Primary Care’s Historic Role in Vaccination and Potential Role in COVID-19 Immunization Programs

Elizabeth Wilkinson; Anuradha Jetty; Stephen Petterson; Yalda Jabbarpour; John M. Westfall

doi:10.1370/afm.2679

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RE: A Canadian Perspective on the Role of Primary Care in Vaccination in Covid-19
WILLIAM HOGG and Sharon Johnston

Published on: 31 August 2021
RE: Primary Care's Critical and Historic Role in Vaccination and Health Crises.
J Lloyd Michener

Published on: 27 July 2021

Published on: (31 August 2021)
Page navigation anchor for RE: A Canadian Perspective on the Role of Primary Care in Vaccination in Covid-19
RE: A Canadian Perspective on the Role of Primary Care in Vaccination in Covid-19
WILLIAM HOGG, Family Physician, University of Ottawa and Institut du Savoir, Montfort
Other Contributors:
Sharon Johnston, Family Physician and researcher
This article by Wilkinson et al is very relevant to the current Canadian context where family physicians, representing almost 50% of the medical workforce1, have historically provided most vaccinations and are one of the most trusted source of information about vaccinations2. The programs to provide COVID-19 vaccinations to Canadians have been dominated by mass vaccination programs run by hospitals and public health. Community pharmacies have played a smaller but important role. Most Canadian primary care practices were and are not involved in the administration of COVID-19 vaccines. However, as the authors highlight, primary care has traditionally provided the counseling and vaccine education infrastructure on which our vaccination system is built. While many primary care clinics had in person care significantly disrupted or restricted due to the COVID-19 pandemic, the ongoing counseling on vaccines remains a crucial tool in increasing vaccine uptake. The trusting relationship between patients and their family physicians is a recognized asset and unprecedented efforts by public health agencies at all levels have offered COVID-19 vaccine information to family physicians to support their engagement with patients. Family physicians are increasingly being relied on to identify and reach out to those patients who remain hesitant or face unique barriers to vaccination3.
The Canadian Primary care Information Network (see https://en.c...
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This article by Wilkinson et al is very relevant to the current Canadian context where family physicians, representing almost 50% of the medical workforce1, have historically provided most vaccinations and are one of the most trusted source of information about vaccinations2. The programs to provide COVID-19 vaccinations to Canadians have been dominated by mass vaccination programs run by hospitals and public health. Community pharmacies have played a smaller but important role. Most Canadian primary care practices were and are not involved in the administration of COVID-19 vaccines. However, as the authors highlight, primary care has traditionally provided the counseling and vaccine education infrastructure on which our vaccination system is built. While many primary care clinics had in person care significantly disrupted or restricted due to the COVID-19 pandemic, the ongoing counseling on vaccines remains a crucial tool in increasing vaccine uptake. The trusting relationship between patients and their family physicians is a recognized asset and unprecedented efforts by public health agencies at all levels have offered COVID-19 vaccine information to family physicians to support their engagement with patients. Family physicians are increasingly being relied on to identify and reach out to those patients who remain hesitant or face unique barriers to vaccination3.
The Canadian Primary care Information Network (see https://en.cpin-rcip.com/) offers a service which sends a questionnaire to all adult patients of a practice which identifies which patients have not yet received a vaccine along with the reasons why they are hesitant. This information is combined with the patient’s sex, age and educational attainment to segment the patients into groups with distinct information needs. A campaign of messages tailored to the different patient segments is then sent by e-mail or text to the patients. The effectiveness of this service is being assessed by a cluster randomized controlled trial. As we consider approaches to future mass vaccination campaigns, whether for the next flu season or next pandemic, we need to learn the lessons from primary care’s performance during this pandemic in both providing vaccines to our patients and also supporting our patients in accessing trusted evidence based information on vaccines. In our current social-media environment of growing online mis-information, this latter role is increasingly crucial.

1. https://www.cihi.ca/en/a-profile-of-physicians-in-canada-2019
2. https://www.edelman.ca/trust-barometer/edelman-trust-barometer-2021
3. https://www.ontariofamilyphysicians.ca/tools-resources/covid-19-resource...
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Competing Interests: None declared.
Published on: (27 July 2021)
Page navigation anchor for RE: Primary Care's Critical and Historic Role in Vaccination and Health Crises.
RE: Primary Care's Critical and Historic Role in Vaccination and Health Crises.
J Lloyd Michener, Family Physician, Duke School of Medicine
To the Editors:

I would like to commend the authors of “Primary Care’s Historic Role in Vaccination and Potential Role in COVID-19 Immunization Programs” (1) for calling out and documenting the critical role primary care plays in responding to epidemics. As trusted, local providers, primary care clinicians have central roles in providing understandable, trustworthy health information and care, including vaccinations, especially to the most vulnerable. The need for primary care and public health to coordinate planning and activities was highlighted in the 2012 National Academies of Medicine Report, “Primary Care and Public Health: Exploring Integration to Improve Population Health” (2) but it took COVID-19 to accelerate those recommendations, and this report to document the large role primary care plays in vaccination. In addition, examples of primary care groups leading community responses were highlighted in a report on the need for community engagement in responding to COVID-19 (3), while a very recent report discussed how an academic group took on local and state leadership roles (4). Put together, these reports document the central role of primary care as a key partner in working with communities responding to health crises.

Lloyd Michener, MD
Professor Emeritus, Department of Family Medicine & Community Health, Duke School of Medicine
Adjunct Professor, Public Health Leadership, UNC Gillings School of Global Public Health
Board Ch...
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To the Editors:

I would like to commend the authors of “Primary Care’s Historic Role in Vaccination and Potential Role in COVID-19 Immunization Programs” (1) for calling out and documenting the critical role primary care plays in responding to epidemics. As trusted, local providers, primary care clinicians have central roles in providing understandable, trustworthy health information and care, including vaccinations, especially to the most vulnerable. The need for primary care and public health to coordinate planning and activities was highlighted in the 2012 National Academies of Medicine Report, “Primary Care and Public Health: Exploring Integration to Improve Population Health” (2) but it took COVID-19 to accelerate those recommendations, and this report to document the large role primary care plays in vaccination. In addition, examples of primary care groups leading community responses were highlighted in a report on the need for community engagement in responding to COVID-19 (3), while a very recent report discussed how an academic group took on local and state leadership roles (4). Put together, these reports document the central role of primary care as a key partner in working with communities responding to health crises.

Lloyd Michener, MD
Professor Emeritus, Department of Family Medicine & Community Health, Duke School of Medicine
Adjunct Professor, Public Health Leadership, UNC Gillings School of Global Public Health
Board Chair, Foundation for Health Leadership and Innovation
PI, the Practical Playbook

1. Wilkinson E, Jetty A, Petterson S, Jabbarpour Y, Westfall JM. Primary Care's Historic Role in Vaccination and Potential Role in COVID-19 Immunization Programs. Ann Fam Med. 2021 Jul-Aug;19(4):351-355. doi: 10.1370/afm.2679. Epub 2021 Mar 11. PMID: 33707190.

2. Institute of Medicine. 2012. Primary Care and Public Health: Exploring Integration to Improve Population Health. Washington, DC: The National Academies Press.

3. Michener L, Aguilar-Gaxiola S, Alberti PM, Castaneda MJ, Castrucci BC, Harrison LM, Hughes LS, Richmond A, Wallerstein N. Engaging With Communities - Lessons (Re)Learned From COVID-19. Prev Chronic Dis. 2020 Jul 16;17:E65. doi: 10.5888/pcd17.200250. PMID: 32678059; PMCID: PMC7380298.

4. Viviana Martinez-Bianchi, Gabriela M. Maradiaga Panayotti, Leonor Corsino, Irene C. Felsman, Rosa M. Gonzalez-Guarda, Gabriela A. Nagy and Alejandro Peña. Health and Wellness for Our Latina Community: The Work of the Latinx Advocacy Team & Interdisciplinary Network for COVID-19 (LATIN-19). North Carolina Medical Journal July 2021, 82 (4) 278-281; DOI: https://doi.org/10.18043/ncm.82.4.278
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Competing Interests: None declared.