Louisville Medicine Volume 69, Issue 2 - Page 29

from 9.1 % in 2006 to 16.7 % by 2013 . 4 The emergence of social media allows easy dissemination of anti-vaccine information and anecdotal stories of dubious veracity , elevating previously obscure theories to household topics . This worsening problem has never been more apparent , or urgent , than with the COVID-19 vaccine rollout : people die unvaccinated , and it ’ s a tragedy .
Vaccine hesitancy is a complex multifactorial issue that cannot be generalized to all parents and patients . My family ’ s story is not the same as the patients ’ tales I hear . Their hesitations and fears differ . Yet there are lessons to be learned from my experience . Despite my childhood , I have frequently endured the familiar frustration of confronting vaccine-hesitant patients and families . I get extra worried , given my own unvaccinated background . A 2011 study of primary care physicians found a reduction in job satisfaction rates secondary to parental vaccine hesitancy . 9 This is unsurprising to anyone who has tackled vaccine hesitancy with their patients . Counseling them is a time-consuming and stressful addition to already hectic clinical demands . It ’ s easy to feel frustrated ( and hard to remain calm , clear and not judgmental ) when talking to patients whose perception of risk greatly outweighs the evidence-based data . However , our role in these discussions could not be more critical : because if there ’ s one thing that consistently overcomes vaccine hesitancy , it ’ s advice from a trusted health care provider .
My mother never knew a physician she trusted enough to have frank discussions about her vaccine concerns . Our family doctor felt unapproachable and paternalistic , and my mother shied away from confrontation , never even felt comfortable asking questions . Negative personal experiences with the health care system further eroded her trust in medicine . When trust is present , it can be a powerful factor in influencing patients to pursue vaccination ; conversely , a lack of trust often amplifies the power of bad information . In communities of color , this trust can be particularly difficult to achieve . Generations of harmful practices - such as the Tuskegee syphilis experiments - and existing institutional racism led to an understandable suspicion of the medical establishment . 12 In studies of vaccine-hesitant parents who changed their minds , advice from a trusted health care provider is the most common reason for reversal . 10 l worry that strategies such as expelling unvaccinated children from pediatric practices , and a failure to remedy the inherent racism in our health care system , only threaten to erode further the critically needed trust in the medical community . We must be careful to serve as strong vaccine advocates while not alienating hesitant patients in the process .
Motivational interviewing , reflective listening and shared decision-making , when employed by trusted physicians , can significantly combat vaccine hesitancy . Often , our impulse is to immediately combat any hesitancy with the copious amounts of evidence-based data available . This can backfire , giving the perception we ’ re not taking patients ’ apprehensions seriously . Physicians respond to data , but patients often connect on a more emotional level . Even if patients are not immediately persuaded , having a trusted physician available to listen and discuss their concerns in a patient-centered manner is critical . In a world of misinformation , we can be powerful advocates fighting to protect our patients . The challenge of vaccine-hesitancy has never been greater . My unvaccinated childhood left me vulnerable , but it also taught me the importance of compassionate physician advocacy . Combating vaccine hesitancy is difficult , frustrating and time-consuming , but it is one of our most critical tasks as physicians - one made easier and more effective with trust , honesty and trying our best to understand where the patient is coming from . The COVID-19 pandemic has proven again the lifesaving power of vaccines and represents a new call to action for us all .
A few years ago , I began talking gently to my aging mother about needed preventive vaccines . I told her of my experiences treating patients whose diseases could have been avoided by vaccination . I showed her the data , emphasizing how even commonplace viruses like the flu could affect her differently than they might a younger woman . I described just how painful shingles could be if not prevented . She trusted me , but it was hard to overcome a lifetime of hearing anecdotal stories of vaccine harm . Eventually , after a lot of these discussions , she became comfortable with receiving vaccines , and more cognizant of the risks of non-vaccination . The day I received my first COVID-19 vaccine was a poignant one , but the day I found my mom had gotten hers was even sweeter . It felt like a full-circle moment , a very personal reminder of the importance of continuing the conversation with our vaccine-hesitant patients , and of the importance of building the trusting relationship that enables that conversation .
References :
Jarrett et al . Strategies for addressing vaccine hesitancy-A systematic review . Vaccine . 2015 .
Kestenbaum et al . Identifying and Addressing Vaccine Hesitancy . Pediatric Annals . April 2016 .
Paterson et al . Vaccine hesitancy and healthcare providers . Vaccine . 2016 .
Succi , Regina Celia de Menezes . Vaccine refusal-what we need to know . Journal of Pediatria . Nov 2018 .
McCauley et al . Exploring the Choice to Refuse or Delay Vaccines : A National Survey of Parents of 6-Through 23-Month Old . Academic Pediatrics . 2012 .
Rates of Adverse Vaccine Reactions : Vaccine Safety Basics E-Learning Course . World Health Organization .
Chung et al . Influences on immunization decision-making among US parents of young children . Maternal Child Health Journal . 2017 .
Schmid et al . Barriers of Influenza Vaccination Intention and Behavior- A Systematic Review of Influenza Vaccine Hesitancy , 2005-2016 . PLoS One . 2017 .
Kempe et al . Prevalence of parental concerns about childhood vaccines : the experience of primary care physicians . American Journal of Preventative Medicine . 2011 .
McGregor , Goldman . Determinants of parental vaccine hesitancy . Canadian Family Physician . 2021 .
Lee , Jon . “ The Utter Familiarity of Even the Strangest Vaccine Conspiracy Theories .” The Atlantic . 2021 .
Bunch , Lauren . A Tale of Two Crises : Addressing Covid-19 Vaccine Hesitancy as Promoting Racial Justice . HEC Forum . 2021 .
Lo et al . Public Health and Economic Consequences of Vaccine Hesitancy for Measles in the United States . JAMA Pediatrics . 2017 .
Dr . Carpenter is a fourth-year resident in internal medicine-pediatrics at the University of Louisville .
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