Vaccine hesitancy in the age of COVID-19

After a year of lockdowns, travel bans, and PPE shortages, it seems Australia is about to make its first steps out of the most significant pandemic in a century. With both the Pfizer and AstraZeneca vaccines now approved, we have a path back to normalcy. But with differing vaccine efficacies and uncertainty about the level of population coverage needed to reach herd immunity, an almighty effort will be required to get people vaccinated. There are clearly two sides to this coin: supply and demand. The supply debate is currently being carried out in public, with criticism being placed, rightly or wrongly, on the Federal Government’s procurement strategy. But the demand side to this equation also needs to be addressed, and doctors, particularly GPs, are well placed to ensure wide vaccination coverage. One hundred and fifty million 

vaccines are useless if only 150,000 people want them.

Already almost 30% of Australians are unsure about a COVID vaccine, and this level of vaccine hesitancy may rise given recent news about novel variants of COVID-19 and their variable responses to vaccines. Australia is also a victim of its own success, with relatively low amounts of cases and deaths perhaps leading to a lack of urgency in getting a vaccine. Despite the proliferation of Anti-Vaxxer sentiment on the internet, international evidence still suggests that patients see their own healthcare providers as their most trusted source of vaccine information. My own anecdotal experience supports this: I’ve already sat in numerous consultations where the patient has posed the question, ‘Should I get the COVID vaccine?’

So how should doctors face this challenge? How should doctors engender support in the vaccine, and help build herd immunity? Luckily, there is a growing evidence base answering this very question, of battling vaccine hesitancy. Firstly, the physician should pick their battle. You can broadly group people’s views towards vaccines into three groups: acceptors, who largely accept vaccines unquestionably, hesitators, who either delay vaccines or are selective, and refusers, who refuse all vaccines. While acceptors clearly do not need to be convinced, you should not spend much time on total refusers: they are unlikely to change their mind. Rather, simply a brief consultation and leaving the door open to these patients if they ever change their mind is the most suitable approach.

The bulk of persuasion and reassurance should be placed on those who are hesitant towards vaccines. The Centre for Disease Control states that a ‘presumptive’ stance should be taken, which should be reiterated after addressing patients’ concerns. This favours language such as ‘You are due for your COVID vaccine today’, rather than ‘What do you think about getting your COVID vaccine today?’. If the patient is still hesitant, clinicians should switch to acknowledging and empathising with the patient’s concerns, while reinforcing the efficacy and safety of vaccines with short simple statistics. If any misinformation is mentioned by the patient, experts state that misinformation should only be referred to once and rebutted concisely with clear simple facts. For example, if there are concerns about severe side effects, the clinician could reply, ‘This vaccine was tested in a trial with over 40,000 people, of which mild side effects like fatigue, a sore arm, and a headache were the most common. Only four serious side effects were noted.’ Clear, easy to understand detail is key to conveying confidence in the vaccine. 

However, narratives and stories, in additional to datapoints, can further reassure patients around COVID vaccines. A survey of US primary care physicians found that personal statements around what they would do for their own family, and what personal experiences they have had, seemed to have the most effect in swaying sceptical patients. These stories and facts should take into consideration the patient’s background, as patients within differing communities would have varying motivations, concerns and fears. Furthermore, referring to certain trusted spokespeople and influencers within communities can provide a unique legitimacy to a vaccine.

Finally, the best way to convince vaccine hesitators is to engage in a genuine dialogue, not a monologue. Trust is fostered through active listening, acknowledge anxieties, and addressing concerns, rather than dictating facts and dismissing worries. By building rapport, the patient will also build trust in your judgement regarding vaccines and that will help convert vaccine hesitators into acceptors. 

Obviously, the COVID vaccines are different. The evidence base is emerging, there are multiple candidates with seemingly differing efficacy and tolerability. Nonetheless, the Australian medical profession is up to the challenge of ensuring that a safe and effective vaccine is widely accepted, bringing us one step closer to a post-COVID age.

About the author 

Leo Coleman is a final year medical student at Prince of Wales Hospital. For article references please email the editor at news@amansw.com.au.