Vaccine hesitancy refers to delay in acceptance or refusal of vaccines despite availability of vaccination services. It is different to being anti-vaxx (anti-vaccines). People who are vaccine hesitant will accept some vaccines but may be ‘hesitant’ about others, delay them or have questions or concerns. An example is MMR vaccine. Certain individuals and communities will refuse or delay the MMR vaccine due to the unfounded link to autism, yet will have participated in the National Routine Childhood Immunisation Programme, accepting the primaries and the 12-month boosters.
Vaccine hesitancy is complex and context-specific, varying across time, place and vaccines. There is a growing body of evidence on assessing the determinants of vaccine hesitancy, particularly by the World Health Organisation’s SAGE Vaccine Hesitancy Working Group. They have identified that it is influenced by confidence (individuals do not trust the vaccine, the provider or health authorities), complacency (do not perceive a need for a vaccine, do not value the vaccine, low perceived risk of disease) and convenience (barriers related to geographic accessibility, affordability and acceptability of services).
Dealing with vaccine hesitancy as healthcare professionals
Healthcare professionals remain the most trusted advisors and influencers of vaccination decisions. Numerous studies have shown that if a healthcare professional recommends or takes the time to answer patients’ questions, the patients are more likely to consent to the vaccination. The capacity and confidence of health workers are often stretched, though, as they are faced with time constraints, limited resources and inadequate information or training to respond to questions and discuss the benefits and rare risks of vaccination. However, what staff say and how they interact with the patient can strongly influence vaccine acceptance.
Where do you start?
The first step to being adequately prepared to address difficult questions is having a good knowledge base about how the two Covid-19 vaccines currently in the UK programme work. This lays the foundation to being confident in having conversations around concerns about Covid-19 vaccines.
Public Health England has online resources including e-learning and guidance for health professionals to help your understanding of how the vaccine works. The British Society for Immunology prioritises having reliable information on vaccines and immunity and have developed training and educational resources to increase confidence in talking to the public about vaccines. This includes having video resources on frequently asked questions, long term immunity, guide on Covid-19 vaccines and infographics for how the different Covid-19 vaccines work. The Vaccine Knowledge Project is another excellent resource for information on vaccines, including on Covid-19 vaccines. This addresses frequently asked questions including circulating rumours and whether the vaccines cover the new variants.
A trap to avoid is looking for or developing a ‘myth busting’ leaflet. Whilst there are studies to show that healthcare professionals like to have up-to-date facts, figures and stock phrases for myth-busting, there is substantial evidence to show that this endeavour can end up reinforcing the myth. Instead, it is better to acknowledge their concerns and be honest. They are worried about themselves or their loved ones. Typical questions asked are around how the vaccines work, the side-effects, catching the virus from the vaccine, components of the vaccine and why some people still get Covid-19 after vaccination.
Motivational interviewing is recommended for having a skilled conversation with vaccine hesitant patients. It has been used widely and proven to be an effective tool in producing behaviour change in other areas of health, such as physical illness, and uses open ended questions to explore the reasons and motivations for the hesitancy (for example, ‘tell me, what do you understand?’). Such training may be available to you in your area. If it isn’t, WHO has training slides called Conversations to build trust in vaccination: A training module for health workersthat you can download and work through with colleagues. These are available here.
Acceptance of Covid-19 vaccines depends on the characteristics of the new vaccines, the national vaccination strategy and factors that impact upon uptake of other immunisation programmes such as compliance with past vaccinations and perceived risk of disease. There are national and regional public health initiatives being developed to reduce Covid-19 vaccine hesitancy. These will directly target specific populations that are under-vaccinated and engage with community leaders and champions to increase knowledge and awareness around the vaccines. However, taking the time to speak with eligible patients about the vaccine before their vaccination appointment or at another primary care appointment goes a long way in encouraging vaccine acceptance.