Project Summary/Abstract Broad population immunization is the ultimate mitigation measure for the SARS-CoV-2 (COVID-19) pandemic. Our research team recently conducted the Rapid Evaluation of COVID-19 Vaccination in Emergency Departments for Underserved Patients (REVVED UP) study that identified a particularly vulnerable population whose primary (and often only) health care access occurs in emergency departments (EDs). This group faces major barriers, especially vaccine hesitancy and limited vaccination site access, to receiving COVID-19 and influenza vaccines. African Americans and Latinos, who have suffered disproportionately high morbidity and mortality from the COVID-19 pandemic, comprise 66% of this ED Usual Source of Care group of patients. The goal of this research is to promote equity and increase COVID-19 and influenza vaccine acceptance and uptake in ED Usual Source of Care patients by developing and delivering trusted messaging and informational platforms (PROmotion of COvid-19 VA(X)ccination in the Emergency Department – PROCOVAXED) that address vaccination barriers, especially vaccine hesitancy. The investigator team, consisting of diverse faculty at four US medical schools, has substantial experience in addressing health care disparities in ED populations, including those that relate to vaccine uptake and hesitancy. Toward gaining insight about effective trusted messaging (Specific Aim I), we will convene and meet with ED Usual Source of Care patient focus groups, consisting of people whose primary health care access is in EDs and members of community partner organizations that serve those populations, in four cities (San Francisco, Philadelphia, Seattle, and Durham, North Carolina). In Specific Aim II we will harmonize data from our focus group meetings with other modules and instruments from national repositories (e.g., the Social Determinants of Health Collection of the PhenX Toolkit) to produce PROCOVAXED platforms, consisting of video clips, printed materials and face-to-face patient messaging that address ED Usual Source of Care patients' barriers to COVID-19 and influenza vaccination, especially vaccine hesitancy. Toward Specific Aims III and IV, we will then conduct a 14-month cluster-randomized, controlled trial of PROCOVAXED platform implementation in six safety net EDs (intervention delivered during patient ED visits), testing the hypothesis that implementation of PROCOVAXED trusted messaging platforms in EDs is associated with increased acceptance and uptake of COVID-19 and influenza vaccines in ED Usual Source of Care Patients. We have engaged a powerful set of stakeholders, including six major hospital systems, seven minority advocacy and faith-based organizations, and the two largest US Emergency Medicine professional organizations, who are committed to disseminating our findings and broadly implementing PROCOVAXED platforms. Our research will be a public health game-changer that paves the way towards ED-based public health messaging and delivery of COVID-19 and influenza vaccines to vulnerable, hard to reach populations.

Project Narrative The goal of this research is to increase COVID-19 and influenza vaccine acceptance and uptake in vulnerable populations whose primary (and often only) health care access occurs in emergency departments (ED Usual Source of Care Patients). Toward this goal we will conduct focus groups with ED Usual Source of Care Patients and community partners and produce trusted messaging informational platforms (PROmotion of COvid-19 VA(X)ccination in the Emergency Department – PROCOVAXED) that will address barriers to COVID-19 and influenza vaccination, especially vaccine hesitancy. We will then conduct a cluster-randomized, controlled trial of PROCOVAXED platforms in six EDs to determine whether their implementation is associated with greater COVID-19 and influenza vaccine acceptance and uptake in ED Usual Source of Care Patients.