Vaccination? Or Hesitation?

How Vaccine Hesitancy is Hindering Uptake of the COVID-19 Vaccine

As the U.S. ticks upward of 26.6 million coronavirus cases, the long-awaited COVID-19 vaccine is being distributed nationwide. Yet uptake rates are lower than expected and health officials have found themselves confronted with another barrier to containing the virus: vaccine hesitancy.

Defined by the World Health Organization as a delay in acceptance or refusal of vaccines despite availability of vaccination services, vaccine hesitancy (also referred to as vaccination hesitancy) can have a devastating impact on infection and death rates in a pandemic like COVID-19.  For this reason, it is imperative that solutions to address vaccine hesitancy are swiftly identified and implemented.

Understanding Vaccine Hesitancy

People refuse vaccines for a variety of complex reasons. History shows that some parents believe vaccinations cause the very illness the vaccine protects against. Others are swayed by false information that is spread about vaccines. Racial and ethnic disparities have had a significant impact on vaccine uptake – with mistrust of the health care system cited as the primary reason. Experts have categorized the many factors influencing vaccine hesitancy into the 3 Cs:

•       Lack of Confidence – in vaccine effectiveness, safety, the system, or policymakers
•       Complacency – perceived low risk of acquiring a vaccine-preventable disease (VPD)
•       Lack of Convenience – in the availability, accessibility, and appeal of immunization services, including time, place, language, and cultural contexts.

Key to the concept of vaccine hesitancy is recognizing that while some will refuse the vaccine outright, others can be influenced in a positive way towards vaccination.

How to Overcome Hesitancy & Increase Uptake

While it is important to understand the reasons for vaccine hesitancy, today’s healthcare providers can benefit from a toolbox of strategies and techniques to encourage COVID-19 vaccination. Below are some of these best practices.

1. Acknowledge Vaccine Hesitancy for People of Color
   

   For black and brown people, mistrust of the healthcare system is intertwined with systemic racism. Meghan Lane-Fall, MD, MSHP, an associate professor and vice-chair of Inclusion, Diversity, and Equity in Anesthesiology and Critical Care at the Perelman School of Medicine, points out, “There have been so many instances of our communities being abused, misused, misled, that this is what we see as a result. We have to acknowledge that history.”

   For health care providers treating culturally diverse patients, it is important to position yourself as an advocate, says Kenya Pitt, manager of Human Resources of the Clinical Practices of the University of Pennsylvania. “…it’s really critical to sit in a seat of non-criticism, to create safe spaces where people feel like they can come to you and you will listen,” she says.

2. A Doctor’s Opinion Matters
   Research shows that a doctor’s recommendation of a vaccine – especially by a general or family practitioner – is the main reason a patient accepts an immunization. When talking with a vaccine-hesitant patient, the recommended strategy is to focus on the risks associated with the disease and the benefits of the vaccine, and to make a statement about it rather than asking a question, i.e., “Let’s get you vaccinated while you’re here,” instead of, “What do you think about getting the vaccine?”
3.       What Not to Say
   Avoid arguing against false information – Some marketing campaigns aim to debunk false information spread by “anti-vaxxers.” This approach can backfire; by repeating the false information, it may be more easily remembered than the truth.

   Avoid statistics – Research suggests that it is not numbers, predictions, or outcomes that motivate people to get a vaccine. Instead, appeal to a patient’s core values and beliefs, such as maintaining good health and protecting loved ones.

4.       Rely on Trusted Sources for Messaging
   If a trusted colleague recommended one restaurant over another, you would be more likely to dine at the recommended establishment. The same holds true of vaccination campaigns and communications. Choose spokespeople who are known, trusted, and can influence behavior, such as a notable healthcare professional, religious leader, or even high-profile personalities. In addition, draw information from trusted sources, such as the Division of Public Health’s vaccine FAQs.
5.       Expand Your Reach with Social Media
   While social media can be a major source of false information about vaccines, it can also be a place to share pro-vaccine messaging. Heidi Larson, from the London School of Hygiene and Tropical Medicine, says “A lot of public health officials have been anxious about going into social media…but that is where the public are to be found these days.”

The good news is that progress is being made. According to the Kaiser Family Foundation’s COVID-19 Vaccine Monitor, vaccine hesitancy decreased from 39% in December 2020 to 31% in January 2021, and the desire to get the vaccine as soon as possible increased from 34% to 41% during the same period. With the right messaging, approach, and understanding, we could be hearing less about vaccine hesitancy and much more about vaccine uptake in the months ahead.

Note: This article represents a compilation of information published by others and does not constitute medical, legal, financial, or consulting advice. All information is believed to be current and accurate at the time of posting. References and links to third parties do not constitute an endorsement, sponsorship, or warranty, expressed or implied.

Resources:

• https://www.kff.org/coronavirus-covid-19/dashboard/kff-covid-19-vaccine-monitor/ 
• MacDonald NE; SAGE Working Group on Vaccine Hesitancy. Vaccine hesitancy: Definition, scope and determinants. Vaccine. 2015 Aug 14;33(34):4161-4. doi: 10.1016/j.vaccine.2015.04.036. Epub 2015 Apr 17. PMID: 25896383.
• Dubé E, Bettinger JA, Fisher WA, Naus M, Mahmud SM, Hilderman T. Vaccine acceptance, hesitancy and refusal in Canada: challenges and potential approaches. Can Commun Dis Rep 2016;42(12):246-51.
• Kahneman, D. A Psychological perspective on economic. Am. Econ. Rev. 2003, 93, 2162–2168
• French J, Deshpande S, Evans W, Obregon R. 5 Key Guidelines in Developing a Pre-Emptive COVID-19 Vaccination Uptake Promotion Strategy. International Journal of Environmental Research and Public Health. 2020 August 13.
• Nayar, K.R.; Nair, A.T.; Sha_, M.; Swarnam, K.; Kumar, A.; Abraham, M.; Lordson, J.; Grace, C. Methods to overcome vaccine hesitancy. Lancet 2019, 393, 1203–1204.
• Deshpande S., Lee N. Social Marketing in India; Sage. New Delhi, India, 2014.
• Kennedy A, Basket M, Sheedy K. Vaccine attitudes, concerns, and information sources reported by parents of young children: results from the 2009 HealthStyles survey. Pediatrics. 2011;127(suppl 1):S92-S99.
• Gargano LM, Herbert NL, Painter JE, et al. Impact of a physician recommendation and parental immunization attitudes on receipt or intention to receive adolescent vaccines. Hum Vaccin Immunother. 2013;9(12): 2627-2633.
• https://www.pennmedicine.org/news/news-blog/2021/january/penn-faculty-and-staff-address-vaccine-hesitancy-for-people-of-color