Strategy
The Rhode Island Department of Health (RIDOH) uses geographic findings to prioritize provider outreach, school and community partnerships, culturally and linguistically appropriate communication, vaccination clinics, and other interventions in communities with the greatest need for MMR vaccination coverage.
Challenge
Rhode Island has historically maintained high MMR vaccination coverage, with approximately 97% of kindergarteners completing the MMR series, placing the state above the Healthy People 2030 target of 95%. However, statewide averages can mask meaningful geographic variation and pockets of under-vaccination. This is particularly important for measles, which is highly contagious and requires very high vaccination coverage to prevent sustained transmission. Nationally, kindergarten MMR coverage has declined in recent years, underscoring the importance of identifying communities where vaccination coverage may be lower than the statewide average.
Geospatial analysis provides an opportunity to move beyond statewide and aggregate measures of MMR coverage and identify where gaps are concentrated. Mapping vaccination data at the community, municipality, or other appropriate geographic level can help the RIDOH identify areas with lower coverage, detect geographic clusters or “hot spots” of under-vaccination, and examine relationships between vaccination coverage and factors such as socioeconomic conditions, health care access, and population characteristics. These analyses can help distinguish whether lower coverage reflects isolated practices, broader community-level barriers, or geographic patterns that warrant targeted intervention.
For Rhode Island, geospatial analysis can therefore support a more targeted and equitable approach to improving MMR coverage. Rather than applying the same intervention statewide, RIDOH can use geographic findings to prioritize provider outreach, school and community partnerships, culturally and linguistically appropriate communication, vaccination clinics, and other interventions in communities with the greatest need. This approach can also provide a mechanism for monitoring changes in coverage over time and evaluating whether targeted interventions are reaching areas with persistent gaps. This analysis identified four “hotspots” – geographic areas were the percent of children age 18-59 months with an overdue dose of MMR vaccine were higher than expected.
Solution
The overall goal of the RIDOH was to decrease the percent of children 18-59 months overdue for an MMR vaccine among children by 90% in at least one hotspot by December 2028.
Objectives identified by the program included:
- Raise awareness about MMR vaccine benefits and severity of disease
- Address vaccine confidence and hesitancy concerns
- Increase access through expanded clinics or partnerships
- Strengthen provider engagement and community trust
Implementation activities based on the MMR vaccine map included:
- Development of an Immunization Outreach Action Plan. These plans are tailored to each of the four locations, allowing the RIDOH to understand local cultures and practices and identify key players and trusted messengers which are instrumental in building trust in these communities. These efforts also allow the RIDOH to tailor messaging and materials to the community.
- Attendance at community events to provide educational materials and address questions and concerns.
- Implementation of a “Building Vaccine Confidence and Trust” mini-grant program for community-based organization projects incorporating vaccine confidence training and information specific to MMR vaccine.
- Work with the Rhode Island chapter of the American Academy of Pediatrics and pediatricians to hold vaccination clinics.
- Leverage of the Immunization Quality Improvement Program (IQIP) for provider engagement. RIDOH identified pediatric providers in the hotspots and recruited them to participate in IQIP.
- Work with other RIDOH programs that serve parents of children 5 and younger – such as working closely with the Family Visiting and WIC programs to share educational materials and we provide vaccine education and inquiry support to program staff.
Outcome
Although these activities have not yet undergone a formal evaluation, preliminary outcomes are:
- More than 110 community events attended from July 2025 through August 2026
- Tables at these events were well visited, with some drawing over 200 people during the event
- Over 245 community partners identified across the four hotspots
- Over 20 pediatricians located in the four hotspots participating in IQIP
- Five CBOs were awarded mini grants.
- Educational presentations – five presentations to parent advisory groups, three educational sessions to family visitors, and three educational sessions to community health workers working in the communities
Supplemental Materials