Vaccine hesitancy is a multi-level issue informed by systemic racism, structural barriers, internet disinformation, and personal concerns and fears. We have so much work to do at each of these levels. As a pediatrician, I have noticed clinicians have a real opportunity at the personal level to break down a subset of these barriers.
At the beginning of the COVID-19 pandemic, I spoke to a mother with her toddler child for a routine telehealth visit. During that appointment, we had a conversation about her vaccine hesitancy. I had listened and shared what I knew, but I walked away from the conversation unsure if I’d made an impact. Apparently, had been helpful — and even convincing — to her. Unbeknownst to me, she had gotten her children vaccinated against routine childhood illnesses.
Recently, I got a MyChart message from that same mom asking if we could schedule a telehealth appointment to answer some of her lingering questions about the next set of vaccines that are due for her children. Getting this follow-up message was validating and another piece of evidence confirming a suspicion I’ve had lately: Many people are looking for an opportunity to talk through their fears and questions with a trusted person who will hear out their concerns, non-judgmentally share information, and support them in making a decision that’s best for them and their family.
Changing our perspective of vaccine hesitancy
Medical professionals are used to thinking that people who choose not to get vaccines aren’t going to change their minds. While I certainly have had conversations with individuals who’ve done their internet research and are set in their decision against vaccination, more commonly, the choice is much more nuanced.
As a physician, one of my biggest roles in vaccine hesitancy is to just raise the topic of vaccines in conversation during appointments. Many times during a checkup for, for example, a 6-month-old, I’ve casually asked the parent or guardian, “So, what are you thinking about the COVID-19 vaccine?” This framing of the question, as starting a dialogue, in my experience, opens the floodgates. I’m often met with an eager outpouring of the family’s thoughts, experiences, and fears. My general impression is that these parents are looking for a trusted source to talk to. No one had yet given them the opportunity.
Addressing myths and valid obstacles to vaccination
Through these conversations, anecdotally, I've learned that many people do want to get vaccinated, but they are facing an obstacle — internal or external — that they need assistance getting past.
For example, I spent a recent evening staffing a COVID-19 vaccine Q&A booth for night-shift workers at Boston Medical Center (BMC). Several people came up to me with basic questions: If they got COVID-19 after getting the first vaccine, will they still be eligible for the second vaccine? If they had a trip planned, do they have to wait until after the trip? Should they avoid it because of a specific health condition? Providing fact-based answers to these questions reassured people that they could move forward with their plan to be vaccinated.
Others have been facing very pragmatic logistical obstacles. The most humbling was an elderly staff member who was eager to be vaccinated, but he hadn't yet been able until this BMC night clinic because he had to get to his day job right after the night shift ends. A mother at a recent clinic visit told me her grandmother isn’t going to get the vaccine because she's elderly and has trouble leaving the house.
That same night clinic, I spoke with a clinical staff member who spends most of her job time in direct contact with COVID-19 patients, but she was worried about getting the vaccine because one of her colleagues had a reaction to it. After we talked through the potential reactions to the vaccine, weighing the risks and benefits, she was ready to get vaccinated.
"Personal conversations alone will not fix health inequities. However, these conversations are a key part of breaking them down."
Some mothers I’ve spoken with during clinic visits are worried the COVID-19 vaccination approval process has been rushed. Despite these fears, they are contemplating getting the vaccine because they want to protect their children. For them, I’ve been able to share information from the FDA to reassure them that while the process has been compressed, steps have not been skipped. They have all vocalized feeling more confident in vaccine safety after these conversations.
I’ve gotten multiple messages from colleagues and friends asking about potential effects on fertility and pregnancy. In these cases, as another reproductive-aged woman, I am able to share the data that show the benefits of obtaining the vaccine most likely outweigh the unknown risk — due to the current lack of data on vaccine testing on pregnant women. The CDC, Society for Maternal-Fetal Medicine, and American College of Obstetricians and Gynecologists all recommend that the COVID-19 vaccines be offered to pregnant women who are eligible. And I encourage them to reach out to their own doctors and services, such as the opportunity BMC is offering its staff to have a telemedicine visit with maternal-fetal medicine specialists, to answer questions.
Personal conversations alone will not fix health inequities. However, these conversations are a key part of breaking them down.
Having a patient read information intended and supplied for the masses is simply never as reassuring as having a personalized conversation with a trusted source. Yes, it is on us as part of healthcare institutions to design systems to break down systemic and logistical barriers to vaccine access. We need to ensure that vaccines are easily accessible to those who need it most and who are most likely to be disenfranchised — home-bound seniors, night-shift essential workers, people of color, homeless populations, people with substance use disorder, and others. But we as trusted providers can each start by opening up the conversation. Sometimes, all it takes is asking what another person is thinking and being willing to listen.