access, with expanded clinic hours, use of mobile clinics, and more offering school-based immunization clinics. These changes mark important steps to increase immunization access across the country and the need for long-term support in the post-pandemic era.

The report underscores the challenges faced by local health departments since the pandemic and the need for augmented workforce capacity, improved outreach efforts to combat the rise of vaccine hesitancy, and increased investments in data modernization.

The Immunization Profile Study data show both point-in-time information, as well as longitudinal change since 2017, about local health departments’ immunization infrastructure, services, and priorities. Some key findings include:

Immunization Workforce Capacity – Half of local health departments reported limited staffing as a key challenge in conducting immunization-related services, despite the recent growth in the overall workforce driven by COVID-related funding, as reported by the 2022 National Profile of Local Health Departments Study.

  • Between 2017 and 2023, the proportion of local health departments with six or more full-time equivalents (FTEs) dedicated to immunization nearly doubled, rising from 18% to 34%. However, in 2023, local health departments had an average of only one-third of an FTE per 10,000 people in their jurisdiction. Although some agencies experienced an increase in immunization staffing, this growth is likely insufficient to meet their communities’ needs.
  • Additionally, over the past five years, local health departments reported allocating more staff time to immunization-related activities. Approximately 45% of local health departments reported spending an average of more than 20 hours per week on immunization services, an increase from 34% in spending the same amount of time in 2017.

Vaccine Uptake and Access  Among local health departments’ top immunization-related priorities for the next three years are increasing vaccine uptake by bolstering vaccine confidence for youth, ages 5-18 (41%), and early childhood immunizations under 5 (39%), and conducting educational outreach efforts with community partners (37%).

  • Local health departments most frequently improved access to routine immunizations by expanding or newly implementing clinics in community settings (42%) or increasing their walk-in hours/flexible hours of operation (41%).
  • Approximately half of local health departments also partnered with either health care providers or community leaders to improve vaccination uptake.
  • The proportion of local health departments using social and/or traditional media for outreach increased to 90% in 2023 compared to 67% in 2017.
  • Despite the increased activities to expand access and messaging, most local health departments (82%) still reported that vaccine hesitancy was a barrier to conducting immunization-related activities.

COVID-19 Immunizations – Local health departments were key players in vaccinating against COVID-19 by more than doubling their spending on immunization activities and increasing access in under-resourced areas.

  • In the 2022 calendar year, 93% of local health departments provided COVID-19 vaccines to adults and 87% provided them to children and youth. On average, local health departments spent 15% of their time administering these vaccines.
  • Average local health department spending on immunization increased during the COVID-19 pandemic – more than doubling from $267,000 in FY2020 to $606,000 in FY2021. Average expenditures in FY2022 were $626,000 – an estimated 5% of average overall spending based on 2022 Profile Study data.
  • Approximately half of local health departments increased their walk-in/flexible hours of operation (51%) or clinics in community settings (48%) to improve COVID-19 vaccine access. Meanwhile, three in five local health departments increased resources to underserved areas or partnered with health care providers or community leaders to increase uptake of COVID-19 vaccinations.

Immunization Data Capacity – Investing in data capacity ensures that local health department efforts are targeting under-vaccinated populations and addressing the motivations behind vaccine hesitancy; however, challenges in data capacity remain.

  • Despite large federal investments in recent years on public health data modernization, more than half of local health departments used paper records to manage immunization records and vaccine inventory, and 41% reported that interjurisdictional data sharing was a key barrier to their work.
  • Fewer prioritized improving data systems to understand coverage rates (13%), collecting data on community attitudes about vaccine uptake (12%), or updating their immunization information systems (8%).

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