Encouraging Immunization in Iowa

A new partnership, the Iowa Immunization Research Network, is working to increase vaccination uptake and reduce vaccine hesitancy in Iowa.

BY DEBRA VENZKE

Measles has been eliminated in the United States since 2000, but outbreaks of the highly contagious disease continue to occur around the country. As of early May 2024, 131 cases of measles have been reported across 21 U.S. states this year, according to the Centers for Disease Control and Prevention.

Cases are usually tied to international travel, but the disease—which can cause severe health complications—can spread in communities that have pockets of unvaccinated people. While many vaccine-preventable diseases are now rare in the U.S. due to high immunization rates, vaccine hesitancy is increasing, and fewer children and adults are receiving the recommended vaccines, putting them at risk for serious illnesses or even death.

Forming a Research Network

The University of Iowa and Iowa Immunizes, a coalition of individuals and organizations dedicated to improving vaccination rates for all Iowans through education, advocacy, and statewide partnerships, have collaborated to form a new initiative called the Iowa Immunization Research Network (IIRN). The network is working to increase vaccination uptake and lower vaccine hesitancy in Iowa by bringing together a statewide group of researchers, health care professionals, and organizations.

“There’s a lot going on in the immunization field right now,” says Natoshia Askelson, head of the IIRN and associate professor of community and behavioral health in the UI College of Public Health. “New immunizations are being developed at a record pace. At the same time, and some of it is a result of COVID, we have a lot more vaccine hesitancy in our population than we’ve ever had before.

“It’s this perfect storm where we have a lot of really exciting things happening, but if people aren’t ready to embrace those immunizations, then they’re not going to be useful,” she adds. “This is a critical time where we should bring our resources together to think about how we solve these big challenges.”

The IIRN was established in May 2023 and is funded by the Iowa Institute for Public Health Practice, Research and Policy at the University of Iowa as part of the institute’s collaboratory program. A collaboratory (a combination of the words “collaboration” and “laboratory”) is a creative group process designed to solve complex problems and form new organizational networks.

The University of Iowa has a strong foundation in immunization research, Askelson says.

“Researchers in the Carver College of Medicine have been working on clinical trials around immunizations for a long time. Others are trying to figure out what’s driving vaccine hesitancy,” says Askelson. “And we have folks like me who are really interested in how you actually get shots in arms. How do you change clinic practices so that immunizations are more fully embraced and become the norm? The thought for the collaboratory was, ‘How do we all work together so that we can really address this problem from bench science all the way to the clinic?’”

Two additional aims of the IIRN are to help health care providers, pharmacists, dental professionals, and public health experts find and use effective evidence-based strategies that encourage vaccination, and to conduct and share research and help shape future interventions. The network’s long-term goal is to create a center for immunization research at the University of Iowa.

Key Partnerships

The IIRN includes researchers from the University of Iowa Colleges of Public Health, Pharmacy, Dentistry, Liberal Arts and Sciences, the Carver College of Medicine, and University of Iowa Health Care. Organizations are also part of the network, including Iowa Immunizes, American Cancer Society, Iowa Cancer Consortium, and Iowa Department of Health and Human Services.

Iowa Immunizes serves as a strong community partner for the IIRN. “They have a really amazing network of immunization providers, immunization advocates, and people who’ve benefited from vaccines,” Askelson says. The piece that was missing from the picture, she notes, was a research arm, a role that the IIRN now fills.

“Iowa Immunizes is extremely proud of the formation of the Iowa Immunization Research Network and was an early champion,” says Elizabeth Faber, director of Iowa Immunizes. “This collaboration is extremely innovative, and not many states are as engaged with the academic institutions and researchers as we are in Iowa.

“It’s important that we approach public health concerns using sound science and promote evidence-based educational programs and policy,” Faber continues. “By partnering with renowned researchers, we are assured to have the latest information backed by science. Having access to those conducting research also benefits us in our efforts to educate the public, health care officials, and decision-makers about the importance, safety, and development of vaccines.”

Concerning Trends

The CDC recommends children be vaccinated against more than a dozen preventable diseases by the age of 6. All 50 states have legislation requiring specified vaccines for students, and most grant religious exemptions (45 states) or philosophical exemptions (15 states), according to the National Conference of State Legislatures.

“One concerning trend in Iowa is in relation to the rise of religious exemptions across the state,” says Faber. “There are immunization requirements for Iowa children to attend licensed childcare and elementary or secondary schools, unless they have a valid medical or religious exemption. Iowa does recognize personal belief, or philosophical exemptions. Post-COVID, the rise of religious exemptions has risen from 2.6% of students to 3.0% of students. While this may seem like a small amount, many exemptions are in pockets of the state, which can increase the likelihood of a disease outbreak.”

Globally, the public perception of the importance of vaccines for children declined during the COVID-19 pandemic in 52 out of 55 countries studied, according to a 2023 UNICEF report on immunization. The same report warns vaccine hesitancy may be growing due to the confluence of several factors, including uncertainty about the response to the pandemic, growing access to misleading information, declining trust in expertise, and political polarization.

The IIRN is working with its partners to respond to the changing landscape of public perception about vaccines.

“I think there are some strategies that that seem to be really effective across lots of groups, regardless of vaccine, regardless of age, regardless of geography,” says Askelson. “One of them is a strong provider recommendation. There’s a lot of evidence that when your health care provider tells you to do something, you’re just much more likely to do it.”

“The COVID-19 pandemic did teach us many things in terms of messaging and education about vaccines,” adds Faber. “We learned that now, more than ever, the public wants to hear information from trusted sources, such as their own providers. We have also learned that trying to shame or scare the public is not effective. We focus on how vaccines fit into your overall plan for a healthy, productive, and full life.”

Learn more about the Iowa Immunization Research Network at cph.uiowa.edu/iirn/