Vaccine hesitancy: Cure the myth and then the patient

The role of healthcare professionals in the battle against vaccine hesitancy

Authors:
Ceyda Louise Oral is a Biomedical Science student at King’s College London, Comfort Oluokun BSC Biomedical Sciences, Harshil Mehta has just finished GCSE and is going into sixth form, Ishan Patel has just completed GCSE and is going into sixth form, Maya Patel is a sixth form student hoping to go to medical school, Yakup Cem Yababa has just finished a BSc in Biomedical Sciences and will start an MSc in Global Health. All have completed a work experience placement at BMJ.

Vaccine hesitancy is characterised by a delay in acceptance or refusal of vaccines despite the availability of vaccination services. Being a complex and context-specific issue varying across time, place, and vaccines, it consists of elements such as complacency, convenience and confidence (Butler and MacDonald, 2015). The World Health Organisation considers vaccine hesitancy to be one of the top ten global health threats (World Health Organisation, 2019). The primary cause of vaccine hesitancy stems mainly from public discussions on medical, ethical, and legal issues related to vaccines. Thus, lack of knowledge, ignorance and distrust of vaccines contributes to the hesitancy among the public (Larson et al., 2014). In order to overcome vaccine hesitancy, a great responsibility falls into the hands of healthcare professionals. Steps that healthcare professionals are taking include promoting and encouraging patients to get vaccinated, increasing public knowledge about the vaccinations, and organising campaigns to motivate people to get vaccinated.

When patients present with vaccine hesitancy, healthcare professionals often respond with facts and statistics. But facts and statistics can only do so much - and sometimes patients have concerns that are not about the facts. Healthcare professionals must find out and acknowledge patient concerns. This vital information can help healthcare professionals find ways to address these concerns. Healthcare professionals must demonstrate empathy and compassion throughout the process. The factors that influence an individual patient's decision could also be used to spread information to those who are reluctant to book an appointment or talk to a healthcare professional.

Patients that take up vaccines often do so with an understanding of the safety and efficacy of vaccines. This suggests that helping those who are hesitant reach this level of understanding could increase vaccine uptake significantly (Savulescu, 2020). There are a large number of educational resources on vaccines from the NHS, BMJ and other organisations. But these are not always sufficient in assuaging the concerns of some people. Often, a more personal approach is required, much like one used by London GPs, Dr Hussain and Dr Fernandez. Their teams have called each of their practice's patients who were yet to accept the call to be vaccinated to address any concerns. They also organised pop-up clinics in places of worship, providing information needed to make informed decisions (Moberly, 2021). At this community-level, evidence-based communication strategies are required for optimum efficacy. Healthcare professionals sometimes use presumptive language in matters which seem indisputable to them, such as vaccinations. However, a motivational tone can be more successful when delivering information (McClure et al.,2017).

Although educating adults has proven to be effective in increasing vaccine compliance, such interventions could be introduced earlier in life. While vaccination is covered in our national curriculum, it is delivered in a scientific format, hence predominantly engaging those who have an interest in and are likely to pursue a career in science. By additionally delivering the concept in a Personal, Social, Health, and Economic format, perhaps with healthcare professionals as guest speakers, myths could be eliminated from the population at a young age - before any hesitancy arises. Consequently, students interested in the humanities and the sciences would leave school with a holistic understanding of vaccination and its benefits (Cramer, 2021).

One myth about vaccines concerns infertility. There have been rumours that vaccines can cause infertility (Bunch et al. 2020). This has especially been the case with COVID-19 vaccines. Even well-educated people can believe this. There is a need to educate all members of the public and also healthcare professionals about vaccines. Healthcare professionals are especially important and they set an example that others will follow.

Political influence is another factor affecting the uptake of the COVID-19 vaccine. Politicians in certain countries have sought to minimise the seriousness of the pandemic. This undermines confidence in healthcare professionals and their messages.  Some people will ask who should we trust - the politicians or the scientists? This shows the importance of healthcare professionals in educating, not only the people, but also senior officials in government on the science behind this crisis.

Public health campaigns are often large determinants of people’s responsiveness to advice (Evidence supports mass media campaigns promoting tobacco control, physical activity and sexual health, 2019). For example, the famous “catch it, bin it, kill it” campaign. It was simple, catchy, and effective. It gave enough information for a viewer to understand the process behind the instruction without overcomplicating things. This is important as people are distrusting of things they do not understand. Just telling people to ‘get on with it’ is not effective.

Often people within minority groups have the highest levels of vaccine hesitancy. According to a survey conducted by NHS England, “57% of [people of] Black, Asian and minority ethnic backgrounds would accept the vaccine compared to the 70% of White respondents” (New poll finds ethnic minority groups less likely to want COVID-19 vaccine, 2021). People from ethnic minorities are sometimes distrusting of healthcare due to the poor healthcare systems in their countries of origin. Some may worry about racism within healthcare systems (Razai et al., 2021). Healthcare professionals must listen to the views of everyone - ensuring they feel safe when taking the vaccine. Sometimes healthcare professionals from ethnic minority backgrounds can encourage people to receive vaccines. One way to do this is to emulate the idea of blood drives and create so-called vaccine drives.

Education. That is what it all comes down to. Educate the children. Educate the adults. Educate elderly people. Even educate other healthcare professionals. This is the way forward in combatting vaccine hesitancy. Being able to spread the science and the truth about vaccines will act as a springboard to ensure the safety of people all around the world. All healthcare professionals around the world must speak up. Whether you are a doctor, nurse, paramedic, physician associate, midwife, or any other healthcare professional…we need you! It is time to educate! Use new and traditional media; there are endless ways of communicating with the general public in modern times. Take advantage of them and prove to people once and for all that vaccines are the pathway to a healthier population and sustainable global health.


BMJ Best Practice 
BMJ Best Practice produces a range of patient information leaflets on vaccines. These include childhood and adult vaccines and of course COVID-19. The patient leaflets are continually updated and evidence based and are written in accessible language that all people will understand.


References

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Cramer, S., 2021. Moving the needle: Promoting vaccination uptake across the life course. Royal Society for Public Health, [online] p.28. Available at: <https://www.rsph.org.uk/static/uploaded/3b82db00-a7ef-494c-85451e78ce18a779.pdf> [Accessed 1 July 2021].

Larson, H.J., Jarrett, C., Eckersberger, E., Smith, D.M.D., Paterson, P. (2014) Understanding vaccine hesitancy around vaccines and vaccination from a global perspective: A systematic review of published literature, 2007–2012. Vaccine. 32 (19): 2150-2159. doi: https://doi.org/10.1016/j.vaccine.2014.01.081.

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Moberly, T., 2021. COVID-19: Vaccine hesitancy fell after vaccination programme started. BMJ, p.n837.

Savulescu, J., 2020. Good reasons to vaccinate: mandatory or payment for risk?. Journal of Medical Ethics, 47(2), pp.78-85.

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