Listening to micropolitan community leaders to support pandemic response efforts

The COVID-19 pandemic hit micropolitan communities (10,000-50,000 people) especially hard. High mortality rates and low vaccination rates were prevalent in these communities that are a crucial part of the rural public health infrastructure. The University of Iowa Prevention Research Center for Rural Health, along with the state public health association and immunization coalition, conducted a listening tour throughout Iowa to better understand how the pandemic impacted micropolitan areas and to subsequently develop interventions to increase vaccine confidence. The study team conducted virtual guided discussions with local public health professionals, county extension employees, faith leaders, leaders of immigrant or Latino organizations, and Chamber of Commerce staff. Participants were asked about the pandemic's effect on their communities, what they had seen work (or not) to increase vaccination, and what strategies they believed would be worth trying. Leaders reported varying success utilizing the CDC's COVID-19 Vaccination Strategies for Communities, with some of these strategies still showing promise in future vaccination efforts. Some of the strategies were expanded upon or adapted to the context of the community (like the expansion of clinic locations to offer sites throughout the community, increased community-wide vaccine marketing efforts, more engagement with worksites, utilizing community partners to support vaccination efforts, etc.). Others were not mentioned by leaders (i.e., motivational interviewing, medical provider vaccine standardization, vaccination requirements, vaccine ambassadors). Future efforts need to focus on providing better supports for these strategies not utilized and to find ways to reduce the burden of strategy implementation by already overburdened public health practitioners in micropolitan communities. Micropolitan communities also require new and innovative strategies that build public trust in government, public health, medicine, and science.