By Christopher Cheney
At the national level, vaccination rates for vaccine-preventable diseases are stable, but healthcare providers need to address vaccine hesitancy at the local level, an infectious disease expert says.
Last year’s polio outbreak in New York and a spike in measles cases in 2019 are recent examples of alarming flare ups of vaccine-preventable diseases in the United States. As of Jan. 4, about 81% of the U.S. population had received at least one dose of a COVID-19 vaccine, with about 69% of the population fully vaccinated.
While national vaccination rates for vaccine-preventable diseases such as measles are relatively high and stable, healthcare providers need to be on guard for vaccination lapses at the local level, says Susan Koletar, MD, a practicing physician and director of the Division of Infectious Diseases at The Ohio State Wexner Medical Center in Columbus, Ohio.
“Some of it is education and hesitancy among populations who have themselves benefited from vaccines. Vaccination rates are stable, but the world is small. You can get on a plane and be anywhere in less than 24 hours and be exposed to a range of diseases. The question is, why are vaccines not more broadly utilized? We don’t talk enough to our patients about vaccines—that’s not just doctors, it is also nurses and pharmacists. Something as important as vaccines requires some time and explanation and understanding of what drives people’s behavior to get vaccinated or not,” she says.
Social determinants of health are a key factor in local lapses of vaccinations, Koletar says. “We must pay attention to the social determinants of health. If you look at the vaccine surveys, while vaccination rates are pretty stable, there are clearly groups of people who are less economically advantaged or minority populations where the numbers are not as good. …. At the foundation, social determinants of health and vaccination intersect at access to healthcare and pharmacies. Do people have the means to have access to good healthcare? When you think about vaccines, you can walk into any Walgreens and get several vaccines, and you can get the COVID vaccine at several locations, but if you do not have the economic means or transportation to get to those places, that impacts vaccine uptake.”
Addressing vaccine hesitancy
In addition to education, communication between healthcare providers and their patients is crucial to address vaccine hesitancy, she says. “With the communication, it needs to be a two-way street. We need to talk with our patients and find out what they know about diseases and what they know about the consequences of not getting vaccinated. We also need to dispel myths such as getting the flu from flu vaccination. Communication is key because healthcare providers need to understand what patients think and what drives their behavior on vaccination. Do they think they are going to get a disease from a vaccination? Do they think there is a nefarious plot to inject chips with vaccines, which was misinformation during the COVID pandemic. Are they worried that their children will be at risk for autism? So, you need honest conversation and to try to understand what people’s concerns are. It takes time to deliver good healthcare, and we need to take time to communicate.”
Effective communication is essential when patients have been misinformed about vaccinations, Koletar says. “You must ask patients what they think they know, what they have heard, and what their sources are. You must start with the basics. Where did you hear your information? You need to be nonjudgmental—did you get your information from respected authorities or respected community members? We have learned a lot about providing information during the COVID pandemic. Did you get your information from Tony Fauci or did you pick it up on Facebook?”
When dealing with vaccine hesitancy, healthcare providers must be honest with their patients, she says. “I am honest about what we know and what we do not know. That was critically important during the pandemic. There were a lot of questions that we did not know the answers to. One of those questions was about long-term side effects from the COVID vaccines, which we did not know. We could not tell patients what was going to happen in 10 years because the vaccines were new. Sometimes, that is comforting, but often it is not comforting. However, there is value in honesty.”
Healthcare providers cannot force their patients to get vaccinated, and the best approach to encouraging vaccination is shared decision-making, Koletar says. “You must realize that you cannot always talk your patients into getting vaccinated. You give the best information you can and the best evidence of what the outcomes will be, then make the decision together. Shared decision-making is critical in the delivery of healthcare. You cannot hold someone down and give them a vaccine—all you can do is give your best advice.”
Christopher Cheney is the senior clinical care editor at HealthLeaders.