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Responding to the Economy: Raising the Profile of Vaccines for Children

Berns, Abby BA; Blum, Alisa MPA; Etkind, Paul DrPH, MPH

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Journal of Public Health Management and Practice: July/August 2011 - Volume 17 - Issue 4 - p 390-392
doi: 10.1097/PHH.0b013e31821ee13a
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About Vaccines for Children

In the recent recession, increased unemployment brought economic hardship and had repercussions on health care access. Many families lost health insurance or have decreased coverage of medical services such as immunizations.1 As a result, many parents must now pay out-of-pocket costs for childhood immunizations that were previously covered by private insurance. Parents may be forced to choose between vaccination and other more immediate needs. Fortunately, the Vaccines for Children (VFC) program can make such a decision unnecessary.

Vaccines for Children is a federal government safety net program that provides all vaccines recommended by the Advisory Committee on Immunization Practices at no or low cost to eligible children and adolescents (newborns to 18-year olds). Eligibility is determined by insurance status: children without insurance, on Medicaid, and those whose insurance does not cover vaccines are most likely eligible for VFC.2 In addition, VFC covers vaccination for children defined as American Indian or Alaska Native under the Indian Health Care Improvement Act.3 Established in 1994, VFC covers vaccination for approximately 43% of children in the United States; however, many more have become eligible in the current economic crisis.2,4 Because many of these families had previously been covered by private insurance, it is quite possible that they were unaware of their eligibility for the VFC benefit. In September 2010, the National Association of County and City Health Officials (NACCHO) launched a campaign to increase awareness of VFC in an attempt to prevent a decline in immunization rates due to lack of access to immunization services associated with changed insurance status. NACCHO received support from Sanofi Pasteur and partnered with Cooney/Waters, a public relations firm, to develop a direct-to-consumer multimedia campaign. The campaign was designed to leverage local health departments' (LHDs) natural capacity to reach the target population in their own communities and share the information with community organizations. The campaign was designed to resonate among uninsured and underinsured parents, acknowledging the difficult economic climate and offering VFC as a solution to a dilemma. Campaign materials urged the public to ask their LHD or health care provider about VFC. To increase access and expand the reach of the campaign, all materials were developed in English and Spanish. The campaign consisted of 3 phases.

NACCHO's VFC Campaign

The first phase of NACCHO's VFC campaign was launched on September 1, 2010, with a Radio Media Tour (RMT). Dr Herminia Palacio, Executive Director of Harris County (TX) Public Health and Environmental Services, conducted 13 live and taped radio interviews in both English and Spanish. She discussed childhood vaccination in general and VFC in particular. Dr Palacio fielded questions ranging from the inquisitive to the pointed, adeptly bringing the discussion back to the benefits of vaccination each time it strayed. The 3-hour RMT reached nearly 2.5 million listeners, covering 9 regional media markets and 3 national networks.

The second phase of NACCHO's VFC campaign consisted of radio public service announcements (PSAs), aired on AM and FM stations around the country. NACCHO worked with Cooney/Waters to develop 15-, 30-, and 60-second PSAs in English, and a 60-second version in Spanish. These PSAs, with an accompanying NACCHO-branded letter detailing the campaign, were distributed to public service directors nationwide. Public service announcements were also made available to LHDs directly. Some LHDs added their contact information to the script and contacted their local radio station for broadcasting or live reading. The 30-second version read as follows:

Today, more families must choose between health care and other critical needs. Fortunately, the VFC Program provides vaccines to children and teens at no or low cost for uninsured families and others who qualify. To learn if you are eligible for the VFC Program, call your health care provider or your local health department. Vaccines for Children: helping you keep your child healthy. This message is brought to you by the National Association of County and City Health Officials, with support from Sanofi Pasteur.

The third phase of the campaign involved the development and distribution of printed materials. NACCHO and Cooney/Waters created 12″ by 18″ glossy posters and pads of 3″ by 5″ cards (tearpads) for the public to tear off and take home. These materials stressed the importance of vaccination, provided information about VFC, and directed people to contact their health care provider or LHD for more information. Materials featured images of diverse children and families and the NACCHO and public health logos. The posters were available in English or Spanish, and the tearpads were bilingual. Local health departments were able to order materials through the NACCHO's Web site. Posters and tearpads were shipped directly to the LHD free of charge. Local health departments were encouraged to share these materials with partners in their communities.

NACCHO promoted the VFC awareness campaign through a variety of channels. Many NACCHO publications ran announcements about the availability of the free materials: NACCHO Connect, Public Health Dispatch, the immunization/infectious disease e-newsletter, and other program-specific e-newsletters. The campaign was also featured on the homepage, and on several pages on the Web site. NACCHO directly contacted members of their advisory groups by e-mail and shared information with other public health organizations. Social media played a role in promotion with frequent posts on Twitter, Facebook, and LinkedIn. In addition, a handout promoting the materials and featuring the order form Web address was distributed at the 2011 Public Health Preparedness Summit in Atlanta.

To assess the success of various methods of promoting the project, the VFC order form for the printed materials queried how LHDs heard about NACCHO's VFC campaign. Respondents were allowed to select more than one mode of communication. Thirty-four percent learned about the VFC campaign through an LHD colleague, 19% through NACCHO's Web site, 12% through NACCHO's Public Health Dispatch, 11% through a public health partner organization, 10% through NACCHO Connect, 8% through CDC, 7% through e-mail from NACCHO staff, and 10% from other sources. Even though these forms of communication were successful in spreading the message, word of mouth was the most powerful promotional tool.

Assessing the Effectiveness of NACCHO's Campaign

The NACCHO's VFC campaign was well-received. The PSAs reached an audience of almost 134 million with approximately 20 000 airings around the country. Of these airings, 1600 were in Spanish, reaching about 15 million listeners of Spanish-language radio stations. The fair-market value of this on-air time is estimated at $1.1 million. The printed materials portion of the campaign was equally successful. Over a period of 3½ months, 185 LHDs ordered 7040 English posters, 1950 Spanish posters, 1045 English tearpads, and 505 Spanish tearpads. Materials were shipped to LHDs in 36 states, plus Washington, DC, and the US Virgin Islands.

To gauge the utility of the printed materials, NACCHO conducted an evaluation. NACCHO distributed a survey to LHDs that had placed orders for posters or tearpads. The Web-based survey consisted of 3 multiple-choice questions and 2 free-response questions. Representatives from 82 LHDs completed the evaluation. Ninety-five percent of these LHDs responded that the materials met their expectations. Several LHDs customized the posters to include their contact information or local VFC information. The survey asked how LHDs used the posters and tearpads, a question that produced a variety of responses. Most LHDs displayed posters in-house in waiting rooms, examination rooms, and at WIC program sites. A majority placed posters in high-traffic community sites, including schools, daycares, laundromats, community centers, libraries, and grocery stores. Other poster locations included hair salons, homeless shelters, pharmacies, Head Start sites, and federally qualified health centers. One respondent noted, “The plan is to post them in areas accessible to low-income families—recreation centers, soup kitchens, grocery stores, etc. We hope this will reach the highest population of uninsured people, not only to get the word out about the importance of immunizations, but also to let people know how to get them if they cannot afford them.” A goal of the VFC campaign was for LHDs to reach out to community organizations to spread printed materials and information about VFC. Local health departments shared materials with local health care providers, departments of social services, and VFC providers and distributed them at health fairs.

Respondents shared feedback about the posters and tearpads, personally or from partners, staff and the public. The vast majority of this feedback was positive. Multiple respondents reported that the materials were readable, easy to understand, concise, user-friendly, eye-catching, and colorful. “We were impressed by the materials sent to us,” wrote one respondent. “As local health department nurses, we are constantly making the public aware of immunizations.” Local health departments appreciated that materials were available in Spanish and English. One LHD staff member commented, “The materials are very appropriate and very diverse. They [are a good fit] for our area.” Several respondents reported that the ordering and shipping process was prompt and organized. Eighty-nine percent of LHDs reported receiving materials within 2 weeks of ordering. Negative feedback was scarce but suggested that posters could have more clearly explained eligibility requirements for VFC. Overall, LHDs were satisfied with the materials offered through the campaign.


Currently, the PSAs continue to air on the radio and LHDs continue to order posters and tearpads. NACCHO presented a poster detailing the VFC campaign at the National Immunization Conference in March 2011. Measuring the impact of NACCHO's campaign on uptake of VFC vaccine or use of the VFC program is difficult. Even if rates of vaccination through VFC have risen since the launch of the campaign, it is impossible to infer a direct relationship between the 2 occurrences. Local health departments' appreciation for and value of free, customizable materials, helping LHDs spread important and useful information and leverage connections with community organizations is noteworthy. Printing costs alone can prevent LHDs from taking full advantage of educational materials produced by many other public health organizations. Offering preprinted materials removed this barrier. Overall, NACCHO's VFC campaign should be considered an effective model to educate potentially eligible families about a program that allows them to protect the health of their children through vaccination.


To order free posters and tearpads promoting VFC, please visit or contact [email protected]


1. Krisberg K Jump in uninsured signals need to implement health reform: economy takes a tool on health coverage. N Engl J Med. 2011;41(2). Accessed March 2011.
2. Center for Disease Control and Prevention. VFC: For parents [Programs & Tools]. Published February 22, 2011. Accessed March 2011.
3. Indian Health Care Improvement Act. P. L. 94–437, Approved, 1976, 30 (90 Stat. 1400)
4. Birkhead GS, Orenstein WA, Almquist JR Reducing financial barriers to vaccination in the United States. Financing of childhood and adolescent vaccines. Pediatrics. 2009;124(suppl 5):S451–S454.

immunization; local health departments; vaccines for children

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