March 28, 2021

Hesitancy is not refusal

Even though the rate of deaths have fallen, cases are starting to rise again in the US. We just passed 30 million confirmed cases and about to pass 550,000 deaths. This is partly due to the new variants and also because of the relaxation of restrictions. This data is concerning. Despite the increase numbers of vaccinations happening, more infections mean more chance for variants to develop that can be resistant to the vaccines we have so far. As this article in The Atlantic writes, we are “now in the hands of the vaccine hesitant”. Some far right extremists are now embracing the anti vaccine movement, just like they are against wearing masks. Many Republicans are now hesitant to get a vaccine. Different minorities have their own reasons to be hesitant about the vaccines. The Ad Council has a COVID-19 Vaccine Education Initiative to help influence the hesitant, including one with Willie Nelson and sports leagues and organizations encouraging vaccination to help get fans back into stadiums. They also made the recent ad with former Presidents Carter, Clinton, Bush, and Obama receiving their vaccines.

I wish it were that simple to change minds, but reasons for vaccine hesitancy are complex. For some minority communities, the hesitancy is based in racial disparities and distrust in the health care system. Many have wanted to blame the Tuskegee Study as the reason African Americans are hesitant but the truth goes deeper than that. It is the health care inequities in the system, access to care, pharmacy deserts, ability to ask questions and have their concerns answered without judgement that are barriers, as well as misinformation swirling around. As someone says in the NPR story about these concerns, vaccine hesitancy is not vaccine refusal.

We can help them, but it takes some effort. Often, all it takes is asking what their concerns and fears are and answering them. It may be something as simple as: “is it safe to get if I take these blood pressure meds” or “is it safe if I have allergies”. One director of a nursing home in Washington, DC worked hard to convince her staff to get their vaccines, after nearly half declined initially. She was able to get close to 80% vaccinated with education, videos, asking and answering questions without judgement, and support, but it took 2 months in which she found each hesitant employee had their own individual concern.

People are wondering about how the new data from the Astra Zeneca vaccine plays into all this. Will it add to hesitancy or help decrease it? This week the company released their US data showing good efficacy and safety, but there was push back from US Officials about the data being cherry-picked to look better. The company then adjusted their data in response, which was still encouraging data, but makes it hard to trust the company. The interesting thing is that this is the way the system is supposed to work. There has been a lot of public scrutiny about its safety and efficacy, which may help reassure those that fear the process of vaccine approval was politicized and shortened. But it harms the reputation of their vaccine and isn’t necessary.

We probably won’t change minds of the vocally resistant, but we are helping many of the hesitant feel safer and more sure about getting immunized. Even with multiple stories about the side effects, more people are worried about COVID-19 than they are worried about getting vaccinated. More people are getting their jabs,

We can continue to encourage and share our knowledge to move people toward the vaccine. One of the best articles I have read recently is this in the New England Journal of Medicine that explores the history of vaccine development since Edward Jenner first inoculated someone against smallpox in 1796. It is fascinating and explains in detail the breakthroughs that occurred and why this new era of vaccine development is truly exciting. It also helps explains how developing an updated vaccine to combat the variants will be a doable project.

Wash your hands, cover your nose, keep safe six (still) and encourage the hesitant.

And finally, my caveat is that this is my experience and my opinions, which are subject to change as more information is available, and not related to the organization I work for. Thanks for reading.

https://www.theatlantic.com/health/archive/2021/03/america-is-now-in-the-hands-of-the-vaccine-hesitant/618352/

https://www.seattletimes.com/nation-world/nation-politics/far-right-extremists-move-from-stop-the-steal-to-stop-the-vaccine/

http://maristpoll.marist.edu/wp-content/uploads/2021/03/NPR_PBS-NewsHour_Marist-Poll_USA-NOS-and-Tables_202103091124.pdf#page=3

https://www.prnewswire.com/news-releases/willie-nelson-thirteen-major-sports-leagues-and-organizations-team-up-with-the-ad-council-and-covid-collaboratives-national-its-up-to-you-covid-19-vaccine-education-initiative-301253252.html

https://www.clinicaladvisor.com/home/topics/vaccine-information-center/overcoming-covid-19-vaccine-hesitancy-minority-communities/

https://www.npr.org/2021/03/23/980234547/advocates-say-tuskegee-study-overshadows-other-health-care-inequities

https://www.npr.org/sections/health-shots/2021/03/23/974059870/stop-blaming-tuskegee-critics-say-its-not-an-excuse-for-current-medical-racism

https://www.nytimes.com/2021/03/28/health/nursing-home-covid-19-vaccine.html

https://www.seattletimes.com/nation-world/astrazeneca-says-its-vaccine-is-76-effective-in-an-updated-company-analysis-released-after-earlier-challenges-of-its-data/

https://www.nytimes.com/2021/03/22/world/us-health-officials-question-results-from-astrazenecas-vaccine-trial-less-than-a-day-after-theyre-released.html

https://www.nytimes.com/2021/03/23/opinion/covid-astrazeneca-vaccine.html

https://www.verywellhealth.com/vaccine-sentiment-tracker-covid-symptoms-vs-vaccine-side-effects-5116655

https://www.nejm.org/doi/full/10.1056/NEJMp2034334