Vaccine Hesitancy

By Stuart Foxman

If the best weapon against COVID-19 is the vaccine, employing Ontario’s doctors might be the best strategy against vaccine hesitancy.

Physicians remain the most trusted source of vaccine information. So, they have a unique role in helping their patients get vaccinated, says Dr. Kieran Moore, Chief Medical Officer of Health for Ontario.

When trying to get people to take any action that benefits their health, doctors “have a powerful influence to change behaviours,” says Dr. Moore. “The conversation with a health care provider is motivating.”

In late July, Dr. Moore talked to Dialogue about how the province’s doctors can help move the needle on vaccine uptake. He discussed how to communicate with patients, understand the mindsets behind hesitancy, and hammer home the message of safety and efficacy.

Start with recognizing the potential.

In any immunization campaign, roughly four to five percent of the population won’t get vaccinated no matter what. The Ministry of Health says that’s in line with the attitude towards the COVID-19 vaccine, i.e., no better or worse than would be expected.

The good news? “We should consider that 95% are open to be immunized,” says Dr. Moore.

According to the Ministry, 10 to 18 percent of those who haven’t yet been vaccinated and who don’t have an appointment express some hesitancy. These aren’t hardcore anti-vaxxers; they can be moved. Another 30 percent of the holdouts are even more persuadable. They say it’s “very likely” they’d have the vaccine if it was offered to them.

What can doctors do to reach these late adopters? Here are six key strategies.

1. Don’t judge
People who remain unvaccinated may have legitimate questions or concerns. “They need them answered in an open, non-judgmental way,” says Dr. Moore.

Ask about their feelings and ideas about the vaccine, he says. Counter misconceptions, but remain empathetic. And if your patient isn’t ready to get vaccinated just yet, keep the door open for more conversations.

2. Recognize the range of barriers
Vaccine hesitancy is a broad term, which doesn’t reveal the nuances of people’s beliefs and values. Among those who express reluctance or refuse to be vaccinated, the Ministry says uncertainty regarding the long-term consequences of the vaccine continues to be cited most often as the main reason (35 percent).

Others have concerns about side effects. Some are apathetic. For still others, resistance is rooted in societal or cultural factors, like fears and distrust of the health care system owing to inequity and historical injustices.

There are more reasons. Dr. Moore says it’s instructive to consider these 5Cs of vaccine hesitancy:

• Lack of confidence in vaccines;
• Complacency about getting sick;
• Convenience about getting the shot;
• A calculation that if you get COVID-19 everything will be okay; and
• Faith in collective responsibility, i.e., I’ll be fine as long as everyone else gets vaccinated.

The factors that drive hesitancy are diverse and will shape very different types of conversations. So, learn what makes your patient tick.

3. Make a connection
Provide accurate information, but don’t drown people in scientific facts. Listen, and talk through people’s fears, apprehensions and whatever is getting in the way of them booking a vaccine. Dr. Moore says it can help to share your own vaccination story, i.e., you’ve been immunized to protect yourself, your family, your patients and your community.

4. Acknowledge uncertainty
There’s still a lot we don’t know about COVID-19. “Acknowledging uncertainty is very important,” says Dr. Moore. “We cannot lose the public trust, and part of that process is remaining accountable to the public and being humble.”

It’s okay to recognize that some people are uneasy with how so much of the knowledge and rules surrounding COVID-19 continue to evolve. Yet, in the face of uncertainty, we’re fortunate to have vaccines that are highly safe and effective. Be honest about side effects and reassure patients that we have a robust vaccine safety system.

5. Have a simple and clear message
Let patients know you have complete confidence in the vaccine, and you universally advise people to take it.

6. Ease the burden
If your patients haven’t been vaccinated yet, offer to help them book an appointment. For some people, navigating the booking systems (or having the time to do it) can be a barrier. Remove it for them.

In doing all of the above, be proactive. Through Ontario Health, family physicians will be made aware of patients on their primary care roster who are vaccinated. So, they’ll be able to target their vaccine strategy towards those individuals who aren’t yet vaccinated.

While vaccination rates continue to tick up, some sizeable segments of the population are vulnerable. Dr. Moore notes that 22 percent of the 40-49 age group and 18 percent of the 50-59 group remain unvaccinated. Going into the fall, he says it’s vital these groups hear from their doctors about the importance of immunization.

Ontario is doing well on the vaccination front and can do even better. The province’s doctors can play a key role in getting the population to the finish line.

Respond to the 5Cs of vaccine hesitancy

Here’s what patient hesitancy and your response can look like in practice, adapted from a Government of Canada primer for health professionals. Check it out for the fuller scenarios.

Barrier: Confidence

If your patient says:
“I don’t trust the vaccines and feel like they were rushed.”

You can respond:
“Decisions to authorize vaccines for use in Canada are based on scientific and medical evidence showing that vaccines are safe and effective. Because of the pandemic, countries and scientists worked closely together to make COVID-19 vaccines a top priority. This has made it possible to develop effective vaccines in record time without compromising safety.”

Barrier: Complacency

If your patient says:
“I’m not really worried about getting sick. My risk of dying is low and I do other things to protect myself.”

You can respond:
“While death rates are one way of looking at the impact of COVID-19, some people have long-term complications. I would never want that for any of my patients. The benefits of vaccination far outweigh the potential risks of getting COVID-19. Think of vaccines as a personal trainer for your immune system, something to make it even stronger and more effective than it is right now. If you’re ever exposed to the COVID-19 virus, being vaccinated will allow your immune system to fight the virus faster and more efficiently so that you’re less likely to get sick.”

Barrier: Convenience

If your patient says:
“It seems like it might be tricky to get the vaccine. Maybe I shouldn’t bother.”

You can respond:
“If it’s helpful, we can walk you through the booking, so it’s one thing off your plate. Getting vaccinated is a good investment in yourself.”

Barrier: Calculation

If your patient says:
“From what I’ve read, if the virus exists at all, it’s no worse than the flu.”

You can respond:
“Unfortunately, that’s not the case. Here’s what we know for sure: COVID-19 seems to spread more easily than flu and causes more serious illnesses in some people. Unlike the flu virus, the virus that causes COVID-19 is new. Because of this, none of us had ever been exposed to the virus or had a chance to build immunity to protect us from it. This left all of us at risk of getting COVID-19. This is a part of why vaccines are so key.”

Barrier: Collective Responsibility

If your patient says:
“With herd immunity, it’s not necessary for everyone to get vaccinated. Since most people are eventually going to get vaccinated, I should be safe, even if I don’t get a vaccine myself.”

You can respond:
“It’s key for each of us to get vaccinated so we can at least ensure our own safety and hopefully decrease the spread of the virus in our communities.”