How to overcome hesitancy for COVID-19 and other vaccines

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doi:doi: 10.12788/jfp.0443

Applied Evidence

How to overcome hesitancy for COVID-19 and other vaccines

J Fam Pract. 2022 July;71(6):239-244 | doi: 10.12788/jfp.0443

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References

1. Ten threats to global health in 2019. World Health Organization. Accessed June 17, 2022. www.who.int/news-room/spotlight/ten-threats-to-global-health-in-2019

2. FDA approves first COVID-19 vaccine. US Food and Drug Administration. August 23, 2021. Accessed June 17, 2022. www.fda.gov/news-events/press-announcements/fda-approves-first-covid-19-vaccine

3. Mathieu E, Ritchie H, Ortiz-Ospina E, et al. A global database of COVID-19 vaccinations. Nat Hum Behav. 2021;5:947-953. doi: 10.1038/s41562-021-01122-8.

4. Ritchie H, Mathieu E, Rodés-Guirao L, et al. Coronavirus pandemic (COVID-19). Our world in data. Accessed June 17, 2022. https://ourworldindata.org/covid-vaccinations?country=USA

5. de Figueiredo A, Simas C, Karafillakis E, et al. Mapping global trends in vaccine confidence and investigating barriers to vaccine uptake: a large-scale retrospective temporal modelling study. Lancet. 2020;396:898-908. doi: 10.1016/S0140-6736(20)31558-0

6. Wang Y, Liu Y. Multilevel determinants of COVID-19 vaccination hesitancy in the United States: a rapid systematic review. Prev Med Rep. 2021;25:101673. doi: 10.1016/j.pmedr.2021.101673

7. Robinson E, Jones A, Lesser I, et al. International estimates of intended uptake and refusal of COVID-19 vaccines: a rapid systematic review and meta-analysis of large nationally representative samples. Vaccine. 2021;39:2024-2034. doi: 10.1016/j.vaccine.2021.02.005

8. Dubé E, Gagnon D, MacDonald NE; SAGE Working Group on Vaccine Hesitancy. Strategies intended to address vaccine hesitancy: review of published reviews. Vaccine. 2015;33:4191-4203. doi: 10.1016/j.vaccine.2015.04.041

9. Sadaf A, Richards JL, Glanz J, et al. A systematic review of interventions for reducing parental vaccine refusal and vaccine hesitancy. Vaccine. 2013;31:4293-4304. doi: 10.1016/j.vaccine.2013.07.013

10. Kim S, Pjesivac I, Jin Y. Effects of message framing on influenza vaccination: understanding the role of risk disclosure, perceived vaccine efficacy, and felt ambivalence. Health Commun. 2019;34:21-30. doi: 10.1080/10410236.2017.1384353

11. Shim E, Chapman GB, Townsend JP, et al. The influence of altruism on influenza vaccination decisions. J R Soc Interface. 2012;9:2234-2243. doi: 10.1098/rsif.2012.0115

12. Sprengholz P, Eitze S, Felgendreff L, et al. Money is not everything: experimental evidence that payments do not increase willingness to be vaccinated against COVID-19. J Med Ethics. 2021;47:547-548. doi: 10.1136/medethics-2020-107122

13. Freeman D, Loe BS, Yu LM, et al. Effects of different types of written vaccination information on COVID-19 vaccine hesitancy in the UK (OCEANS-III): a single-blind, parallel-group, randomised controlled trial. Lancet Public Health. 2021;6:e416-e427. doi: 10.1016/S2468-2667(21)00096-7

14. Hakim H, Provencher T, Chambers CT, et al. Interventions to help people understand community immunity: a systematic review. Vaccine. 2019;37:235-247. doi: 10.1016/j.vaccine.2018.11.016

15. Betsch C, Böhm R, Korn L, et al. On the benefits of explaining herd immunity in vaccine advocacy. Nat Hum Behav. 2017;1:1-6. doi: 10.1038/s41562-017-0056

16. Logan J, Nederhoff D, Koch B, et al. ‘What have you HEARD about the HERD?’ Does education about local influenza vaccination coverage and herd immunity affect willingness to vaccinate? Vaccine. 2018;36:4118-4125. doi: 10.1016/j.vaccine.2018.05.037

17. Pfattheicher S, Petersen MB, Böhm R. Information about herd immunity through vaccination and empathy promote COVID-19 vaccination intentions. Health Psychol. 2022;41:85-93. doi: 10.1037/hea0001096

18. Loomba S, de Figueiredo A, Piatek SJ, et al. Measuring the impact of COVID-19 vaccine misinformation on vaccination intent in the UK and USA. Nat Hum Behav. 2021;5:337-348. doi: 10.1038/s41562-021-01056-1

19. Limaye RJ, Opel DJ, Dempsey A, et al. Communicating with vaccine-hesitant parents: a narrative review. Acad Pediatr. 2021;21:S24-S29. doi: 10.1016/j.acap.2021.01.018

20. Omer SB, Amin AB, Limaye RJ. Communicating about vaccines in a fact-resistant world. JAMA Pediatr. 2017;171:929-930. doi: 10.1001/jamapediatrics.2017.2219

21. Nyhan B, Reifler J. Does correcting myths about the flu vaccine work? An experimental evaluation of the effects of corrective information. Vaccine. 2015;33:459-464. doi: 10.1016/j.vaccine.2014.11.017

22. Nyhan B, Reifler J, Richey S, et al. Effective messages in vaccine promotion: a randomized trial. Pediatrics. 2014;133:e835-e842. doi: 10.1542/peds.2013-2365

23. Steffens MS, Dunn AG, Marques MD, et al. Addressing myths and vaccine hesitancy: a randomized trial. Pediatrics. 2021;148:e2020049304. doi: 10.1542/peds.2020-049304

24. Carey JM, Chi V, Flynn DJ, et al. The effects of corrective information about disease epidemics and outbreaks: evidence from Zika and yellow fever in Brazil. Sci Adv. 2020;6:eaaw7449. doi: 10.1126/sciadv.aaw7449

25. Yousuf H, van der Linden S, Bredius L, et al. A media intervention applying debunking versus non-debunking content to combat vaccine misinformation in elderly in the Netherlands: a digital randomised trial. EClinicalMedicine. 2021;35:100881. doi: 10.1016/j.eclinm.2021.100881

26. Cambon L, Schwarzinger M, Alla F. Increasing acceptance of a vaccination program for coronavirus disease 2019 in France: a challenge for one of the world’s most vaccine-hesitant countries. Vaccine. 2022;40:178-182. doi: 10.1016/j.vaccine.2021.11.023

27. Leask J, Kinnersley P, Jackson C, et al. Communicating with parents about vaccination: a framework for health professionals. BMC Pediatr. 2012;12:154. doi: 10.1186/1471-2431-12-154

28. Martela F, Hankonen N, Ryan RM, et al. Motivating voluntary compliance to behavioural restrictions: self-determination theory–based checklist of principles for COVID-19 and other emergency communications. Eur Rev Soc Psychol. 2021:305-347. doi: 10.1080/10463283.2020.1857082

29. Boness CL, Nelson M, Douaihy AB. Motivational interviewing strategies for addressing COVID-19 vaccine hesitancy. J Am Board Fam Med. 2022;35:420-426. doi: 10.3122/jabfm.2022.02.210327

30. Salomoni MG, Di Valerio Z, Gabrielli E, et al. Hesitant or not hesitant? A systematic review on global COVID-19 vaccine acceptance in different populations. Vaccines (Basel). 2021;9:873. doi: 10.3390/vaccines9080873

31. Pitts SI, Maruthur NM, Millar KR, et al. A systematic review of mandatory influenza vaccination in healthcare personnel. Am J Prev Med. 2014;47:330-340. doi: 10.1016/j.amepre.2014.05.035

The authors speculated that this may be because Zika is a relatively new virus when compared to yellow fever, and participants may have more pre-existing knowledge about yellow fever.²⁴ These findings are important to keep in mind when addressing misinformation regarding COVID-19. When addressing myth perceptions with patients, consider pivoting the conversation from vaccine myths to the disease itself, focusing on the disease risk and severity of symptoms.^19,20

Other studies have had positive results when addressing misinformation, including a digital RCT of older adults in the Netherlands by Yousuf and colleagues.²⁵ In this study, participants were randomized to view 1 of 2 versions of an information video on vaccination featuring an informative discussion by celebrity scientists, government officials, and a cardiologist. Video 1 did not include debunking strategies, only information about vaccination; Video 2 provided the same information about vaccines but also described the myths surrounding vaccines and reiterated the truth to debunk the myths.

Findings demonstrated that a significantly higher number of participants in the Video 2 group overcame vaccination myths related to influenza and COVID-19.²⁵ Notably, this study took place prior to the widespread availability of COVID-19 vaccines and did not measure intent to vaccinate against COVID-19.

Taken together, strategies for correcting vaccine misinformation may vary by population as well as type of vaccine; however, placing emphasis on facts delivered by trusted sources appears to be beneficial. When addressing misinformation, PCPs should first focus on key details (not all supporting information) and clearly explain why the misinformation is false before pointing out the actual myth and providing an alternative explanation.²⁰ When caring for patients who express strong concerns over the vaccine in question or have avid beliefs in certain myths or conspiracy theories, it’s best to pivot the conversation back to the disease rather than address the misinformation to avoid a potential backfire effect.

Utilize these effective communication techniques

TABLE 1^{10,13,16,17,19,20} summarizes the “do’s and don’ts” of communicating with vaccine-hesitant patients. PCPs should provide strong recommendations for vaccination, approaching it presumptively—ie, framing it as normative behavior.^19,26 This approach is critical to building patient trust so that vaccine-hesitant patients feel the PCP is truly listening to them and addressing their concerns.²⁷ Additionally, implementing motivational interviewing (MI) and self-determination theory (SDT)²⁸ techniques when discussing vaccinations with patients can improve intentions and uptake.^19,29TABLE 2^19,29outlines specific techniques based on SDT and MI that PCPs may utilize to communicate with vaccine-hesitant individuals or parents.

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