Tips for Physicians on How to Talk to Patients Who Are Hesitant about the COVID-19 Vaccine

Targeted Talking Points

Paul Offit, MD, director of the Vaccine Education Center at the Children’s Hospital of Philadelphia and a member of the FDA advisory panel on COVID-19 vaccines, said that it’s important to distinguish between those who are staunchly anti-vaccine who will never be swayed, and those who have real reservations that a physician or a trusted community leader might be able to persuade.

“In terms of people who say, ‘I’m not going to give my child any vaccines,’ I still think it’s less than 2% of this country,” he said. “I think very quickly you can determine whether or not someone is really interested in hearing what you have to say—in other words, if they’re persuadable. I often ask, ‘Is there anything I can say that will change your mind? If the answer’s no, then why are we having this discussion?’ But I think most people do trust their doctor. When you choose to not listen to your doctor, you alienate him or her to some extent. You want your doctor to like you—you want him or her to care about you and your illness.”

Another concern is long-term side effects, said Dr. Alexander. “In fairness, people are right: I don’t know what effect these vaccines might have on somebody a year from now. But is there any precedent for a vaccine having a long-term effect like that? The only one I can think of offhand is an extremely rare side effect (subacute sclerosing panencephalitis) from the measles vaccine that can happen years down the road from the time of vaccination. But it’s so rare that people don’t even think to talk about it.”

I think you need to find who the influencers are and then work that way, because it isn’t just a matter of me saying, ‘Look, the vaccine is safe and effective.’ That isn’t going to do it.  —Paul Offit, MD

Groups that harbor reservations are most likely to be persuaded by physicians with whom they can identify, Dr. Offit said. “I think you need to find who the influencers are and then work that way, because it isn’t just a matter of me saying, ‘Look, the vaccine is safe and effective.’ That isn’t going to do it.”

In a video posted online, James Hildreth, MD, PhD, an immunology expert, president of Meharry Medical College in Nashville and a member of the FDA advisory panel on COVID-19 vaccines, participated in an event that took this approach. Held at a community center, it was moderated by a director of racial justice ministries in Nashville.

“I know that the trauma, the reaction, to all those things that we’ve been through is deep-seated and real,” he told the mostly African American audience. “We have to acknowledge that up front if we’re going to deal with it. And I’ve tried my best to make sure that I, being in the medical profession and a medical scientist, deeply appreciate the fact that so many people who look like me have that hesitation.

“But,” he added, “they really need to understand that things could not be more different now. The fact that we have so many people of color, not just on the scientific side, but also on the policy-making side, the review side.”

Dr. Taylor emphasized that it’s modern-day health disparities, not just ethically bereft experiments of yesterday, that contribute to the hesitation among African Americans.

“For example, in one neighborhood you might see a police officer or a fireman getting a cat down out of a tree. There are these warm and fuzzy feelings of safety, that someone is looking out for you,” he said. “But go to another community, separated by not a lot of physical distance—only by the demographics—and the sight of police can cause chills up your spine and make you feel uncomfortable.” 

In this way, he said, health disparities—not being as likely to get a catheterization as someone else in the same situation, say, or not getting a proper medical referral—create suspicion of the medical community. “We’re not talking about decades ago,” said Dr. Taylor. “People are aware of some of the disparities of either access or outcomes … those smaller, non-public things people have a sense of. When they see the COVID-19 vaccines coming out with rapid speed, there’s just a hesitation.”

Dr. Taylor said he doesn’t discuss vaccines with all his patients—some, after all, are cases of newly diagnosed head and neck cancer and other priorities have to be addressed. But, with many patients in follow-up visits, he does discuss the vaccinations. Clinicians talking to African American patients about the vaccines need to address the standard questions of safety and efficacy, but it’s also worth acknowledging that deep-rooted hesitation.

“I approach them like I would my neighbor,” he said. “And I think that tone sets you up for a positive experience. And I still think, no matter what your background is, to acknowledge that there is skepticism out there. I think you get buy-in and credibility.”