I feel privileged to have received both of my COVID-19 vaccine doses. Although, despite the COVID-19 pandemic killing over 562,000 Americans, 37% are hesitant about receiving this vaccine themselves. The World Health Organization defines vaccine hesitancy as a “delay in acceptance or refusal of vaccines despite availability of vaccine services” and in 2019, named vaccine hesitancy as one of the top 10 global threats to public health. As a pediatrician, I have experience with counseling patients about vaccine hesitancy as it has historically impacted about 19% of my pediatric patient families. However, for adult medicine providers, this may be a new discussion in their practice, and given its importance, I would like to offer advice about how to approach it given that 46% of the vaccine-hesitant population reports that they may change their mind if given more information.
2020 was the perfect storm for vaccine hesitancy to grow. As distrust in the government was high, social media misinformation was rampant. We had a campaign branded politically as Operation Warp Speed, leading to concerns that science was being rushed at the expense of American people. It is therefore not surprising that the most hesitant groups of people tend to be Republicans (42%) who have downplayed the severity of COVID-19, adults aged 30-49 years (36%) who think of themselves as healthy, rural residents (35%) with lower education levels and poorer access to health care, and Black adults (35%) who have a longstanding mistrust of the health care system. Understanding the demographics of hesitancy can help us tailor our approach in providing education that is impactful for our audience.
Communities of color have been disproportionately affected by the COVID-19 pandemic– making up nearly 60% of COVID-19 hospitalizations. Yet at the time the vaccine was being publicized at the end of 2020, there was a lack of trust in the vaccine development process from within the Black community. In a focus group on vaccine hesitancy, Black participants cited systemic racism in health care, stemming from the Tuskegee Syphilis Study, as the root of their concern, and 48% of Black adults worry that the vaccine development process did not take their needs into account. Reassuringly though, the participants in the Pfizer-BioNTech vaccine studies are representative of the U.S. population: 10% Black or African American, 13% Hispanic, and 4% Asian. Credible outreach efforts in communities of color have centered on using members from the community to endorse and administer the vaccine, which both improves acceptance and access. The success of programs such as the Black Doctors COVID-19 Consortium in Philadelphia, PA, demonstrates that often removing barriers to access is all that is needed to increase acceptance of the COVID-19 vaccine, and we should not confuse hesitancy with access barriers.
After understanding who the most vaccine-hesitant audience may be, there are a few strategies that we can use to be successful in earning their trust. Prior research studies have shown that using a presumptive approach rather than a participatory approach has greater success in vaccine acceptance. For example, saying “you are eligible for the COVID-19 vaccine today” rather than “what do you think about getting the COVID-19 vaccine?” In Seattle, where non-medical exemptions for vaccines tend to be high, a presumptive approach led to 75% of families accepting the vaccine, whereas a participatory approach led to 83% refusing the vaccine. Health care providers can also engage in motivational interviewing, partner with families, show empathy, and listen to their concerns, understanding that this conversation may happen over a longitudinal relationship.
We should embrace the questions about vaccine safety and efficacy that our patients proffer as an opening to challenge what is often considered dogma in our medical training. The COVID-19 pandemic has created an opportunity for health care providers to refresh our knowledge of epidemiology, microbiology, and public health as the lifelong learners we had always intended to be. Vaccines have been a core component of the preventative health we administer, but none have been as critically evaluated in the public eye during our careers. Rather than let the spotlight on science intimidate us, as there are always unknowns we cannot answer, we can use this to our advantage. Sharing our own research with patients, including the limits of our knowledge in this ever-evolving pandemic, builds trust and acceptance not only in vaccines but in all of the care we render.
Using emotional pleas is a strategy the anti-vaccine movement has used for years but is one that we can also use for a positive force. 85% of Americans see their health care provider as the most trusted source of COVID-19 vaccine information. Storytelling is a powerful tool, so providers should share their own motivation for getting the vaccine or the impact COVID-19 has had on their patients and families. We should avoid getting entangled in debunking myths that circulate online and instead dilute their online presence with our own messages on the safety and efficacy of the COVID-19 vaccines. As health care providers, we hope that this vaccine is the way out of this devastating pandemic, and fortunately, we can be leaders in increasing vaccine acceptance.
Katie Lockwood is a pediatrician and host, Primary Care Perspectives podcast. She can be reached on Twitter @mommy_call.
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