Strategies for improving influenza immunization rates among hard-to-reach populations

David Vlahov, Micaela H. Coady, Danielle C. Ompad, Sandro Galea

Research output: Contribution to journalReview articlepeer-review


Whereas considerable attention has been devoted to achieving high levels of influenza immunization, the importance of this issue is magnified by concern over pandemic influenza. Most recommendations for vaccine administration address high risk groups such as the elderly and those with chronic diseases, but coverage for hard-to-reach (HTR) populations has had less attention. HTR populations include minorities but also include other primarily urban groups such as undocumented immigrants, substance users, the homeless, and homebound elderly. Obstacles to the provision of immunization to HTR populations are present at the patient, provider, and structural levels. Strategies at the individual level for increasing immunization coverage include community-based educational campaigns to improve attitudes and increase motivation for receiving vaccine; at the provider level, education of providers to encourage immunizations, improving patient-provider interactions, broadening the provider base to include additional nurses and pharmacists, and adoption of standing orders for immunization administration; and at the structural level, promoting wider availability of and access to vaccine. The planning process for an influenza pandemic should include community engagement and extension of strategies beyond traditional providers to involve community-based organizations addressing HTR populations.

Original languageEnglish (US)
Pages (from-to)615-631
Number of pages17
JournalJournal of Urban Health
Issue number4
StatePublished - Jul 2007


  • Hard-to-reach populations
  • High-risk populations
  • Immunization
  • Influenza
  • Pandemic
  • Vaccination

ASJC Scopus subject areas

  • Health(social science)
  • Urban Studies
  • Public Health, Environmental and Occupational Health


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