Working to Reduce Vaccine Hesitancy

By: The CHEST COVID-19 Task Force

May 5, 2021

At the time of this writing, COVID-19 cases in the United States seem to be decreasing. This is following a fourth peak that, although markedly smaller than the dramatic third peak in late 2020 to early 2021, has nonetheless sickened thousands and strained health systems in Michigan, Minnesota, the Northeast, and elsewhere.

Although some of this decline has been due to social distancing, the use of face coverings, and the natural history of pandemic transmission, a huge component of the decline has been the remarkable achievements of rapid vaccine development and deployment. As of May 10, 2021, adults and children in the US aged 12 and older are eligible for vaccination against SARS-CoV-2, and 157 million have received at least one dose of the Pfizer, Moderna, or Janssen (Johnson & Johnson) vaccines.¹ This represents nearly 60% of adults 18 and older and more than 40% of the total US population.

This vaccine program is a triumph of science and implementation. Having vaccinated the first half of the US population, our next step as a society is the vaccination of the remaining second half. Unlike late 2020, when vaccine supplies were extremely limited, there is now an adequate supply of vaccines for every adult in the country. Yet there are reasons to believe that this second half will be an even greater challenge, due to a high degree of vaccine hesitancy among our patients and our fellow health care workers (HCWs). For various reasons, many are still reluctant to be vaccinated despite a high risk of infection at work and at home.

As pulmonary, critical care, and sleep medicine specialists, our patients are at the highest risk for severe disease and death due to COVID-19. They usually present with high rates of chronic lung disease, obesity, and hypertension, to name a few. Most of us are practicing medicine at the bedside, in the office, in the procedure suite, or in the ICU. We are not highly visible leaders in public health. We do have tools to help us, though: The relationships we have built with our patients and the respect we have earned from our fellow HCWs.

In order to overcome this hesitancy to receive the vaccine, it is important to first identify the potential reasons for it:

1. Mistrust of the science. It is true that these vaccines against COVID-19 were developed at a faster pace than any prior vaccines. (The mumps vaccine was the prior record holder at 4 years.) We would be hasty to dismiss all of this mistrust as the result of simple conspiracy theories. COVID-19 vaccines were developed based on decades of preceding work with mRNA platforms, viral vectors, SARS and MERS vaccines, and other innovations. To a person not familiar with what went into developing the vaccines, the development indeed could seem rushed. Similarly, people of color may be reluctant to seek vaccination due to understandable concerns about historic injustices perpetrated on their communities.

2. Mistrust of politics. While vaccine acceptance rates appear to be improving, political divisions within our country have crept into this aspect of the pandemic as well. Polls have estimated that up to half of men who identify as members of the Republican Party do not intend to seek vaccination, compared with a much smaller number of self-identified Democrats and Independents.

3. A sense of invulnerability. Many younger adults are hesitating to seek vaccination despite being eligible. Some of this is due to the reasons listed above. Some of it is due to feeling that it is more important for higher-risk persons to be vaccinated first (that is, out of a sense of altruism). And some of it is due to a sense that COVID-19 is a mild disease in younger people and that their risk is low.

4. Fear of side effects. Mild adverse effects like fever, myalgia, and malaise are common after any vaccination. While generally self-limited, they are common and real. More concerning are recent reports of thrombosis following the two adenovirus vector vaccines (Janssen and AstraZeneca), resembling heparin-induced thrombocytopenia clinically and mostly affecting younger women. These events appear to be extremely rare, occurring in fewer than 1 out of 500,000 vaccine recipients (and likely much lower than the risk of thrombosis with COVID-19), but these reports can stoke fear among already reluctant people. It is important to put this risk in context: The annual risk of dying in a motor vehicle accident in the US was 51 deaths out of 500,000 persons in 2013, or 50 times greater than the risk of a pathologic clot due to these vaccines.

How Can We Help?

This is not a comprehensive list, but it is a reasonable list. So how can we, as a clinical community, help convince our neighbors and colleagues to be vaccinated?

1. Lead by example. Talk about your vaccine experience and share the relief you felt after getting your doses. Let others know about how the vaccines were developed and why you have faith in their efficacy and safety.

2. Be candid about potential side effects. Many of us were fortunate to have an entirely benign course after receiving one of the mRNA vaccines, but fever and malaise are common events. While self-limited in the overwhelming majority of cases, they can make the vaccine recipient miserable. Discuss these with your reluctant patients and colleagues, reassure them that it is self-limited, and recommend ways to plan for and mitigate these effects. Similarly, concerns about thrombosis with the adenovirus vector vaccines might lead you to recommend younger women to seek out one of the mRNA vaccines while allowing for the low risk; it is more important to be vaccinated than it is to receive a particular vaccine.

3. If you are in a supervisory position, help staff members get their vaccine at a time that will minimize disruption to their work and personal lives, and strongly consider the option of paid time off after their dose if it is within your power to grant.

4. Don’t condemn or debate those people who disagree with you. Instead, approach their hesitancy with curiosity. This is too important a topic and can undermine trust. Speak the truth, but strive to persuade rather than bludgeon. Very few people have been successfully bullied into receiving a vaccine, but many people have been gradually persuaded by the respectful advice of a trusted physician or nurse. And if they aren’t receptive the first time, then try again later when the time is right. Different patients may respond better to different perspectives; while some young people may not value vaccination for themselves, they might be more receptive to being vaccinated to protect elderly family members and neighbors, for example.

5. Celebrate small victories. Every one patient you are able to encourage to be vaccinated is one fewer person who is likely to fall ill from COVID-19. It is possible that, without your effort, this patient might never have been vaccinated otherwise. This is a victory. Be proud of it.

6. Advocate for change. Limitations in vaccine supply early on were compounded by limitations in access in historically disadvantaged and marginalized communities. Work with your local health systems to ensure that the patients at the greatest risk of COVID-19, including communities of color, have rapid and convenient access to vaccination.

The COVID-19 vaccines are our world’s route out of the pandemic. As specialists in pulmonary, critical care, and sleep medicine, we have a chance to protect our most vulnerable. Thank you again for everything you’ve done and for everything you will do.

References

1. Centers for Disease Control and Prevention. COVID-19 Vaccinations in the United States. Centers for Disease Control and Prevention; 2021. Accessed May 17, 2021. https://covid.cdc.gov/covid-data-tracker/#vaccinations

Read more COVID-19: Voices From the Community blog posts:

Being a Part of Something Bigger Than Ourselves

CHEST’s COVID-19 Task Force – The Secrets Behind Our Success

How COVID-19 Turned Our Hospital—and Patients—Upside Down