Communication and Promoting Vaccination
The dug-in anti-vaccination movement, rooted largely in conspiracy theories, is a more difficult problem requiring a more forceful counteroffensive to battle coordinated disinformation efforts, Dr. Hotez said. Amplifying and fine-tuning a pro-vaccine message is part of the effort, he said, but he has also advocated for a federal interagency task force, including HHS and the Department of Justice, dedicated to dismantling the anti-vaccine message.
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January 2021
I communicate that the safety of the vaccine is high in many large studies, and that the studies show that they’re helpful in protecting families and communities and keeping us all healthy. —Caleb Simmons, MD
On an individual level, good communication from physicians—both inside the exam room and, some experts say, outside of it—can boost faith in vaccines. But otolaryngologists aren’t always eager to bring up the topic of COVID-19 vaccines, Dr. Wenaas said. “I don’t offer my opinion unless asked because what’s most important is my physician-patient relationship,” she said. “When patients visit my office, they’re coming to me for specific things. It’s important that we maintain a good relationship and the ability to talk freely.
“A lot of people will ask my opinion about various things, however, and then I’m happy to offer it,” she continued. In the case of a patient who asks her opinion on COVID-19 vaccines but might harbor some reservations, Dr. Wenaas said she reminds them that there are risks and benefits in acting, but also risks and benefits in not acting. For example, she might say, “For me, the benefit of the vaccine significantly outweighs the risk. We can talk about the details if you like.” But she added, “Some people have very specific feelings about the COVID-19 vaccines, and I’m not necessarily going to change their mind if they aren’t looking for an opinion.”
Caleb Simmons, MD, an otolaryngologist at the Austin Regional Clinic in Texas, said he isn’t inclined to bring up the COVID-19 vaccines with patients on his own due to the lack of availability—although he will when availability improves—but he does discuss the HPV and flu vaccines with certain patients.
When a patient initiates a discussion about vaccines, he said, they’re usually doing so in good faith and are truly interested in his opinion. When he has these conversations, he usually sits down to show that he’s listening. When a patient expresses doubt, he asks why they feel that way and about their sources of information, letting them share their viewpoints.
“I usually lead the next part by Socratic method, asking them why they believe one part of the evidence over another, why they believe one source over another,” he said. “My main goal is to get them to examine how they’re thinking and to challenge their assumptions, and I’m listening for any personal stories that they share.
“Finally, I mention what I’ve been reading and how in the process of making these vaccines we’re building on the foundations of what’s been done before,” he said. “I communicate that the safety of the vaccine is high in many large studies, and that the studies show that they’re helpful in protecting families and communities and keeping us all healthy.” He also makes it known that he will get the vaccine.
Dr. Hotez said that patients should be made aware that the available COVID-19 vaccines all work in more or less the same way, by provoking an immune response to the virus’s spike protein. “Don’t let patients overthink it—you want them to take advantage of whatever vaccine is available to them,” he said. “We won’t know what the best vaccine is for months or years in terms of durability of protection and other issues, so this isn’t a time to cherry-pick which vaccine you think might be the best.”
Dr. Alexander cautioned physicians against saying too much or offering statistics, which can often solidify someone’s preformed opposition to vaccinations. “Patients want to know three simple things: Is it safe? Does it work? and What is the doctor’s recommendation? When I go to the grocery store and ask for the jam, I don’t want a discussion on how you built the shelf that holds it,” he said.
And when it comes to the recommendation, be unequivocal, he said. “Families aren’t looking for advice like, ‘It’s available if you want it,’” he said. “What they’re looking for is, ‘I’m a physician, I took this vaccine. My wife has taken this vaccine. We gave it to my parents. Vaccinating people is what you do for those you love.’ Turn it into a story or an emotional case.”
Todd Wolynn, MD, MMM, chief executive officer at Pittsburgh-based Kids Plus Pediatrics, which was the target of a massive social media attack after the practice posted a video promoting HPV vaccination in 2017 (see “Attacked for Being Pro-Vaccine,” below), said that bringing up vaccinations should be a matter of course. “Just educate people,” he said. “If it becomes part of your culture, then it doesn’t seem so odd.”
He describes his approach with an acronym: AIMS (Announce, Inquire, Mirror, Secure). First, he announces that a patient needs a vaccine. If they’re hesitant, he inquires, “Can I find out a little bit more about why you’re hesitant?” Then, he mirrors them, repeating their comment back to them. “Just by repeating back their words, you’ve shifted the dynamics of the entire conversation because they now know you’re listening to them. It opens up an opportunity for you to share the science-based information.”
Finally, if a patient still doesn’t want the vaccine, a physician should secure the physician-patient relationship. “You could say something like, ‘We can agree to disagree on that, but I appreciate you hearing me out. We can always revisit it,’” said Dr. Wolynn.
Dr. Simmons said there are thorny issues that, in the end, will be difficult to resolve, especially since so much political division has evolved from COVID-19. But that doesn’t mean physicians shouldn’t try.
“I think we have to acknowledge political, cultural, and religious reasons patients have for not getting the vaccine,” he said. “I’m not always sure what to do, but I think we can listen and see if we can help the patient find a way to the vaccines,” he said. “Sometimes, we have to help patients navigate familial relationships and religious implications. That might mean simply helping patients keep the end goal in mind: We all want our families to be healthy and safe, and we want a healthy country to share.”