Measuring the Success of the US COVID-19 Vaccine Campaign

It's Time to Invest in and Strengthen Immunization Information Systems

Jade Benjamin-Chung, PhD, MPH; Arthur Reingold, MD


Am J Public Health. 2021;111(6):1078-1080. 

How to Strengthen IISs

According to the Advisory Committee on Immunization Practices (ACIP), IISs have the potential to ensure proper vaccination dosage, generate reminders about upcoming vaccinations, minimize vaccine waste, reduce time spent locating vaccination records, and evaluate vaccine campaigns. We believe there are three key improvements that, if undertaken, will unlock this potential.

First, IISs must receive all vaccination records, including those of older children and adults. A 2012 study estimated that 42% of states and localities operating IISs lacked a reporting mandate for vaccine providers.[3] Without reporting mandates, data are typically incomplete, and IISs cannot reliably evaluate vaccination campaigns. While reporting to IISs is high for young children's vaccination records (96% in 2019), it is lower for older children and adults (82% for 11–17 years and 60% for ≥ 19 years in 2019).[4] The pandemic response effort will require immunization data for all ages, especially older adults, who are more vulnerable to COVID-19.

Second, IISs require more complete demographic information. Race/ethnicity, occupation, and residence type (e.g., long-term care) data are needed to facilitate prioritized SARS-CoV-2 vaccine administration. Occupation and residence type are not included in the CDC's recommended core IIS data elements, although the CDC's pandemic plans prioritize risk groups by occupation. Race/ethnicity data are included but are incomplete in some IISs, preventing the examination of vaccination disparities based on these variables.[5] Vaccine hesitancy is greater in Black populations, and minorities have been disproportionately impacted by the pandemic.[6] Identifying gaps in vaccination coverage by race/ethnicity is essential to reducing such inequities.

Third, increased linkage between IISs and EHRs is needed to support more rigorous evaluations, thereby increasing vaccine campaign effectiveness. If linked with EHR data, IIS data could be used to help assess SARS-CoV-2 vaccine effectiveness and safety within age and race/ethnicity subgroups. The unprecedented speed of SARS-CoV-2 vaccine development makes postlicensure evaluation especially important. Such data linkage would also benefit evaluations of school-based influenza and human papillomavirus vaccination programs, among others. However, interoperability between IISs and EHRs is often limited because of conflicting regulations governing IISs and patient privacy.[3]