Abstract
Vulnerable populations such as the uninsured, unemployed, and unhoused face significant morbidity and mortality from influenza but are less likely to receive the annual vaccine and have limited access to medical care. We describe an interprofessional, student-run vaccine outreach program (VOP) in Davidson County, Tennessee that lowers barriers to vaccination through free vaccination events in nontraditional community locations. We provide this framework as a model to expand novel, seasonal, or outbreak-oriented vaccine outreach to resource-poor populations. Demographic data were collected from the patients who received an influenza vaccine between 2015 and 2019 through an optional survey to determine whether these events were reaching unhoused, uninsured, and/or unemployed individuals. Of 1,803 patients, 1,733 (96.1%) completed at least one field of the demographic form. Overall, 481 (27.8%) were individuals without homes or living in temporary housing and 673 (38.8%) were unemployed. Most patients, 1,109 (64.0%), did not have health insurance at any point during the prior two years. With the addition of a nurse practitioner student to VOP leadership, the 2018–2019 VOP reached the most homeless or temporarily-housed (228, 32.3%), unemployed (313, 18.5%), and disabled (60, 8.5%) patients. The VOP can be adapted to meet community needs, funding, and volunteer interest. The VOP model may be applicable to a SARS-CoV-2 vaccine, especially since the economic impact of COVID-19 has increased unemployment rates and housing instability. Healthcare students serve as an eager, underutilized resource who can be leveraged to disseminate vaccines to individuals with limited access to care.
Introduction
For marginalized populations, access to high-value, high-quality medical services is limited and directly impacts vaccination status.1 A 2005 study in Davidson County, Tennessee found that access to a primary care provider, health insurance, and employment predict influenza vaccination.1 Over the last five years, less than half of the Tennessee population has received an influenza vaccination (36.4–49.1%), with comparable influenza vaccination uptake in Davidson County (49% in 2016 and 2017).2,3 Compared to the average Tennessee resident, individuals who experience homelessness are persistently undervaccinated and the most vulnerable to communicable diseases.4 This population has a high burden of episodic respiratory illness that is more likely to lead to complications due to infection frequency and underlying chronic disease(s)—which makes them especially high risk for COVID-19-related morbidity and mortality.4,5 Davidson County contains approximately one-third of the unhoused population in Tennessee, with counts ranging from 1,986 to 2,365 people over the last five years.6
Many Tennesseans with homes still face unemployment, lack insurance, or require disability support. At baseline, 2.6–6.5% of Davidson Country residents were unemployed over the last five years, compared to 3.5–8.2% in Tennessee overall, and 13–19% were uninsured, compared to 11–16% in Tennessee overall.3 In 2017, 10.5% of Davidson County residents utilized disability benefits compared to 15.4% in the state.7 Other barriers to influenza vaccination may include low health literacy or English proficiency. From 2015–2020, percent of people not proficient in English in Davidson County ranged from 3.9–5% (1–2% in Tennessee) and high school graduation rates ranged from 77–80% (86–90% in Tennessee).3 The COVID-19 pandemic has exacerbated these existing problems by increasing unemployment, leaving people at risk for job, insurance, and housing loss.8 Our literature review (see supplement for search terms) shows that student-run influenza vaccination programs in the U.S. have increased vaccination rates.9,10,11,12,13 Prior student-run vaccination clinics have also reported high patient satisfaction.12,13 However, these programs are not consistently interprofessional, independently funded, or community location-based. Implementation of an interprofessional volunteer work force increased the success of one student-run community vaccination program, indicated by increased number of volunteers and expansion of services, but the events were only offered on a single day.11
The Vaccine Outreach Program (VOP), founded in 2009, responded to a call to action for community-based vaccine outreach efforts in Davidson County.1 It is an alternative student-run vaccination model that combines interprofessional leadership11 with the structure of community outreach events offered over several weeks10 to create a sustainable, adaptable immunization program that provides free influenza vaccinations to uninsured, unemployed, and unhoused individuals with high barriers to vaccination. We describe the demographics of patients vaccinated during four influenza seasons to show how academic medical centers in urban areas can leverage healthcare students to improve vaccination rates among patients in their community who might otherwise be overlooked by the healthcare system. Healthcare students are uniquely positioned to assist with vaccination due to their medical training, intermediate certification, and relatively flexible schedules compared to working physicians, nurses, and pharmacists.14 This is especially important in the era of COVID-19, as students are an eager and underutilized workforce who can rise to the challenge of widely administering a SARS-CoV-2 vaccine, as they have risen to the challenge of other student-driven projects during the ongoing pandemic.14
Methods
Setting
Vanderbilt University School of Medicine’s (VUSM) student-run free clinic, Shade Tree Clinic (STC), was founded in 2005 to provide medical care at no cost to uninsured residents of Davidson County in partnership with Vanderbilt University Medical Center (VUMC). STC is staffed by Vanderbilt medical students, nursing students, and University of Tennessee College of Pharmacy students, who provide comprehensive medical care to un(der)insured patients under the oversight of VUMC physicians and nurse practitioners. STC’s community outreach programs expand the reach of its health interventions by providing medical services to individuals outside of the patient panel.
STC’s Vaccine Outreach Program (VOP) provides free influenza vaccines to vulnerable populations in Davidson County. From 2009 to 2018, two to four medical students each year led the initiative as VOP Coordinators during their first year of medical school training. Although nursing students participated in events during prior years, the 2018–2019 influenza season was the first year a nurse practitioner student joined the leadership team. From 2015 to 2019, 1,803 influenza vaccines were administered at these outreach events. Figure 1 provides an example of the scope, locale, and target populations of the events through a breakdown of the 2018–2019 VOP season.
Figure 1:
(Left) Map of Vaccine Outreach Program (VOP) events in Davidson County, TN with the (right) frequency of events at each location and its corresponding poverty level from 2017 American Community Survey data based on location zip code.15 The community partners who provided access to these sites included the Jefferson Bridge Ministry, Napier Community Outreach and Resource Center (NCORC), Nashville International Center for Empowerment (NICE), Room in the Inn, Siloam Health, and the YWCA.
Vaccine Outreach Program Overview
The previous year’s VOP Coordinators and the STC Dispensary and Community Outreach Directors train the incoming VOP Coordinators each September. VOP Coordinators are responsible for leading vaccination events, obtaining the necessary staff and supplies, recruiting community partners, and maintaining the vaccine cold chain. Community events occur between late September and January to align with rising influenza transmission in October and November, which typically reaches its apex between December and February.16
Interprofessional collaboration between nurse practitioner students with registered nursing licenses, medical students, nursing students, and pharmacy students is foundational to the VOP model. Healthcare students administer vaccines under the direct supervision of a licensed registered nurse, pharmacist with a Doctor of Pharmacy, or physician.
VOP Coordinators contact community organizations that serve vulnerable populations in Davidson County to schedule vaccine events. Examples include Siloam Health, a local clinic that serves and conducts community outreach in immigrant and refugee populations; the Bridge Ministry, which serves individuals who are experiencing homelessness; and the Nashville Community Outreach and Resource Center, which serves housing-insecure, low-income, and otherwise vulnerable populations. For Siloam Clinic, VOP Coordinators have a predetermined list of uninsured, refugee, or immigrant patients at Siloam who have been contacted in advance by the clinic. At most events, community partners advertise that free influenza vaccinations will be offered on a certain day. These events usually coincide with an event by the community partner, such as meal distribution, that attracts their target population. At these events, VOP volunteers have one-on-one conversations with potential patients about the influenza vaccine and recruit interested individuals to the vaccine station. All individuals who attend our events are eligible to be screened for influenza vaccination. Prior to the event, VOP Coordinators work with community partners to predict the languages spoken by event participants and recruit appropriate interpreters. For other languages, VOP volunteers use a telephone-based medical interpreting service. Influenza Vaccine Information Statement (VIS) forms are available to patients in various languages from the Centers for Disease Control (CDC) website.17
The VOP purchases single-dose influenza vaccine vials through Vanderbilt University Hospital Central Pharmacy. Although the price of the influenza vaccine varies per year, STC applies annually to a Nashville community-based grant designed to support organizations that assist individuals experiencing homelessness. This community grant covers most of the expense—approximately $25,000 per influenza season depending on the number of standard dose and high dose vaccinations administered. In the circumstance that the community grant is not awarded to the VOP, a smaller scale version of the program could be supported by STC’s annual budget, with emphasis of the VOP’s financial need at STC’s biannual major fundraisers. Additionally, the CDC offers grant opportunities for preventative health programs that may be utilized in funding an expanded program to distribute a novel SARS-CoV-2 vaccine.18
Workflow
Volunteers are selected on a first-come, first-serve basis through an online signup system. Although medical and nursing students do not receive course credit, pharmacy students receive credit towards their program for community vaccine administration.
At each event, one to six student volunteers provide influenza vaccine education and gather informed consent. Between 2015 and 2019, patients had the option to complete demographic forms that recorded information on gender, age, housing status, employment status, location of residence, disability status, insurance status, frequency of influenza vaccination, and race. Demographic groups were modeled after the United States Census Bureau American Community Survey.9 This was deemed exempt by the VUMC institutional review board (#191027).
Eligible patients are then escorted to a vaccine station for vaccine administration. One registered nurse and up to four medical students or nursing students staff a typical vaccine station, which is equipped with standard vaccination supplies. Before vaccine administration, the registered nurse teaches student volunteers how to draw up the vaccine, maintain aseptic technique, and identify an appropriate vaccination site. Each medical or nursing student without a state-issued license administers vaccines under the supervising registered nurse’s license. Pharmacy students certified to administer vaccines work independently at a single station but cannot oversee medical or nursing students.
After vaccine administration, student volunteers record the injection site, vaccine lot number, vaccine expiration date, adverse events, and the name of the vaccine administrator. Children under eight years old are not vaccinated at these events to minimize the potential for first-time adverse reactions and the need for shorter needle lengths. There has never been an on-site adverse reaction. A health record is not generated for each patient, although consent documents are scanned into a secure location and the VOP provides documentation to patients who request proof-of-vaccination.
During the event, influenza vaccines must be maintained between two and eight degrees Celsius and cannot deviate out of this range for more than 30 minutes. VOP Coordinators establish and monitor a cold chain for the influenza vaccines through temperature monitoring of vaccine coolers. They report any temperature excursions to VUMC pharmacy leadership to confirm vaccine safety and effectiveness.
Statistical Analysis
Data were collected on paper forms at each vaccine event from 2015 to 2019 across four influenza seasons. VOP Coordinators manually entered deidentified data into Excel spreadsheets at the end of each influenza season and used MATLAB Version R2018b (The MathWorks Inc., Natick, Massachusetts) to generate descriptive statistics of patient demographic information by program year from 2015 to 2019. In the 2015–2016 season 432 out of 453 (95.4%) patients filled out at least one section of the demographic form. Of note, demographic forms were not provided during an event that served 21 patients in 2016. In the 2016–2017, 2017–2018, and 2018–2019 seasons, 297 out of 297 (100%), 297 out of 297 (100%), and 707 out of 756 (93.5%) patients filled out at least one section of the demographic form, respectively. Not all participants completed the full survey (Table 1).
Table 1.
Vaccine Outreach Program patient demographic data from the 2015–2016 to the 2018–2019 influenza seasons.
| 2015–2016 | 2016–2017 | 2017–2018 | 2018–2019 | Total | ||
|---|---|---|---|---|---|---|
| n (%) mean (SD) |
n (%) mean (SD) |
n (%) mean (SD) |
n (%) mean (SD) |
n (%) mean (SD) |
||
| Number of Patients | 432 | 297 | 297 | 707 | 1733 | |
| Mean Age | 40.9 (18.6) | 42.7 (13.9) | 38.8 (15.8) | 40.9 (18.1) | 40.8 (17.2) | |
| Gender | Female | 224 (51.9) | 160 (53.9) | 127 (42.8) | 333 (47.1) | 844 (48.7) |
| Male | 197 (45.6) | 133 (44.8) | 168 (56.6) | 358 (50.6) | 856 (49.4) | |
| Missing | 11 (2.5) | 2 (1.3) | 2 (0.7) | 16 (2.3) | 33 (1.9) | |
| Housing | Permanent | 300 (69.4) | 227 (76.4) | 207 (69.7) | 438 (62.0) | 1172 (67.6) |
| Temporary | 79 (18.3) | 55 (18.5) | 51 (17.2) | 134 (19.0) | 319 (18.4) | |
| Homeless | 41 (9.5) | 0 (0.0) | 27 (9.1) | 94 (13.3) | 162 (9.3) | |
| Other housing | 3 (0.7) | 3 (1.0) | 8 (2.7) | 1 (0.1) | 15 (0.9) | |
| Missing | 9 (2.1) | 12 (4.0) | 4 (1.3) | 40 (5.7) | 65 (3.8) | |
| Employment | Full time | 125 (28.9) | 130 (43.8) | 105 (35.4) | 200 (28.3) | 560 (32.3) |
| Part time | 74 (17.1) | 39 (13.1) | 39 (13.1) | 98 (13.9) | 250 (14.4) | |
| Unemployed | 110 (25.5) | 119 (40.1) | 131 (44.1) | 313 (44.3) | 673 (38.8) | |
| Missing | 123 (28.5) | 9 (3.0) | 22 (7.4) | 96 (13.6) | 250 (14.4) | |
| Race | White | 172 (39.8) | 69 (23.2) | 28 (9.4) | 131 (18.5) | 400 (23.1) |
| Black/African American | 57 (13.2) | 7 (2.4) | 51 (17.2) | 99 (14.0) | 214 (12.3) | |
| American Indian | 5 (1.2) | 0 (0.0) | 2 (0.7) | 5 (0.7) | 12 (0.7) | |
| Asian/Pacific Islander | 19 (4.4) | 43 (14.5) | 74 (24.9) | 88 (12.4) | 224 (12.9) | |
| Middle Eastern | 64 (14.8) | 138 (46.5) | 24 (8.1) | 50 (7.1) | 276 (15.9) | |
| Other | 0 (0.0) | 0 (0.0) | 18 (6.1) | 1 (0.1) | 19 (1.1) | |
| Missing | 115 (26.6) | 40 (13.5) | 100 (33.7) | 333 (47.1) | 588 (33.9) | |
| Ethnicity | Hispanic | 147 (34.0) | 59 (19.9) | 66 (22.2) | 290 (41.0) | 562 (32.4) |
| Not Hispanic | 245 (56.7) | 200 (67.3) | 214 (72.1) | 284 (40.2) | 943 (54.4) | |
| Missing | 40 (9.3) | 38 (12.8) | 17 (5.7) | 133 (18.8) | 228 (13.2) | |
| Vaccine History | Annual | 229 (53.0) | 125 (42.1) | 143 (48.1) | 360 (50.9) | 857 (49.5) |
| Couple years | 56 (13.0) | 45 (15.2) | 40 (13.5) | 105 (14.9) | 246 (14.2) | |
| Rarely | 56 (13.0) | 37 (12.5) | 40 (13.5) | 104 (14.7) | 237 (13.7) | |
| First ever | 86 (19.9) | 88 (29.6) | 73 (24.6) | 130 (18.4) | 377 (21.8) | |
| Missing | 5 (1.2) | 2 (0.7) | 1 (0.3) | 8 (1.1) | 16 (0.9) | |
| On Disability | 33 (7.6) | 13 (4.4) | 24 (8.1) | 60 (8.5) | 130 (7.5) | |
| No Insurance in Last 2 Yrs | 286 (66.2) | 185 (62.3) | 167 (56.2) | 459 (64.9) | 1097 (63.3) | |
Results
Demographic data from the 2015–2016 influenza season to the 2018–2019 influenza season, as well as totals across all included seasons, are summarized in Table 1. Of 1,733 total responders who received a vaccine between 2015 and 2019, 481 (27.8%) were individuals either experiencing homelessness or living in temporary housing and 673 (38.8%) were unemployed. Most patients, 1,097 (63.3%), were not insured at any point during the prior two years. The VOP provided the first ever influenza vaccine to 377 (21.8%) patients. “Missing” indicates that the specific question was not answered on a form that was otherwise completed.
The VOP administered 228 (32.2%) vaccines to patients experiencing homelessness or living in temporary housing in 2018–2019, as compared with 120 (27.8%) in 2015–2016, 55 (18.5%) in 2016–2017, and 78 (25.2%) in 2017–2018. The 2018–2019 VOP also reached the most patients on disability (60, 8.5%), compared to 33 (7.6%) in 2015–2016, 13 (4.4%) in 2016–2017, and 24 (8.1%) in 2017–2018. The 2018–2019 VOP reached the most unemployed patients (313, 44.3%), compared to 110 (25.5%) in 2015–2016, 119 (40.1%) in 2016–2017, and 131 (44.1%) in 2017–2018.
Discussion
In Davidson County, Tennessee, uninsured patients have limited access to influenza vaccinations. The Metro Nashville Public Health Department has three locations where uninsured adults can schedule an appointment and receive a $20 influenza vaccine (with an income-based sliding scale as needed).19 Tennessee Vaccines for Children is a statewide program that provides influenza vaccines to un(der)insured children for a fee than cannot exceed $20.00. Unfortunately, these programs do not meet the existing need for influenza vaccination and will not meet the anticipated need for novel SARS-CoV-2 vaccine distribution.20
With a relatively small team of students and annual four-month timeframe, the VOP vaccinated 1,803 individuals over four influenza seasons, addressing an established need for community-based vaccine outreach efforts in Davidson County.1 Through intentional selection of community partner organizations, the VOP reached hundreds of residents who were more vulnerable to influenza infection, including patients who were under- or uninsured, lacked stable housing, and/or were unemployed. Additionally, among VOP patients, 377 (21.8%) received their first ever vaccine and 483 (27.9%) obtained the influenza vaccine rarely or every few years which indicates the VOP reached many vaccine-naïve and vaccine-inconsistent individuals.
During the 2018–2019 season, with a nurse practitioner student on the leadership team for the first time, the VOP vaccinated more patients, approximately 750, as compared to 300 to 500 patients in the previous three years. This was likely due to increased ease of recruitment of nurse practitioner students, who provided the vast majority of supervision by registered nurses at VOP events. For the 2019–2020 season, the leadership expanded to three medical students and two nurse practitioner students. Approximately 850 patients were vaccinated, which reproduces the greater vaccine outreach that occurred with nurse practitioner students involved in VOP leadership. The 2018–2019 VOP’s increased reach of homeless or temporarily-house, disabled, and unemployed patients also reflects a concerted effort by program leaders to hold more events under a well-trafficked city bridge than in prior years. The VOP continues to improve towards its goal of safely vaccinating as many patients as possible through events targeted towards patients who are unemployed, uninsured, and/or face housing instability. The 2020–2021 program has adapted to the challenge of COVID-19 safety through implementing mandatory masking, eye protection, and distancing guidelines. Additionally, all participants have their temperature taken and are screened for COVID-19 symptoms and potential exposure prior to admission into the vaccination site.
The student-developed consent process, cold chain protocols, and vaccination methods described have been successfully deployed by a separate program to address a hepatitis A outbreak in Davidson County.21 In this program, medical students traveled to homeless encampments with a street psychiatry team and maintained the vaccine cold chain, elicited informed consent, and administered hepatitis A vaccinations.21 Community outreach programs are particularly important for reaching populations who are geographically isolated, have no interaction with the Health Department, and lack the stable housing required to minimize contact with others when sick. This is particularly relevant during the COVID-19 pandemic. If a SARS-CoV-2 vaccine is developed, vaccination of these vulnerable populations will be essential to truly curb community transmission. In its current form, the VOP is seasonal, but it could be expanded to a year-round program to meet the demand for a novel vaccine. The first step would be to obtain outbreak-oriented funding, followed by the creation of additional VOP modules. Multiple VOPs with different student leaders would operate out of the same medical, nursing, and pharmacy school conglomerate, which has consistently offered an excess of volunteers to prior VOP events, to cover unique geographic locations. Institutions looking to implement similar programs should consider adopting interprofessional student leadership, committing to developing long-standing community relationships, creating protocols for and testing the cold chain, and recruiting interpreters via undergraduate, graduate, and community programs.
Limitations
The demographic form developed by VOP Coordinators in 2015 was designed to be a low effort and time commitment for patients, as many were nervous in healthcare settings and did not want to answer additional questions that may have been considered personal. To lower any potential barriers to vaccination, the demographic form was introduced as highly optional. Incomplete demographic forms (Table 1), as well as 70 (3.9%) declined demographic forms over four influenza seasons, allow us to describe trends from this analysis but not draw absolute conclusions about the characteristics of the patients. The only measure of health insurance collected was, “Have you had health insurance coverage at any point in the last two years?” Patients who answered “no” were assumed to not have health insurance at the time of vaccination through the VOP. A question that captured current insurance status and insurance provider, as well as a question that captured if a patient would have sought influenza vaccination elsewhere if there was not a VOP, would strengthen our ability to comment on the barriers to vaccination in the patient population and whether patients would have been able to obtain an influenza vaccination without the VOP. The United States Census Bureau classifications of race and ethnicity were confusing to VOP patients. Many told VOP volunteers that their race and/or ethnicity was not represented on the form by the options American Indian, Black or African American, White or Caucasian, Pacific Islander/Asian, and Middle Eastern, and were confused that Hispanic was considered “White.” We did not include race/ethnicity data trend interpretation for this reason.
Next Steps
To promote completion of the full demographic survey and improve the ease of data collection, the VOP began using tablets to provide digital surveys linked to the Research Electronic Database Capture (REDCap)22 database to patients for the 2019–2020 and 2020–2021 seasons. VOP Coordinators also updated the demographic form to reduce confusion regarding race and ethnicity by adding additional race categories, as well as added survey questions to capture whether patients would not have been vaccinated without the existence of the VOP. The VOP will also facilitate vaccination records for patients who request this service by logging vaccine administration into TennIIS, the Tennessee immunization registry. Since approximately 50% of VOP patients did not receive annual influenza vaccinations, VOP events also provide an opportunity for patient health education about the importance of annual influenza immunization.
Although community-based vaccination programs increase vaccination rates in select populations,23 additional studies should explore whether student-led vaccine outreach is viable in rural locations and if outreach to communities of color decreases race-related disparities in vaccine-preventable disease. There has not, to our knowledge, been an analysis that assesses how healthcare student volunteerism impacts morbidity from vaccine-preventable diseases as compared to the resources required to extend vaccine outreach. Finally, while the influenza vaccine only requires one dose to achieve adequate immunity, other vaccines—including several SARS-CoV-2 vaccines—require multiple doses; additional studies should address delivery and follow-up strategies for vaccinations that require multiple administrations.
Conclusions
Vaccines’ preventative health impact and ability to be administered outside the bounds of traditional healthcare settings make them an essential component of a robust public health system, especially in states that did not expand Medicaid and have sparse statewide medical safety nets like Tennessee.24 This VOP addressed the need for increased vaccination rates in Davidson County, where influenza vaccination rates are less than 50%,2 in people who have difficulty accessing healthcare such as the unemployed, uninsured, and unhoused. A unique and critical aspect of this program is that it is composed of healthcare student volunteers who are able to bolster the workforce of existing nurses, pharmacists, and doctors—a finite resource exhausted by the COVID-19 pandemic. Although this program only administered influenza vaccines, it can be adapted to deliver existing or novel vaccines for endemic and emerging infections, including SARS-CoV-2. Interprofessional student-run, community-based VOPs should be established to address or help prevent outbreaks of vaccine-preventable diseases in at-risk populations.
Supplementary Material
Highlights.
Healthcare students are an underutilized resource for community influenza vaccine delivery
Vaccine outreach programs reach unhoused, uninsured, unemployed, and disabled patients
A student workforce can bridge gaps in local public health systems for resource-poor populations
Interprofessional leadership increases success of student-run vaccine programs
This vaccine outreach model can be adapted to deliver a novel SARS-CoV-2 vaccine to vulnerable populations
Acknowledgements
The authors would like to thank the previous Shade Tree Clinic VOP Coordinators, Dispensary Directors, and Financial Directors, with special mention to the VOP Coordinators over four influenza seasons from 2015 to 2019 for their data. The authors would also like to thank the community partners and student volunteers who participated in the VOP. Finally, the authors would like to thank all the participants who received their influenza vaccinations through the VOP. The research presented in this paper is that of the authors and does not reflect the official position of VUMC, VUSM, or VUSN. The VOP was funded by a community grant, the Boulevard Bolt, as well as STC. STC is affiliated with VUSM, VUSN, UT College of Pharmacy, and VUMC. All are located in Nashville, TN. This study does not have a sponsor. An Institutional Review Board exemption was granted for this study (IRB #191027) by the Vanderbilt University Medical Center Human Research Protections Program. Gregory P. Fricker was a 2015–2016 VOP Coordinator and designed the demographic form and completed data collection. Sarah H. Brown, Emilie L. Fisher, and Alexandra Q. Taylor were 2018–2019 VOP Coordinators and completed data collection and analysis, as well as paper drafting and editing. Kevin E. Neuzil, Samuel W. Trump, and Daniel E. Sack were 2018–2019 STC Dispensary, Community Outreach, and Operations Director, respectively. They were critical to vaccination outreach as well as the development of this paper. Robert F. Miller is a STC Medical Director who oversees VOP operations and was critical for the inception and development of this paper. The data included in this manuscript were presented at the Society of Student-Run Free Clinics Annual Conference in Orlando, Florida on March 8, 2020. The authors have no financial disclosures.
Conflict of interest statement:
Sarah H. Brown, Emilie L. Fisher, Alexandra Q. Taylor, Kevin E. Neuzil, Samuel W. Trump, Daniel E. Sack, Gregory P. Fricker, and Robert F. Miller have no conflicts of interest. The Vaccine Outreach Program was funded by a community grant, the Boulevard Bolt, as well as Shade Tree Clinic. Shade Tree Clinic is affiliated with Vanderbilt University School of Medicine, Vanderbilt University School of Nursing, University of TN College of Pharmacy, and Vanderbilt University Medical Center. All are located in Nashville, TN. This study does not have a sponsor.
Footnotes
Financial disclosure:
Sarah H. Brown, Emilie L. Fisher, Alexandra Q. Taylor, Kevin E. Neuzil, Samuel W. Trump, Daniel E. Sack, Gregory P. Fricker, and Robert F. Miller have no financial disclosures. [Publishable Statement] No financial disclosures were reported by the authors of this paper.
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