How to overcome hesitancy for COVID-19 and other vaccines

,; ,; ,; ,; ,

doi:doi: 10.12788/jfp.0443

Applied Evidence

How to overcome hesitancy for COVID-19 and other vaccines

J Fam Pract. 2022 July;71(6):239-244 | doi: 10.12788/jfp.0443

PDF Download

References

1. Ten threats to global health in 2019. World Health Organization. Accessed June 17, 2022. www.who.int/news-room/spotlight/ten-threats-to-global-health-in-2019

2. FDA approves first COVID-19 vaccine. US Food and Drug Administration. August 23, 2021. Accessed June 17, 2022. www.fda.gov/news-events/press-announcements/fda-approves-first-covid-19-vaccine

3. Mathieu E, Ritchie H, Ortiz-Ospina E, et al. A global database of COVID-19 vaccinations. Nat Hum Behav. 2021;5:947-953. doi: 10.1038/s41562-021-01122-8.

4. Ritchie H, Mathieu E, Rodés-Guirao L, et al. Coronavirus pandemic (COVID-19). Our world in data. Accessed June 17, 2022. https://ourworldindata.org/covid-vaccinations?country=USA

5. de Figueiredo A, Simas C, Karafillakis E, et al. Mapping global trends in vaccine confidence and investigating barriers to vaccine uptake: a large-scale retrospective temporal modelling study. Lancet. 2020;396:898-908. doi: 10.1016/S0140-6736(20)31558-0

6. Wang Y, Liu Y. Multilevel determinants of COVID-19 vaccination hesitancy in the United States: a rapid systematic review. Prev Med Rep. 2021;25:101673. doi: 10.1016/j.pmedr.2021.101673

7. Robinson E, Jones A, Lesser I, et al. International estimates of intended uptake and refusal of COVID-19 vaccines: a rapid systematic review and meta-analysis of large nationally representative samples. Vaccine. 2021;39:2024-2034. doi: 10.1016/j.vaccine.2021.02.005

8. Dubé E, Gagnon D, MacDonald NE; SAGE Working Group on Vaccine Hesitancy. Strategies intended to address vaccine hesitancy: review of published reviews. Vaccine. 2015;33:4191-4203. doi: 10.1016/j.vaccine.2015.04.041

9. Sadaf A, Richards JL, Glanz J, et al. A systematic review of interventions for reducing parental vaccine refusal and vaccine hesitancy. Vaccine. 2013;31:4293-4304. doi: 10.1016/j.vaccine.2013.07.013

10. Kim S, Pjesivac I, Jin Y. Effects of message framing on influenza vaccination: understanding the role of risk disclosure, perceived vaccine efficacy, and felt ambivalence. Health Commun. 2019;34:21-30. doi: 10.1080/10410236.2017.1384353

11. Shim E, Chapman GB, Townsend JP, et al. The influence of altruism on influenza vaccination decisions. J R Soc Interface. 2012;9:2234-2243. doi: 10.1098/rsif.2012.0115

12. Sprengholz P, Eitze S, Felgendreff L, et al. Money is not everything: experimental evidence that payments do not increase willingness to be vaccinated against COVID-19. J Med Ethics. 2021;47:547-548. doi: 10.1136/medethics-2020-107122

13. Freeman D, Loe BS, Yu LM, et al. Effects of different types of written vaccination information on COVID-19 vaccine hesitancy in the UK (OCEANS-III): a single-blind, parallel-group, randomised controlled trial. Lancet Public Health. 2021;6:e416-e427. doi: 10.1016/S2468-2667(21)00096-7

14. Hakim H, Provencher T, Chambers CT, et al. Interventions to help people understand community immunity: a systematic review. Vaccine. 2019;37:235-247. doi: 10.1016/j.vaccine.2018.11.016

15. Betsch C, Böhm R, Korn L, et al. On the benefits of explaining herd immunity in vaccine advocacy. Nat Hum Behav. 2017;1:1-6. doi: 10.1038/s41562-017-0056

16. Logan J, Nederhoff D, Koch B, et al. ‘What have you HEARD about the HERD?’ Does education about local influenza vaccination coverage and herd immunity affect willingness to vaccinate? Vaccine. 2018;36:4118-4125. doi: 10.1016/j.vaccine.2018.05.037

17. Pfattheicher S, Petersen MB, Böhm R. Information about herd immunity through vaccination and empathy promote COVID-19 vaccination intentions. Health Psychol. 2022;41:85-93. doi: 10.1037/hea0001096

18. Loomba S, de Figueiredo A, Piatek SJ, et al. Measuring the impact of COVID-19 vaccine misinformation on vaccination intent in the UK and USA. Nat Hum Behav. 2021;5:337-348. doi: 10.1038/s41562-021-01056-1

19. Limaye RJ, Opel DJ, Dempsey A, et al. Communicating with vaccine-hesitant parents: a narrative review. Acad Pediatr. 2021;21:S24-S29. doi: 10.1016/j.acap.2021.01.018

20. Omer SB, Amin AB, Limaye RJ. Communicating about vaccines in a fact-resistant world. JAMA Pediatr. 2017;171:929-930. doi: 10.1001/jamapediatrics.2017.2219

21. Nyhan B, Reifler J. Does correcting myths about the flu vaccine work? An experimental evaluation of the effects of corrective information. Vaccine. 2015;33:459-464. doi: 10.1016/j.vaccine.2014.11.017

22. Nyhan B, Reifler J, Richey S, et al. Effective messages in vaccine promotion: a randomized trial. Pediatrics. 2014;133:e835-e842. doi: 10.1542/peds.2013-2365

23. Steffens MS, Dunn AG, Marques MD, et al. Addressing myths and vaccine hesitancy: a randomized trial. Pediatrics. 2021;148:e2020049304. doi: 10.1542/peds.2020-049304

24. Carey JM, Chi V, Flynn DJ, et al. The effects of corrective information about disease epidemics and outbreaks: evidence from Zika and yellow fever in Brazil. Sci Adv. 2020;6:eaaw7449. doi: 10.1126/sciadv.aaw7449

25. Yousuf H, van der Linden S, Bredius L, et al. A media intervention applying debunking versus non-debunking content to combat vaccine misinformation in elderly in the Netherlands: a digital randomised trial. EClinicalMedicine. 2021;35:100881. doi: 10.1016/j.eclinm.2021.100881

26. Cambon L, Schwarzinger M, Alla F. Increasing acceptance of a vaccination program for coronavirus disease 2019 in France: a challenge for one of the world’s most vaccine-hesitant countries. Vaccine. 2022;40:178-182. doi: 10.1016/j.vaccine.2021.11.023

27. Leask J, Kinnersley P, Jackson C, et al. Communicating with parents about vaccination: a framework for health professionals. BMC Pediatr. 2012;12:154. doi: 10.1186/1471-2431-12-154

28. Martela F, Hankonen N, Ryan RM, et al. Motivating voluntary compliance to behavioural restrictions: self-determination theory–based checklist of principles for COVID-19 and other emergency communications. Eur Rev Soc Psychol. 2021:305-347. doi: 10.1080/10463283.2020.1857082

29. Boness CL, Nelson M, Douaihy AB. Motivational interviewing strategies for addressing COVID-19 vaccine hesitancy. J Am Board Fam Med. 2022;35:420-426. doi: 10.3122/jabfm.2022.02.210327

30. Salomoni MG, Di Valerio Z, Gabrielli E, et al. Hesitant or not hesitant? A systematic review on global COVID-19 vaccine acceptance in different populations. Vaccines (Basel). 2021;9:873. doi: 10.3390/vaccines9080873

31. Pitts SI, Maruthur NM, Millar KR, et al. A systematic review of mandatory influenza vaccination in healthcare personnel. Am J Prev Med. 2014;47:330-340. doi: 10.1016/j.amepre.2014.05.035

The takeaway

Strategies for increasing vaccine intentions include educating hesitant patients about the benefits and risks of vaccines, addressing misinformation, and explaining the personal and collective benefits of vaccination. These strategies appear to be more effective when delivered by a trusted source, such as a health care provider (HCP). Care should be taken when implementing vaccine-acceptance strategies to ensure that they are tailored to specific populations and vaccines.

At this stage in the COVID-19 pandemic, when several vaccines have been widely available for more than a year, we expect that the majority of patients desiring vaccination (ie, those with the greatest vaccine intent) have already received them. With the recent approval of COVID-19 vaccines for children younger than 5 years, we must now advocate for our patients to vaccinate not only themselves, but their children. Patients who remain unvaccinated may be hesitant or outright reject vaccination for a number of reasons, including fear or skepticism over the safety and efficacy of the vaccine, belief in conspiracy theories, belief that COVID-19 is not real or not severe, or mistrust of the government.⁶ Vaccine hesitation or rejection is also often political in nature.

Based on the studies included in this review, we have identified several strategies for reducing vaccine hesitancy, which can be used with vaccine-hesitant patients and parents. We suggest emphasizing the personal benefit of vaccination and focusing on specific disease risks. If time allows, you can also explain the collective benefit of vaccination through herd immunity, including the current levels of local vaccine uptake compared to the desired level for community immunity. Communicating the collective benefits of vaccination may be more effective when paired with a strategy intended to increase empathy and altruism, such as sharing actual stories about those who have suffered from a vaccine-preventable disease.

Build trust by asking your patient: What kind of information do you feel you are missing about the vaccine?

Addressing myths and misinformation related to COVID-19 and other vaccines, with emphasis placed on the correct information delivered by trusted sources may be beneficial for those who are uncertain but not strongly against vaccination. For those who remain staunchly hesitant against vaccination, we recommend focusing on the personal benefits of vaccination with a focus on delivering facts about the risk of the disease in question, rather than trying to refute misinformation.

COVID-19 vaccine acceptance in the United States is disturbingly low among health care workers, particularly nurses, technicians, and those in nonclinical roles, compared to physicians.^6,30 Many of the strategies for addressing vaccine hesitancy among the general population can also apply to health care personnel (eg, vaccine education, addressing misinformation, delivering information from a trusted source). Health care personnel may also be subject to vaccine mandates by their employers, which have demonstrated increases in vaccination rates for influenza.³¹ Given that COVID-19 vaccination recommendations made by HCPs are associated with greater vaccine intentions and uptake,⁶reducing hesitancy among health care workers is a critical first step to achieving optimal implementation.

CORRESPONDENCE
Nicole Mayo, PhD, 236 Pearl Street, Rochester, NY 14607; Nicole_Mayo@URMC.Rochester.edu