Retail Pharmacy Vouchers to Promote Tdap Vaccination for Adults Living With Infants

The incidence of pertussis, a highly contagious respiratory illness, has more than tripled in the past five years, and is on track this year to be the most severe in over a half century. Pertussis is particularly dangerous, and commonly fatal, for young infants who have not completed the primary vaccination series. To protect infants, pregnant women and adult caregivers should receive Tdap vaccination, but coverage is estimated at only 10% for adult caregivers in close contact with infants.

The objective of this study is to conduct a small-scale randomized controlled trial of an intervention to increase Tdap immunization rates among infant caregivers. The intervention is delivered at the newborn primary care visit and consists of two components: (1) Tdap vaccine vouchers redeemable at neighborhood retail pharmacies and (2) video-based education. The vouchers improve vaccine supply by reducing cost and improving accessibility of the vaccine, while the education component increases demand for the vaccine by making salient the dangers of pertussis and the importance adult vaccination to "cocoon" vulnerable infants. We will evaluate the feasibility and acceptability of each component or both compared to none and assess the impact on the vaccination of parents/caregivers of newborn infants.

Recruitment for this pilot study will take place at a pediatric primary care practice site affiliated with a large children's hospital in Philadelphia, Pennsylvania (PA). The practice schedules approximately 135 newborn visits per month, typically at 2-14 days of life. Participants will redeem Tdap vaccine vouchers at 2 local Rite Aid pharmacies which are the closest Rite Aid locations to the clinic site. The pharmacy accepts all major insurance plans, although most plans (including Medicaid) do not cover Tdap vaccine delivered in pharmacies.

All caregivers ≥ 18 years old who accompany an infant to a newborn visit will be approached by the study coordinator and details of the study will be explained. Caregivers will be asked to participate in the study and if interested, informed consent will be obtained before any study related procedures are performed. Potential subjects will then be screened using the protocol inclusion and exclusion criteria. The research assistant will utilize a data collection form to collect demographic data. After completion of the data collection form, participants will view an educational video if randomized to the education arm. After viewing the educational video, or after completion of data collection form for those who were not randomized to video, participants will receive an envelope containing the Tdap and baby care item voucher or gift card.

Unvaccinated caregivers will receive an envelope containing 2 vouchers or a voucher and a gift card. The vouchers are: one for Tdap vaccination and one for a baby care item. Vouchers will be redeemable only at the two participating nearby Rite Aid pharmacies, will have no monetary value, and cannot be redeemed for any items other than the specified vaccine/baby care product.The gift card can be redeemed at any Rite Aid pharmacy.All envelopes will also contain the Center for Disease Control and Prevention (CDC) Vaccine Information Sheet (V.I.S) for the Tdap vaccine. Participants will be randomized to receive either: (1) a voucher for the full price of a Tdap vaccine ($63.99) + a baby care product voucher/or gift card, or (2) a voucher for $5 off a Tdap vaccine + a baby care product voucher/or gift card. The baby care product voucher / gift card will allow us to assess the proportion of respondents who make a trip to one of the pharmacies following the primary care visit and may also increase the probability that the study participants will visit one of the designated retail pharmacies. The full cost voucher removes any cost barriers related to the Tdap vaccine. The $5 voucher allows us to assess the effect of increased awareness, convenience, and accessibility on vaccine uptake, but without a significant price change. If two unvaccinated caregivers accompany an infant and both choose to enroll in the study, they may receive discordant Tdap voucher amounts; however, both will receive baby care product vouchers / gift cards.