A southern Arizona medical center's unique approach boosted vaccination rates. Here's how

Facing historically low immunization rates and unprecedented increases in vaccine hesitancy after the COVID-19 pandemic, one rural Arizona health center took an innovative approach: offering vaccines at dental visits.

“We have the opportunity to get them the vaccines at this dental appointment, rather than to not get them the vaccines at all, which would be the case if they're just coming to dental appointments,” said Kelsey Vincent, program manager of Chiricahua Community Health Centers' vaccine program.

Chiricahua began the pilot phase of the program for adults in August of 2022, and since then has delivered more than 1,800 vaccines to children and adults who likely would not have received them otherwise.

The success of the program led to Chiricahua being chosen as one of the recipients of this year's Arizona Big Shots Awards by The Arizona Partnership for Immunization for improving the health and wellness of Arizona’s communities through increasing immunization rates.

It's an example of "Chiricahua going the extra mile, having an evidence base in our practice," said Dennis Walto, Chiricahua's chief of external affairs and foundation executive director. "This is health equity in action."

In 2022, Chiricahua found a decrease in vaccination coverage, from 48% to 35% in pediatric patients.

Before the program was implemented, fewer than 41% of the health center’s patients had received the flu vaccine, and only 33% had finished their COVID-19 vaccine series.

When the health center first saw immunization rates declining during the pandemic, Chiricahua's clinics began increasing outreach and used their mobile clinic to boost vaccination rates. But after that initial uptick, immunization rates in Cochise County began to reflect the nationwide decline.

This decline was due in part to the pandemic. COVID-19 impacted health service delivery, including immunization programs throughout the world, according to a global 2021 study.

Nationally, the U.S. Centers for Disease Control and Prevention found a decline in immunization coverage in children and adolescents, putting them at risk for preventable diseases.

The Arizona Center for Investigative Reporting found that out of nearly 1,000 Arizona schools with kindergarten classes, about 60% had decreases in students considered immune from measles, mumps and rubella between 2018 and 2021. The analysis found the decrease followed a years-long decline in immunizations among Arizona students overall.

Chiricahua also saw an uptick in HPV vaccinations

During Chiricahua's dental integration program, providers saw an increase in human papillomavirus vaccinations, an important tool to prevent cervical cancer and other types of cancers. In 2023, Chiricahua administered 2,330 HPV vaccines compared to 1,933 the year before, an increase of over 20%.

“Administering in the dental space … being able to talk about its ability to prevent oropharyngeal cancer, shifts the narrative and offers a unique way of bringing up the life-saving benefits of the vaccine,” said Emily Harris, Chiricahua’s director of community health, during a video interview.

Harris noted the global struggle to administer HPV vaccines, in part because it involves a conversation around sexual health. She pointed to a commonly held belief among parents that talking about sexual health will promote certain kinds of behavior.

“It makes it really tricky and taboo to bring up a vaccine that is, really, really vital to cancer prevention," Harris said.

A 2021 study tracked the shift in parental opinion about the HPV vaccine and found it increased in some ethnic and age groups. The study found that just over half of adolescents in the United States have received two or more doses of the vaccine. 

How Chiricahua helps residents in remote locations access healthcare

One challenge in accessing medical care in rural areas of Arizona is the long distances people are required to travel for medical appointments. Offering vaccinations at dental appointments allows Chiricahua to maximize every health visit.

“We have to take advantage of every encounter and reduce the missed opportunity when you may have someone in your office who's had to take the day off from work or has driven 45 miles to get to you,” Walto said.

To reduce barriers to accessing health care, Chiricahua has opened clinics around the county and is ramping up its mobile clinic program to meet the needs of most rural patients.

As Chiricahua's works to decrease barriers to healthcare access, the organization is also working to scale the dental integration program and train other health centers to implement similar programs.  

"We created this to be scalable and replicable in other Federally Qualified Health Centers or other clinic settings, anywhere throughout the country or even further," Harris said.

Reach the reporter at sarah.lapidus@gannett.com. The Republic’s coverage of southern Arizona is funded, in part, with a grant from Report for America. Support Arizona news coverage with a tax-deductible donation at supportjournalism.azcentral.com.