Reviews and Perspectives with Hobart Lee: Vaccine Hesitancy
Hobart Lee, MD, and Heidi James, MD
We’ve seen a rise in vaccine hesitancy in our offices; from Andrew Wakefield’s spurious claims that measles-mumps-rubella (MMR) vaccines cause autism to push-back against government-mandated COVID vaccination to the compelling, if misleading, social media narratives, it's now a tough slog to convince some patients to be vaccinated. Hoby and Heidi share their approach to chatting with these patients.
- General principles
- Assume a posture of curiosity rather than defensiveness or condemnation.
- Patients feel strongly about this and understanding why will help the discussion.
- Explore patients’ concerns.
- Play the long game:
- Continuity of care is our superpower.
- We can revisit this issue as many times as we need.
- Strive to follow vaccine schedules yet also be flexible and vaccinate opportunistically as patients are willing.
- Specific scenarios:
- Patient is opposed to vaccine mandates (by government or other)
- There is little to be gained by getting into the policies and politics of mandates.
- Explore how vaccination is helpful for the individual patient.
- Suggest that choosing to be vaccinated and opposing vaccination mandates are not mutually exclusive positions.
- Patient adheres to conspiracy theories
- This is difficult to work through with patients.
- Explore how firmly these beliefs are held.
- As you are able, gently challenge beliefs.
- Consider whether your patient might have an underlying mental health condition contributing to these beliefs.
- Patient has a religious objection
- Affirm the value of religious belief.
- Explore what the patient understands to be the objection.
- Be aware the official stance of religious organizations can differ from a patient’s interpretation.
- Partner with local religious leaders to ensure a clear message is being communicated to followers.
- “But we won’t be exposed to those diseases!”
- Time for a history lesson:
- Discuss the realities of the prevaccine era, particularly childhood mortality from now-preventable infectious diseases.
- Discuss public health principles (eg, herd immunity).
- Inform patients that some of the diseases are more common now:
- Eg, measles, polio, diphtheria
- Patient believes that vaccination may lead to undesired behaviors.
- Some parents fear that consenting to human papillomavirus (HPV) vaccination of their children will lead to sexual activity contrary to their family values.
- Ensure patients understand that HPV is more than “just” a sexually transmitted infection.
- Explain the vaccine’s benefits (ie, preventing cancer).
- Reassure parents that their voice in their child’s life matters and influences their values and behavioral choices.
- Patient is concerned about side effects.
- Acknowledge that side effects do exist and be aware of the actual risk of these.
- Share common and serious side effects as part of informed consent.
- Be aware that worst-case scenario side effects are overshared on social media, causing patients to be afraid.
- Help patients understand risk and benefits.
- This is as much a public relations battle as it is a public health one—good luck to you and let us know what works for you!
PEARL: Approach your patients’ concerns about vaccinations with a sense of curiosity, of wanting to understand their concerns. This will yield a more fruitful and less confrontational discussion.
REFERENCES:
Strategies for addressing vaccine hesitancy - A systematic review
Jarrett C, Wilson R, O'Leary M, et al. Vaccine. 2015;33(34):4180-4190. doi: 10.1016/j.vaccine.2015.04.040. PMID: 25896377
Identifying and addressing vaccine hesitancy
Kestenbaum LA, Feemster KA. Pediatr Ann. 2015;44(4):e71-5. doi: 10.3928/00904481-20150410-07. PMID: 25875982
Addressing parental vaccine hesitancy towards childhood vaccines in the United States: a systematic literature review of communication interventions and strategies
Olson O, Berry C, Kumar N. Vaccines (Basel). 2020;8(4):590. doi: 10.3390/vaccines8040590. PMID: 33049956
Resources for assessing parents' vaccine hesitancy: a systematic review of the literature
Cella P, Voglino G, Barberis I, et al. J Prev Med Hyg. 2020;61(3):E340-E373. doi: 10.15167/2421-4248/jpmh2020.61.3.1448. PMID: 33150224
Determinants of parental vaccine hesitancy
McGregor S, Goldman RD. Can Fam Physician. 2021;67(5):339-341. doi: https://doi.org/10.46747/cfp.6705339. PMID: 33980625
Parental perspectives on immunizations: impact of the COVID-19 pandemic on childhood vaccine hesitancy
He K, Mack WJ, Neely M, et al. J Community Health. 2022;47(1):39-52. doi: 10.1007/s10900-021-01017-9. PMID: 34297272
RELATED CONTENT:
EM:RAP Breaking News June 18, 2021: Vaccine Hesitancy
ROP Breaking News May 22, 2021: Parental Hesitancy Around COVID-19 Vaccines
PCMA Archive 2017 March: Countering Vaccine Hesitancy
Nate S. - April 5, 2023 6:58 AM
For vaccine discussion - for people who are stating "government puts trackers or nano tech into vaccines" I have a very simple statement to share, and it might not be an immediate win, but it worked out a lot over time. "I appreciate your concern of being tracked by the government... but you have a credit card, a cell phone, a bank account, you use the internet.... you are always being tracked. Try it, talk about something near your cell phone and it will show in a thread you google next time. the Smart Technology is tracking you... and the vaccine isn't one of the ways to do it, but it will help you from getting really sick." I have also used, "We are not that important! Do you think we are so scary to the government that they would want to track us?!? I mean, there's criminals, hate mongers, and people doing horrible things against humanity and the government... you and I, we are NOT important enough to track..."
Hobart L. - April 6, 2023 12:40 PM
Nate -- thanks for the comment! I love your suggestion -- another excellent way to reframe the discussion and help them understand. Thank you!