On Sept. 11, the Food and Drug Administration approved an emergency use authorization for updated COVID-19 vaccines. The next day, the Centers for Disease Control and Prevention released a statement that recommended updated vaccines for people 6 months and older. As these new vaccines become available, it is critical that we improve access to save lives.
We know that vaccine effectiveness and immunity wane over time, which increases susceptibility to infection and the potential for the virus to spread and mutate. The new booster targets XBB.1.5, a recent omicron strain variant, and protects against serious illness and hospitalization, which have been increasing recently. We have a new “effective thing” to fight infection, but its effectiveness relies on access – shots being available – and uptake – shots in arms.
Implementation scientists are a missing puzzle piece to this success. Our job focuses on studying approaches to increase the uptake of effective health services and equitably deploy such services in real-world settings. Implementation science helps bridge the gap between knowledge (what we know) and practice (what we do) through a few key steps. First, we must understand what makes it difficult or easy to implement the “thing.” Second, we need to co-design strategies to implement the “thing.” Third, we need to test the impact and effectiveness of those strategies for continuous improvement.
To date, 70% of all individuals in the United States have completed the primary COVID-19 vaccine series (two doses), of which only 20% of people received a COVID-19 booster. Years since the initial approval, uptake is still poor. Previous trends suggest suboptimal coverage of the new booster. This gap in adoption will exacerbate poor health outcomes, especially among minority communities. We need to figure out how to get COVID-19 vaccines, particularly booster doses, to the people who need them.
This dilemma is at the heart of problems that implementation science aims to solve.
Numerous studies identified barriers to implementation of COVID-19 vaccines, such as health literacy, vaccine hesitancy and transportation. Missing from prior vaccine distribution efforts was acknowledgment that there is this field of science that can help address such barriers. The former federal Coronavirus Task Force consisted of some of the nation’s top clinicians. However, the scientists who dedicate their careers to developing implementation strategies did not have a seat at the table.
As we embark on this next rollout of vaccines, we must harness the science of implementation and center the voice of implementation scientists.
In implementation science, context is queen. Our context since the start of the pandemic has evolved. The federal COVID-19 public health emergency declaration has ended. Vaccination mandates no longer exist. Vaccines are now commercialized. We are faced with greater structural barriers than the first rollout of vaccines – one that resulted in little success, particularly for booster shots. This evolution in context further highlights this imperative.
We must appoint implementation scientists to positions of leadership on task forces working to roll out vaccines. A successful public health response requires the perspectives of individuals with expertise on how to increase the equitable reach of effective interventions.
We must invest in implementation research. The National Institutes of Health has increased investment in the field, but the allocation for discovery-oriented science still far surpasses the study of implementation. Preparation for the next public health emergency requires a shift in focus on developing the evidence base of rigorous implementation approaches now.
We must increase awareness of the field among clinicians, patients and organizations to benefit from the value of implementation science and in the reshaping of vaccine adoption.
The rapid development of COVID-19 vaccines has added effective tools to our public health tool kit. However, new vaccines that sit in freezers will serve little purpose to our community.
We cannot afford to wait until the next wave of COVID-19 cases incapacitates our health system or the next public health crisis emerges. Implementation scientists require a seat at the table to help shape decisions to save lives and improve public health.
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