Talking About Vaccines with Your Patients
by Deborah Ungerleider, MD
With growing conversations about vaccines and increasing vaccine hesitancy, often fueled by misinformation and disinformation, physicians need to figure out how to best speak to their patients about this topic.
This has been an ongoing concern in primary care (especially for pediatricians) and the infectious disease world, but has become even more prevalent since the COVID-19 pandemic, with the rise of more structured anti-vaccination movements. A recent study showed that 81 percent of primary care providers reported encountering patients who expressed vaccine hesitancy daily or weekly. Additionally, only 41 percent of providers said they were very confident in their communications with these patients. The study also found that 40 percent of the providers had at least one office staff member who expressed vaccine hesitancy.
You may be struggling with vaccine hesitancy among your patients, just like other physicians and healthcare providers. Let’s explore the best ways to communicate about vaccines.
What Is Vaccine Hesitancy?
Vaccine hesitancy is defined as the “delay in acceptance or refusal of vaccination despite availability of vaccine services.” Online and mass medical communication about vaccines is often not accessible, making it difficult to reach the general public. While issues relating to complacency, confidence, and convenience have all added to vaccine hesitancy.
This has led to a serious threat to global health, according to the World Health Organization, by hindering vaccination efforts and, consequently, leading to disease outbreaks among vulnerable groups.
In the United States, there are mandatory vaccination policies, which have been somewhat effective. However, issues arise if there isn’t support from healthcare providers, who have the closest individual contact with patients and the parents of pediatric patients.
What Can You Do?
Much of vaccine hesitancy is rooted in fear—fear of the unknown, but also fear of the harm proposed by anti-vaccination groups. While acknowledging the risks of vaccines, healthcare providers should address this fear and discuss the risks and benefits of immunizations in a balanced way. A few strategies for communication could include:
Studies have shown that the opinion of a patient’s healthcare provider was key when it came to deciding on whether to receive vaccinations for themselves or a child. A strong recommendation from a healthcare provider may seem obvious, but there are often missed opportunities for recommending vaccines.
One of the challenges when communicating about vaccinations is the fact that vaccines are administered to healthy individuals, making the risk of getting these diseases seem like a distant possibility. That fact makes the vaccination itself feel like a greater risk—and an unnecessary one. That’s why open communication and building trust with patients is key.
Evidence-Based Strategies
There are some evidence-based strategies that you can use to help improve vaccine uptake. The American Academy of Pediatrics has a recent clinical report outlining the issue of vaccine hesitancy and the latest evidence on effective communication for this issue. These strategies have been found to work even better than apps and web-based interventions or mass communication.
Presumptive Method
They suggest starting the conversation during prenatal visits (obstetrical and pediatric). Using a strong recommendation and the presumptive format for the discussion are several of the communication techniques suggested. The presumptive method means saying something like, “We’re going to be…,” making a presumption that parents/patients are ready to vaccinate.
Motivational Interviewing
Motivational interviewing is another strategy that can be particularly helpful for individuals who are still resistant to vaccinations. At its core are five key principles:
Although not as strong, there’s also evidence that several other techniques can help, such as continuing to pursue adherence to vaccines at a visit despite the parents’ reluctance and discussing all the vaccines for which the child is eligible together.
Debunking Misinformation and Disinformation
Misinformation and disinformation increase vaccine hesitancy. Addressing this ahead of vaccination time, before it has a chance to stick (“prebunking”), is one strategy. Another is actually teaching people to be resilient to attempts at manipulation by identifying strategies that anti-vaccine individuals use to convince people to decline vaccinations. Many patients use a search engine to get their medical questions answered; vaccination information is also often obtained this way. Making sure your patients know where to get their information is vital. And it starts with having open and empathetic conversations about the fears and misinformation surrounding vaccinations.
It’s also important to be sure your whole office is on board with vaccinations because vaccine hesitancy, even among nonclinical staff, can adversely affect the uptake of vaccines by your patients. The Centers for Disease Control and Prevention has educational materials available for training providers and staff on this topic. The Advisory Committee on Immunization Practices also has written information for providers.
It has been shown that providers need the support of policies and help with a communication infrastructure to aid in building patient trust in the healthcare system. Additionally, if you’re someone with expertise in infectious diseases and vaccinations, it would be helpful to communicate any updates on public health and immunizations to your colleagues.
Help from Your Healthcare System and Community
There are also some strategies that healthcare systems can use, added to the providers’ individual strategies, which have been shown to be effective when communicating about vaccinations:
You may want to speak to your healthcare organization about implementing some or all of these strategies.
Community-based interventions to address vaccine hesitancy may also be helpful. As a healthcare provider, you may be able to partner with allies in the community, such as health departments, schools, faith-based organizations, civic organizations, or pharmacies, to aid in overcoming barriers.
Community groups can help in developing the messages in clinical materials that you distribute; this helps build trust and decrease possible misunderstandings by using cultural and community sensitivity. Primary care providers should also participate in continuing education programs to help answer parents’ questions about emerging issues.
You also may want to consider serving on panels with parents, patients, and other community members to provide your expertise and get feedback from the other community members. More collaboration and improved messaging can lead to building trust, addressing vaccine hesitancy, increasing vaccination rates, and improving patient’s health.
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