COVID-19 vaccine hesitancy

Definitions & Key takeaways

The World Health Organization defines vaccine hesitancy as a delay in acceptance or refusal of vaccination despite the availability of vaccination services. � There is a great deal of hesitancy surrounding the potential COVID-19 vaccine. Some of this hesitancy may be due to general distrust in pharmaceutical companies, while other concerns may be specific to the vaccine.

There are concerns that the vaccine could lead to severe side effects, although these claims have not yet been substantiated. Some people also worry that the vaccine will be used for nefarious purposes, such as controlling the population or profiting from vaccine sales. Still, studies have revealed that COVID-19 vaccines have saved many lives by reducing adverse outcomes, including deaths and hospital admissions, especially in the ICU.

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Vaccine hesitancy has become a significant health concern, and is defined by the World Health Organization as “a delay in acceptance or refusal of vaccination despite availability of vaccination services” Vaccine hesitancy is a complex issue, and its causes are unique to each individual.
While vaccine hesitancy has been an ongoing public health issue for years, the rapid development of vaccines in response to the COVID-19 pandemic has exacerbated the issue.
A survey by Fisher et al. in September 2020 revealed 11% of people in the United States plan to decline the COVID-19 vaccine, with another 32% of people undecided if they’d accept the vaccine.
With such a large percentage of the population being hesitant to vaccination, it’s imperative healthcare providers initiate and maintain an open dialog about vaccination with patients.Patients are often willing to have a discussion about vaccination, even if they are hesitant to receive a vaccine.
When beginning a dialog on vaccines with patients, always ensure you frame the discussion in a positive, non-confrontational light.
Be respectful and truly understand the person’s perspective. Do they feel worried?
Do they feel suspicious? These are legitimate feelings that warrant a conversation about safety and the process of how vaccines get made and evaluated before they’re given to patients.
Even if the patient decides not to be vaccinated, it is important to maintain a strong healthcare provider-patient relationship so that you can continue to engage them over time.
The more opportunities you have to engage them, the more likely a skeptical patient may be to change their mind and decide to become vaccinated.Patients are the ultimate decision makers on whether they’ll be vaccinated or not.
Your role as a healthcare provider is to be a resource to them. Reinforcing this with the patient will help build trust and a strong clinician-patient relationship.
Highlight that both of you have shared goals, to do what is best for them, and acknowledge that there is an enormous amount of difficult to understand information around vaccines.
Let the patient know you want them to be able to make an informed decision. Offer to help them find the best information on vaccines, and that you are available to answer any questions they might have.
As soon as possible, try to establish how knowledgeable the patient is on COVID-19 and the vaccines, as well as how strong their beliefs are regarding vaccination generally.Knowing if a patient has strong opposition to vaccination early on will help you make decisions on how to navigate your conversation with them in order to maintain a good relationship with the patient.Avoid making presumptuous statements, that limit what a patient can say in response, such as “Would you like me to schedule you for a COVID-19 vaccine?” or “Have you received your COVID-19 vaccine yet?” Instead focus on more participatory dialog, and use open-ended prompts, such as “What are your thoughts on the COVID-19 vaccination rollout?” or “How do you feel about the COVID-19 vaccines?”.
Both the American Academy of Pediatrics and the World Health Organization have sample scripts healthcare providers may find helpful as they prepare to initiate dialogues with their patients.When talking about vaccines, avoid referring to complicated statistics or using complicated terms unless the patient specifically asks for clarification.
Instead focus on the key information and broad takeaways. You want to keep the message clear and concise to patients, but also answer specific questions they have.
When possible, personalize information to patients, explaining how information affects them specifically based on their health history.
For example, patients who are thinking about becoming pregnant, or who are currently taking immunosuppressive medications may wonder if they should take the new COVID-19 vaccines.
Contextualizing information like vaccine risks is also important. Patients tend to overestimate the risks of vaccines, misunderstand statistical concepts, or have difficulty grasping risk rates such as 1 in 100,000 as 100,000 is a number so big most people have little to compare it to.
Using analogies patients can personally relate to may help, such as comparing the population of the city the patient lives in versus the risk of experiencing a vaccine complication.
Similarly, patients tend to underestimate the risk of acquiring a disease, or the risk of serious symptoms developing from a disease.
Directly comparing the risks of contracting a disease with the risk of complications from vaccines may help convince some hesitant patients.After your first vaccine conversation with a patient, it’s important to keep the dialog going, regardless of whether they continue to be hesitant or not.
Patients may not be forthcoming with concerns or questions they have, so you want to provide them an opportunity to have a discussion at every visit.
If a patient has previously expressed support for vaccination, asking them about how they feel about the vaccine rollout or how their mental health has been, while they wait to receive a vaccine may be a great conversation starter.
For patients that have previously expressed hesitancy towards vaccination, asking them how they feel about the vaccine given all the media coverage recently may also be a good conversation starter.
For patients you see infrequently, consider sending them an email or calling them directly to evaluate their interest in receiving the vaccine, and address any concerns they might have.
This is especially important for patients at high risk of COVID-19 illness and complications.While the reasons patients are hesitant towards receiving vaccines are unique to them, there are some concerns that are more common than others.
For example, patients are often concerned about how safe the COVID-19 vaccines are, given how fast they were developed, and that the Pfizer and Moderna vaccines are the first mRNA vaccines to be used.
They may worry shortcuts were taken to get the vaccines out quickly.Taking time to review the clinical trial process with patients as well as the results from those trials may help decrease vaccine hesitancy.
Patients might also respond well to reviewing the number of vaccinations given since the trial. For example as of January 2021, well over 30 million doses of COVID-19 vaccines have been administered world-wide without any adverse reactions not already seen in the clinical trials.Another common belief held by patients is they are not at risk of infection or serious illness, or that COVID-19 is not a real disease.
Young adults in particular may feel they are immune to infection or serious illness. Highlighting epidemiological trends and emphasizing young patients can still develop serious symptoms that may persist for years after infection may help promote vaccination.
For patients who doubt COVID-19 is real, one strategy may be to ask them about their friends, family, and coworkers. Have any of them been getting sick?
What have their experiences been like? Encouraging these patients to talk with those they trust who have been ill, or who have worked directly with those who have been ill, may help encourage them to get vaccinated.Patients may also be hesitant towards the vaccine because they have existing hesitancy towards other vaccines.
This can be due to many of the reasons we’ve already discussed, as well as religious reasons, mistrust of the government, healthcare or pharmaceutical institutions, a desire to maintain control of their body, beliefs that natural infection produces stronger immunity than vaccination, that vaccines don’t work, or that vaccines cause diseases such as autism.
Identifying which of these beliefs a patient holds and providing resources that address these beliefs may help patients become less hesitant.To summarize, start a conversation with your patients on vaccination early, and continue to engage them on the subject regularly.
Do your best to understand their existing knowledge and opinions, and learn about their specific concerns and where their concerns are coming from.
Always approach the subject in a supportive manner, and above all else maintain a good working relationship with your patient, even if they decide vaccination