Vaccine hesitancy and the COVID-19 pandemic
As a healthcare professional, reading this essay on COVID-19 vaccine hesitancy encouraged me to reflect on my own experiences with this issue. What healthcare professional hasn’t experienced vaccine hesitancy on a personal and/or professional level? This issue is increasingly important this year with the rush to develop and deploy COVID-19 vaccines. Will there be increased uptake of vaccines, given the worsening of the pandemic? Will vaccine hesitancy be more pronounced, given the uncertainty around vaccine safety?
How should healthcare professionals approach individuals who are vaccine hesitant? I started by reflecting on my own personal experiences with vaccine hesitancy…
Several years ago, I was socializing at a bar with colleagues from my Toastmaster’s club, when I found myself discussing vaccines with guest, who happened to be a nutritionist. I had erroneously assumed that this health professional was pro-vaccination. After talking to her for a few minutes through the lens of my pro-vaccine bias, I labelled her an anti-vaxxer. She made a compelling case against vaccination. She expressed vague concerns around vaccine efficacy and the uncertainties of long-term safety. I don’t recall the specifics, as I wasn’t really listening to her. I launched into a paternalistic rant, lecturing her on the potential consequences of not vaccinating. I cited increasing cases of diseases like measles that were thought to be eradicated, but thanks to the anti-vaxxer movement, have experienced recent resurgences in some jurisdictions. I refused to understand her perspective and motivations. Eventually, I think our argument drove her to leave the bar early. After she left, one of my colleagues exclaimed that he had never seen me as passionate about any issue before!
Unfortunately, this encounter was not my only experience with vaccine hesitancy. My dad refuses to get the influenza vaccine. There is likely a myriad of reasons why, which may include mistrust in the healthcare system and perceived lack of benefit of vaccines. I’ve heard the all too familiar justification: “I don’t get the flu vaccine and never get the flu” from him, as well as (sadly) from colleagues across healthcare settings.
Perhaps the concept of population health is lost on those that do not perceive an individual benefit from vaccination.
Ahmed & Majid’s conceptual model attempted to explain parents’ vaccine hesitancy, which could be applied more broadly. They used the metaphor of a gear train representing broad categories of reasons for vaccine hesitancy, which include: previous experiences, natural/organic living, perceptions of others, experiences with healthcare providers, information sources/preferences, distrust in healthcare system players, and mandatory vaccination policies. Each gear influences the other gears in various ways, resulting in an overall push towards vaccine hesitancy. An understanding of the motivations behind vaccine hesitancy would help develop potential mitigation strategies.
The model proposes a reverse gear to mitigate vaccine hesitancy called “shared decision making” (SDM). SDM is proposed for interactions between healthcare providers and individuals who are vaccine hesitant, but also as a concept to develop vaccination policies. Literature has demonstrated that when healthcare providers provide balanced perspectives on vaccines, explaining the benefits, risks and uncertainties, individuals may be more open to considering vaccination. In contrast, mandatory vaccination policies have been shown to promote vaccine hesitancy.
My favourite CBC radio show, “White Coat, Black Art” recently profiled PromoVac, a successful pro-vaccination program at Sherbooke hospital in Quebec that promoted an SDM-like approach. The program involved vaccination counsellors trained in motivational interviewing techniques meeting parents in the maternity ward soon after their child was born. Meeting parents when they were ready before the point of decision making around vaccination for their newborns likely contributed to success, as did the non-judgemental, open dialogue approach of motivational interviewing.
Vaccination experts suggest that motivational interviewing could be applied to vaccine hesitancy associated with receiving the COVID-19 vaccine.
As a pharmacist, I received some training around motivational interviewing. I’m sure many healthcare providers have as well, especially more recent graduates. This form of dialogue doesn’t take much time and could be applied at multiple health-related touch points, such as within pharmacies, primary care and virtual care settings.
I wish I had remembered to use open dialogue and a non-judgemental approach when I had that heated discussion with the nutritionist that I quickly labelled an anti-vaxxer, and whose views I dismissed as they did not align with my own. In my experience, most individuals (whether anti-vaxxers or not) want vaccination to be a choice; the more it is framed that way, the more likely individuals may be swayed to the pro-vaccine side.
