 the covid 19 vaccine roll out in chicagos long term care facilities ltcfs was a component of a larger initiative to increase vaccine uptake in the city of chicago as the federal pharmacy partnership program ppp was introduced the chicago department of public health cdph offered to liaise with ltcfs and facilitate the vaccination process we were uniquely positioned to assist in ltcfs because of existing relationships with ltcfs after the past year of routine individual facility engagement for covid 19 related infection control guidance we worked with the community and leveraged the healthcare facility communication platforms we created to support ltcfs during the pandemic to address vaccine hesitancy and provide vaccine education we acted quickly to facilitate vaccination coordination in ltcfs because they were included in the first phase of vaccine distribution due to their residents high risk of covid 19 morbidity and mortality in partnership with project hope we held two listening sessions with directors of nursing assistant directors of nursing and infection preventionists at ltcfs in chicago where we assessed their levels of vaccine hesitancy discussed vaccine hesitancy among residents and collected ideas on how to increase vaccine uptake for example during the listening sessions we heard concerns from communities of color who felt targeted and pressured to get vaccinated and were hesitant about getting it we used the information shared and questions asked during the listening sessions to better tailor our vaccine education efforts in ltcfs these efforts included converting our weekly covid 19 ltcf roundtables into a vaccine education and implementation series during these roundtables we discussed vaccine hesitancy and encouraged ltcf leaders to empower their staff to become vaccine influencers we also shared with ltcf leadership concerns we heard from staff and residents and suggested ltcf leaders use the information to adjust their vaccine responses to the needs of residents and staff for example we heard that some ltcf staff were hesitant because of how quickly it was being rolled out and concerns about being used as test subjects so many administrators got the vaccine in front of their staff to show confidence in it in the early stages of the ppp representatives from different pharmacies spoke about logistics and provided answers about the vaccination process the cdph commissioner hosting a qa session for all facilities which was advertised to all residents and their families transforming our existing testing strike teams into vaccine mobilization and education teams the vaccine education teams used the information from the listening sessions to address the concerns of ltcf staff and residents people viewed the vaccine education teams as trusted sources of information that could speak about the vaccine without outside influences at one facility we saw a 40 percent increase in vaccine uptake after one education event leadership at the ltcf and the vaccine education team worked together to organize the event we kept learning new information as our efforts continued like the importance of expanding vaccine education initiatives beyond staff and residents at ltcfs we found that in many cases the healthcare power of attorney for residents of ltcfs declined the vaccine on behalf of the residents typically the healthcare powers of attorney do not attend the vaccine education events and miss these opportunities this gap underscored the importance of empowering family and community members to be vaccine champions during the roll out of covid 19 vaccinations in ltcfs we continued to appreciate the importance of coordination and planning much planning was required to make the vaccine readily available in facilities particularly second doses a lot of coordination was also needed to ensure a seamless transition to ltc pharmacies when the ppp ended before the ppp ended we quickly surveyed facilities to identify their ltc pharmacies and encouraged those pharmacies to enroll as covid 19 vaccine providers we found that some of chicagos ltc pharmacies were located outside of chicago borders we could not deliver vaccine to those facilities because the union contracts of our drivers meant they could only drive within the boundaries of chicago in order to overcome this roadblock we partnered with the illinois department of public health idph and provided them with doses of moderna through tiberius idph then distributed the vaccine to ltc pharmacies that served chicago facilities but were based outside of city limits the challenges successes and experiences supporting covid 19 vaccine uptake at ltcfs helped us identify strategies to address vaccine hesitancy going forward given high staff and resident turnover in ltcfs it is important to keep high vaccination coverage in ltcfs it is also important to continue education efforts about vaccines and vaccine hesitancy we saw that individuals who were hesitant to receive the covid 19 vaccine may have also been hesitant to get the influenza vaccine overall the educational and coordination strategies we used to address vaccine hesitancy resources we shared for informed decision making and methods to increase access of the covid 19 vaccine in ltcfs will be critical for future vaccine initiatives shannon xydis liz shane christy zelinski 