The findings of Khubchandani and colleagues suggest there are still some Americans who are hesitant to receive vaccines, likely due to the misjustice in Tuskegee regarding syphilis

I am also seeing vaccine hesitancy among some Black health care professionals here in the New York City area. About 60% of the nurses and ancillary staff at the hospital where I see patients in Bronx, New York, are refusing to accept the COVID-19 vaccine, stating they do not trust the government and do not understand how the vaccine could have been developed so rapidly. To address their concerns, we are having town halls and workshops where we try to understand why people are vaccine hesitant and answer their questions as best as we can.

We remind them that coronaviruses were first discovered in the late 1960s. The coronaviruses are responsible for 15% to 30% of common colds. The first outbreak of severe coronavirus-related diseases occurred in 2003, followed by outbreaks involving the Middle Eastern Respiratory Syndrome in 2012 and now SARS-CoV-2. We emphasize how a lot of the work in establishing a vaccine was already done before the first case of COVID-19 was diagnosed. We also inform them of the thorough FDA review process and pharmaceutical manufacturer’s obligations once their product has received an emergency use authorization and responsibilities following approval. This information has helped alleviate some concerns.

The message might need to be a little different for patients who are vaccine hesitant. We should try to remind them that the death rate from people who have been infected with COVID-19 is 2%. And although instances of anaphylaxis have been reported, as of early January, there have only been about 21 cases and no deaths among nearly 2 million doses of COVID-19 vaccine that have been administered. In addition, very few have been hospitalized or required to the emergency room care after receiving a COVID-19 vaccine. We should also tell patients even after they have recovered from COVID-19, there is an up to 40% likelihood, depending on age, that they will experience long-term sequelae. There are also emerging data to suggest the SARS-CoV-2 virus can affect the brain, our cognitive function and our ability to perform daily tasks. We should inform our patients of these facts and explain that they can avoid these risks by receiving a vaccine.

The results of the survey on COVID-19 vaccine hesitancy by Khubchandani and colleagues validate the anecdotal experience of many of us in clinical practice. Their findings also dovetail nicely with data recently released by the Kaiser Family Foundation. The question is, how do we address this hesitancy when we encounter it in clinical practice?

While there are only a small portion of individuals in the U.S. who are anti-vaccine, there is a large group of individuals who have questions and concerns and, thus, need information and reassurance before deciding to get vaccinated. We must recognize that this discussion may take some time, and we must regard patient questions and concerns as valid.

Psychologists tell us that if we mirror patients’ concerns back to them, we can help reassure those who are anxious. Telling someone that their beliefs are wrong will prompt most individuals to double down on their beliefs. Instead, ask these patients what their concerns are, so they know they have been heard, respected and may be ready to listen to some new messages.

Depending on the circumstance, simply providing data may not be the best thing to do. Although facts are important, they do not always change behavior. If we ask about how patients feel about vaccination, we can help the patient feel more comfortable and reassured, then behavior change is more likely to follow. For example, consider an affirming statement such as, “You’re worried that the vaccine may not be safe. We hear that a lot.” Then, emphasize the positive: “The vaccine has been tested in multiple clinical trials, each of which has involved thousands of individuals.” Personalize it: “I got the vaccine; everyone here on our staff got vaccinated.” We can also explain how receiving a vaccination helps protect their family and friends. Recast the notion that the individual is doing something for others, not just themselves.

We cannot expect people to change their minds immediately — we must give people permission to think about it. With influenza vaccine, I will push my patients and make annual flu vaccination the norm. With the COVID-19 vaccines, the circumstances are different. Because these are new vaccines, we need to give patients time to consider: “We’re always here for you. You can always come back to get the vaccine.” (We hope that will be true very soon.)

Reference:

Hamel L, et al. KFF COVID-19 vaccine monitor: December 2020. https://www.kff.org/coronavirus-covid-19/report/kff-covid-19-vaccine-monitor-december-2020/. Accessed January 11, 2021.