Healthcare provider and medical student impressions of vaccine hesitancy in Romania.

Objectives: Vaccine hesitancy, including vaccination delay and refusal, threatens gains made to improve global health. Recent outbreaks of measles attributed to lower vaccination rates and the COVID-19 pandemic have added urgency to the need for current and future healthcare providers to effectively identify and address barriers to vaccination. Study design: Cross-sectional interviews and online surveys. Methods: Healthcare providers in Cluj-Napoca, Romania were interviewed. Transcripts were translated for inductive coding. Medical students at the Iuliu Hațieganu University completed an online survey accessed via a university social media group. Descriptive statistics were calculated for each survey question. Results: Practicing clinicians lack confidence in their ability to communicate risks and benefits of vaccination, including the need to use social media for this purpose and seek greater support from the Ministry of Health and parents. Medical students have higher confidence in national and local health officials than practitioners. Conclusion: Neither practicing clinicians nor medical students feel adequately prepared to effectively address vaccine hesitancy. They need additional support from health authorities, particularly around communication and policy.

Long-Term Care Planning, Preparedness, and Response Among Rural Long-Term Care Providers.

OBJECTIVE: Rural Long-term Care (LTC) providers face unique challenges when planning, preparing for, and responding to disasters. We sought to better understand challenges and identify best practices for LTC in rural areas. METHODS: Case studies including key informant interviews and site visits were conducted with LTC staff and emergency planning, preparedness, and response partners in three rural communities. Themes were identified across sites using inductive coding. RESULTS: Communication across disaster phases continues to be a challenge for LTC providers in rural communities for all disaster types. Communication challenges limit LTC providers' ability to address patient needs during emergencies and limit the resilience of providers and patients to future disasters. Limited coordination among local leadership and LTC providers prevents dissemination of information, resources, and services, and slows response and recovery time. Including LTC providers as stakeholders in planning and exercises may improve communication and coordination. CONCLUSION: More than two decades into efforts to increase preparedness of health care systems to all hazards, rural LTC facilities still face challenges related to communication and coordination. Agencies at the federal, state, and local level should include input from rural LTC stakeholders to address gaps in communication and coordination and increase their disaster resilience.

Public Health Student Response to COVID-19.

To understand the role public health students play in response to COVID-19 despite cuts in funding for graduate student emergency response programs (GSERPs), we reviewed the websites of the Association of Schools and Programs of Public Health, Council on Education in Public Health, and individual schools and programs to identify student participation in COVID-19 response activities. Thirty schools and programs of public health are supporting public health agencies in response to COVID-19, primarily through the provision of surge capacity (n = 20, 66.7%), contact tracing (n = 19, 63.3%), and training (n = 11, 36.7%). The opportunity to participate in formal and informal applied public health experiences like practica, service-learning, and field placements can benefit both public health students and agency partners. Although recent publications have identified gaps in academic public health response to COVID-19, in part due to the cessation of funding for workforce development and other university-based programs in public health preparedness, schools and programs of public health continue to support public health agencies. Future funding should explicitly link public health students to applied public health activities in ways that can be measured to document impacts on public health emergency response and the future public health workforce.

Associations Between State Public Health Agency Structure and Pace and Extent of Implementation of Social Distancing Control Measures.

OBJECTIVE: To assess associations between state public health agency governance and timing and extent of implementation of social distancing control measures during COVID-19 response. DESIGN: State public health agencies were stratified by governance, and data on timing and extent of social distancing were collected from the Institute for Health Metrics and Evaluation. Multinomial logistic regression and time-to-event analyses were conducted to quantify impacts of governance structure on timing and extent of social distancing. SETTING: State health departments in the United States. RESULTS: States operating under centralized public health governance structures enacted social distancing 4 days after decentralized states and had a 73% reduced likelihood of enacting a social distancing policy (hazard ratio = 0.27; 95% CI, 0.08 to 0.86). CONCLUSION: State health department governance structure may have implications on timing and extent of social distancing control measures implemented during a public health emergency.