The role of family doctors in addressing vaccine hesitancy

Weng-yee Chin

HK Pract 2021;43:33-34

I relocated with my family from Hong Kong to New York in August 2019, unaware that we would soon be living in an epicenter of the COVID-19 pandemic. Worried friends and family frequently checked in on us after seeing media reports of the strong aversion Americans held to mask- wearing and social distancing, which perplexed those from Hong Kong. Fast forward one year, and the most commonly asked questions lately have been – “Have you been vaccinated yet?” followed by, “Are you going to get vaccinated?” and “Which vaccine are you going to get?”

Vaccination has been amongst the greatest achievements in modern medicine contributing to reductions in morbidity and mortality across a spectrum of infectious diseases. In order for vaccination programs to be successful however a high level of uptake is required to achieve sufficient herd immunity to slow down disease transmission.¹ Ever since the successful sequencing of the SARS-CoV-2 genome, there has been a race to produce and distribute a vaccine, however, even with vaccine availability, there are still hurdles to overcome to attain sufficient population coverage including vaccine hesitancy.^2-4

Vaccine hesitancy as defined by the World Health Organization is the “delay in acceptance or refusal of vaccines despite availability of vaccination services”.⁵ Decision-making around getting vaccinated is complex and influenced by a range of socio-political, cultural, psychological and cognitive factors.⁶ There are three main reasons for vaccine hesitancy: (1) lack of Confidence (i.e. concerns over efficacy and safety, or distrust of health authorities), (2) Complacency (due to low self-perceived risk of the disease), and (3) lack of Convenience (i.e. poor availability and/or lack of accessibility).⁵These three Cs all appear to be relevant in hindering the uptake of COVID-19 vaccinations locally and globally.

A variety of strategies have been used to promote vaccine uptake. For people who are already intending on getting vaccinated, strategies such as default appointments and onsite vaccinations are known to effectively increase uptake rates. Unfortunately, for those who are fence-sitting or hesitant, interventions such as those aimed at emotional activation, or education campaigns directed at changing negative beliefs have often failed at making any impact, and in some cases, have made people even less willing to get vaccinated.^7,8 Research has found the single most effective method to increase vaccine uptake is through a recommendation from a clinician or health official in whom the individual or public has confidence.⁹ In otherwards, overcoming vaccine hesitancy is less about what the doctor says to motivate their patient, and more about how much the patient trusts their doctor.

So, what is the family doctors’ role in addressing vaccine hesitancy?

First, be aware of your own stance on vaccination and how it can affect patient interactions. In most countries, healthcare workers were amongst the first to be offered COVID-19 vaccinations, and those who have been vaccinated can speak to their patients with confidence and authenticity. However, many health professionals in Hong Kong and internationally have voiced reluctance to be vaccinated.^2,3Hesitant physicians are less likely to convince hesitant patients, and less likely to address patients’ questions regarding vaccine efficacy and safety.¹⁰ Healthcare providers therefore need to be aware about their potential to negatively impact patient decision-making.

Secondly, acknowledge that your patients’ vaccine concerns may be valid. In the case of the COVID-19 vaccines, the newness of mRNA vaccine technology, the speed of vaccine development, and the lack of longitudinal data are all valid concerns. The family doctor needs to be perceived as trustworthy, and to deny or play down these concerns may make the doctor appear biased or blasé. In such cases, one strategy may be to remind patients that whilst there are many unknowns, what is already known about vaccine safety and efficacy is a lot more than what isn’t yet known.¹¹

Thirdly, before trying to persuade a patient who may be hesitant, try to understand them. The COVID-19 pandemic has polarized communities and separated families. Rather than simply instructing patients to get vaccinated, perhaps begin the conversation by asking them how they’ve been coping or what they miss most. By letting them do the talking, your patient may end up persuading themselves to get vaccinated.¹¹

Fourthly, utilise time as a tool.¹² Vaccine hesitancy is not necessarily static, and people’s willingness to accept the vaccine can change over time.¹³ Preserving the doctor-patient relationship is probably more important than fighting over a vaccination, and physicians should respect their patients’ decisions even when they disagree. This way, at least you get to keep the door open for further conversations in the future.

Disclaimer: I have received the Pfizer-BioNTech COVID-19 Vaccine COVID-19 vaccination provided through the New York State COVID Vaccination programme.