The Editorial Office on “Addressing Vaccine Hesitancy: Tips for Healthcare Providers”

What is “Vaccine Hesitancy”? 

The COVID-19 pandemic has shown the world the importance of working together as an interdisciplinary team to achieve a global goal: to create a vaccine. Since the creation of the COVID-19 vaccines, there has been an increased prevalence of vaccine hesitancy, specifically in racial and ethnic minorities. Vaccine hesitancy refers to the delay in acceptance or refusal of vaccines despite the availability of vaccine services. It is a complex issue that is influenced by a myriad of factors such as complacency, compliance, and confidence.1 Today, we see that vaccine hesitancy is fueled by anecdotal evidence from a variety of sources that often outweighs scientific facts. The spread of misinformation is a pandemic in itself. Many people prefer sensational emotional stories heard through their social networks or found on easy to digest sites online. Additionally, mistrust in the medical system has been at an all-time high during the pandemic, further fueling the prevalence of vaccine hesitancy. 

Strategies for Addressing Vaccine Hesitancy 

Strategies for addressing vaccine hesitancy cannot be standardized and are context-specific. Strategies depend on the time, place, targeted demographic, and vaccine. Addressing vaccine hesitancy has been shown to be effective when starting early in primary care. Presenting vaccines as a default approach, building trust between physicians and patients, being up-front about the side effects, providing reassurance surrounding robust vaccine safety systems, focusing on the protection of the patient and community, and addressing pain have all been found to be beneficial methods for preventing vaccine hesitancy.2 As a trusted source of information on vaccines, family physicians play a key role in driving vaccine acceptance. 

Due to the evidence of vaccine hesitancy not occurring uniformly, but rather occurring in clusters, connections formed in these clusters between healthcare providers and patients are vital in order to decrease the prevalence of vaccine hesitancy. These clusters often occur in regions of religious communities or groups focused on non-traditional medical practices.3 The likeliness of patient uptake of their physician’s advice regarding vaccinations increases with the confidence of the healthcare providers regarding vaccine safety and efficacy, and the transparency and openness they show when listening and understanding a patient’s concerns. 

Strategies Known to Increase Vaccine Uptake include3:

  1. Targeting under-immunized subgroups with tailored interventions
  2. Making vaccine services more convenient and accessible
    1. Community outreach with translators/ multilingual staff members 
    2. Having translators at vaccination sites 
    3. Better promotion of vaccine pop-ups 
  3. Engaging community partners (i.e. religious leaders, community centre workers, teachers)
  4. Reminding patients by text, email, or snail mail
  5. Ensuring uniformity of information, especially regarding vaccine benefits and risks
  6. Promoting and using strategies to minimize immunization pain
  7. Consider mandates and/or incentives for immunization
  8. Building trust between the immunization program and the community: foundational and can help mitigate community vaccine confidence crisis
  9. Workplace and school enforcement of vaccinations 

Longer-term solutions for vaccine hesitancy include early childhood and adolescent education and regular public health programs that provide culturally appropriate education to the community that run regularly, not just during pandemics.4 Vaccination information should be available at schools, workplaces, retirement homes, and all healthcare facilities, and should be provided in a variety of languages. Additionally, having consistent information also decreases the chances of re-emerging diseases that were currently eradicated by vaccines. The resurgence of diseases like Smallpox is also present because of vaccine hesitancy. The lack of fear of the disease and the misinformation of vaccines, both stemming from the lack of education, lead to vaccine hesitancy.  It has been shown that children can affect adults’ attitudes regarding vaccines, and that social groups can heavily influence vaccine hesitancy, so having scientifically correct information available for different age groups may decrease vaccine hesitancy.3 These solutions allow for the steady and consistent intake of accurate information, normalizing vaccines, and increasing health literacy at all ages and communities.

Moreover, addressing vaccine hesitancy in vulnerable populations is an increasingly complex issue due to lack of access and unstable supplies of vaccines.5 Oftentimes factors such as socioeconomic status and lack of awareness are the most important reasons to address when it comes to vaccine hesitancy in vulnerable populations. Providing resources in different languages and providing accessible transportation to vaccination clinics can increase vaccination rates. The introduction of cash assistance, digital vaccine cards, and the involvement of local healers have been effective strategies in improving vaccine coverage and decreasing vaccine hesitancy in India.6 Furthermore, a study in South Africa affirmed the importance of improving communication strategies by creating trust-building relationships which focus on transparency between healthcare providers and the community.7 Lastly, the inclusion of a diverse representation of the population in clinical trials is a lacking factor that should be considered in the future.8 

Conclusion

Evidently, vaccine hesitancy is a complex and global issue that disproportionately affects visible minorities and vulnerable populations. In order to prioritize our own health and the health of others it is vital we take steps to ensure additional measures are considered when distributing vaccines in vulnerable populations, such as stronger communication strategies and more diverse representative data during clinical trials. 

“The closer we get to herd immunity by closing gaps in vaccine coverage and overcoming vaccine hesitancy, the safer, healthier, and more open our society will be”

Lauren Ancel Meyers PhD9 
References
  1. Butler R, MacDonald NE; SAGE Working Group on Vaccine Hesitancy. Diagnosing the determinants of vaccine hesitancy in specific subgroups: The Guide to Tailoring Immunization Programmes (TIP). Vaccine. 2015;33(34):4176-4179. doi:10.1016/j.vaccine.2015.04.038
  2. ​​Shen SC, Dubey V. Addressing vaccine hesitancy: Clinical guidance for primary care physicians working with parents. Can Fam Physician. 2019;65(3):175-181.
  3. MacDonald NE, Dubé E. Addressing vaccine hesitancy in immunization programs, clinics and practices. Paediatr Child Health. 2018;23(8):559-560. doi:10.1093/pch/pxy131
  4. Arede M, Bravo-Araya M, Bouchard É, et al. Combating Vaccine Hesitancy: Teaching the Next Generation to Navigate Through the Post Truth Era. Front Public Health. 2019;6:381. Published 2019 Jan 14. doi:10.3389/fpubh.2018.00381
  5. Ratzan SC, Bloom BR, El-Mohandes A, et al. The Salzburg Statement on Vaccination Acceptance. J Health Commun. 2019;24(5):581-583. doi:10.1080/10810730.2019.1622611
  6. Priya P K, Pathak VK, Giri AK. Vaccination coverage and vaccine hesitancy among vulnerable population of India. Hum Vaccin Immunother. 2020;16(7):1502-1507. doi:10.1080/21645515.2019.1708164
  7. Cooper S, van Rooyen H, Wiysonge CS. COVID-19 vaccine hesitancy in South Africa: how can we maximize uptake of COVID-19 vaccines?. Expert Rev Vaccines. 2021;20(8):921-933. doi:10.1080/14760584.2021.1949291
  8. Nguyen LH, Joshi AD, Drew DA, et al. Racial and ethnic differences in COVID-19 vaccine hesitancy and uptake. Preprint. medRxiv. 2021;2021.02.25.21252402. Published 2021 Feb 28. doi:10.1101/2021.02.25.21252402
  9. Ancel Meyers L. What is herd immunity and what will happen to SARS-CoV-2 if we reach it? Infectious Disease News. 2021.

Written by Danica Bui & Hannah Polley