Addressing Vaccine Hesitancy

Klara Barfian

Analyzing Efficacy of Approaches Addressing Vaccine Hesitancy

Over the past few years, vaccination rates have been declining globally. In fact, according to the Johns Hopkins School of Public Health, kindergarten vaccination rates for measles, MMR, tetanus, DTaP, polio, diphtheria, and varicella have steadily declined. Additionally, these declining vaccine rates have led to significant measles outbreaks, placing the United States at risk of losing measles elimination status for the first time since 2000. 

Lack of access, vaccine hesitancy, and increasing vaccine misinformation during the COVID-19 pandemic have been listed as potential factors causing declining vaccination rates. Public health researchers attribute a rise in vaccine hesitancy to the rapid development of the COVID-19 vaccine, widespread misinformation, cultural beliefs, and general public mistrust in clinicians. Thus, in order to manage vaccination rates and end outbreaks, it is imperative to recognize increasing vaccine hesitancy as a major public health threat and understand how to appropriately address it. 

Public health officials have pinpointed several ways to manage vaccine hesitancy, including managing vaccine hesitancy among healthcare workers, motivational interviewing with patients, and government mandates. In this paper, the efficacy of these methods in decreasing vaccine hesitancy will be explored.

  1. Addressing vaccine hesitancy among healthcare workers

According to a study done on the “unspoken vaccine hesitancy” regarding healthcare workers, many healthcare clinicians are hesitant about receiving a COVID-19 vaccine. This is critical, because clinicians are the first source of contact for patients on trusted information about vaccines and their encouragement can play a role in whether their patients decide to get a vaccine. This issue can be difficult to address because it is largely an unspoken phenomena as most healthcare workers do not share their vaccine hesitancy with colleagues and institutions due to stigma and fear of backlash. This is particularly problematic because if healthcare workers are doubtful about vaccines and do not voice their concerns, vaccination campaigns can be hindered which would further lower public trust in vaccines. In order to manage this, there needs to be a shift in focus to build vaccine confidence amongst healthcare professionals. According to  Heyerdahl et. al, healthcare institutions must create a “constructive dialogue” between healthcare workers in which vaccine hesitancy sentiments will not be shamed, but appropriately addressed. This can help build overall vaccine confidence in healthcare professionals which will have a direct influence on patient vaccine uptake.

  1. Motivational Interviewing 

A popular method to encourage vaccine uptake amongst the public is motivational interviewing done by health providers, meant to effectively handle the wide spectrum of vaccine acceptance varying from absolute refusal to strong vaccine advocates. According to a paper written on the distinct approaches to combat vaccine hesitancy, motivational interviewing (MI) is a way to give structured counseling by drawing out internal motivation. The efficacy of this approach can be analyzed through the “PromoVac”, a motivational interviewing program started in Canada targeting newborn parents in the maternity ward. Researchers had a control group (parents who were not approached) and experimental group (parents who were approached) which was then split into parents who agreed to receive a vaccine and those who did not. Overall, this intervention was seen as effective because immunization status was improved at 3, 5, and 7 months of infancy for those that received PromoVac. Although traditional face-to-face interventions are ineffective and can even backfire with anti-vax parents, MI is seen as effective because it focuses on creating a “respectful and empathetic discussion” between the parents and provider. Thus, creating a space in which patients can share their concerns and reservations without judgement is preferred over the traditional educational methods that can seem impersonal and scolding.

  1. Coercive Techniques-Mandates

Another approach taken with varying degrees of severity based on different governments are coercive techniques such as mandates. Mandates have been receiving recent attention due to their use during the Covid-19 pandemic, including school entry requirements, work requirements, financial penalties, etc. Coercive techniques have been met with polarizing opinions by public health officials. On one hand, the impact of mandates are undeniable in increasing vaccine coverage, but they can also have negative outcomes. For example, according to Tuckerman et. al. , mandates can further strengthen antivaccine sentiment and also alienate physicians that experience vaccine hesitancy. Thus, public health researchers agree that mandates should only be pursued when these factors are met: mandate should be democratic, the penalty should not be unreasonable, there should be a stable supply of vaccines with equal access, the burden of disease should justify coercion, and the vaccine should be deemed safe. In this case, mandates can help establish effective vaccine coverage.

Copy editor: Evelyn Lynch

Photography source: https://www.fda.gov/vaccines-blood-biologics/vaccines