COVID-19 Pandemic and Vaccine hesitancy: How to have right vaccine related conversations

This article was exclusively written for The European Sting by Ms. Sadia Khalid, Junior researcher, and a PhD candidate at Tallinn University of Technology (TalTech), Estonia. She is affiliated with the International Federation of Medical Students Associations (IFMSA), cordial partner of The Sting. The opinions expressed in this piece belong strictly to the writers and do not necessarily reflect IFMSA’s view on the topic, nor The European Sting’s one.

One of the greatest scientific accomplishments was the development of vaccines and it is by far one of the most successful public health interventions. Globally, vaccination programs have led to the promotion of health, reduction of the burden of infectious diseases, loss of life, and this public health intervention alone have contributed significantly to strengthening the health system.

The World Health Organization labelled vaccine hesitancy among the 10 greatest threats to global health, stressing the scientific community to identify the psychological, contextual, and sociodemographic factors associated with this phenomenon deemed as urgent.

For any given public health crisis such as the present pandemic involving viral infections the successful eradication greatly depends on the availability and routine implementation of vaccines. The procedural mass vaccination programs implementation for successful eradication heavily depends on low vaccine hesitancy, but this process can further get affected by a vaccine hesitancy or a willingness to vaccinate by the public. Despite the overall high immunization rate in developed countries, the vaccine resistance phenomenon is becoming a growing concern in relation to emerging infectious diseases causing outbreaks in communities.

Recent studies provide some preliminary data about vaccination trends and insight into a broad array of cognitive, social, political, and contextual factors in vaccine acceptance. Individuals who perceived COVID-19 to be a serious public health concern have higher vaccination intentions and the other covariables for vaccine hesitancy during COVID-19 were;
1) psychological disposition, fear of side effects, questioning the legitimacy of science, health-related fears, beliefs and cognitions, and confirmatory biases, the mistrust in government and health care officials.
2)Increased individuals’ social media accessibility and presence enabled exposure to misleading, biased (towards false) information, and conspiratorial information about COVID-19 vaccines. Researchers considered social media to be one of the potential sources of the vaccine hesitancy problem and it played a huge role in undermining the global response and jeopardizing measures to control the pandemic by amplifying the misinformation.
3) the lack of confidence due to the novelty and rapid development of vaccines and this fear was interwoven with the risk of at what pace the vaccine was developed and the novel technology (i.e., mRNA vaccines) utilized contrary to conventional vaccine development approaches.

Most individuals surf the Internet seeking health-related information and the pandemic significantly increased this trend where individuals were exposed to predominantly inaccurate or negative information regarding vaccines. WHO reports that 28.5% of scientific content shared on social media was seriously concerning.

Before the pandemic more than half of the patients were getting their information about vaccination from their primary healthcare providers especially new parents despite the increasing internet (Dr.Google) reliance shift. Fortunately, health care providers are still considered to be the most trusted information source for most individuals about vaccination but due to severe restrictions during pandemics and increased healthcare system burden, these visits were significantly reduced and, in some cases, shortened digital consultation was provided for a patient with urgent health matters leaving out information gap for individuals who weren’t seeking medical intervention and it’s where the same information communication technologies (ICTs) can be used as a mean to spread accurate information in the field of Public Health and vaccinology by healthcare providers. This pandemic taught us the importance of the media presence of physician-scientists and public health researchers. They are key groups in the context of this pandemic and share in the collective responsibility to help us stop misinformation and transmission of infection by discussing vaccination and encouraging vaccine-hesitant individuals.

Some of the communication approaches and counselling strategies for addressing vaccine hesitancy through the online presence or e-health service or in-office visits and about vaccinations are following:

1) Vaccine-related conversation should be started using a presumptive approach where vaccination should be presented as the default approach. for example, instead of “What are your thoughts on a vaccine?”, the conversation should start with; when we should book you for the recommended vaccine to keep you healthy and safe.

2)If the patient and individual are still unsure then the conversation should focus on addressing the concerns, and strong recommendations. For example, Vaccines do work. One can face serious health consequences if not immunized.

3)Vaccine benefits and side effects should be honestly described to the individual to build trust. For example, Vaccines are important in preventing serious illnesses, and the risk of side effects such as anaphylaxis after vaccination is approximately 1 in a million and there is a risk associated with everything in life. Providing reassurance on a robust vaccine safety system, focusing on the protection of the individual and community, telling stories not scientific facts only, and addressing pain associated with needles is important.

4) For a common question such as “Can vaccines cause long-term health problems?” and “Are vaccines safe for minors and elderly? The answer should start with reference to the scientific literature that in more than 50 years of vaccine administration, studies have found no relationship between vaccination and the development of chronic diseases. And it is highly unlikely that vaccines cause unexpected long-term problems. The safety of each vaccine is carefully checked before it is licensed to be used. This statement should be followed by “I understand your concerns but in my best belief and years of practice have taught me that “the risk of disease is far greater than any minor risk caused by vaccines.”

5) One of the common concerns often seen in vaccine-hesitant individuals is that chemicals and ingredients in vaccines are toxic. To address chemophobia, physicians should use approaches such as “Water is also a chemical compound. Lemon has chemical compounds such as water, citric acid, and carboxylic acid. Chemical compounds in vaccines can be toxic, but only at much higher doses. Everything, even water, can be toxic at high enough doses. These ingredients such as formaldehyde in vaccines are there to preserve them and keep vaccines from getting contaminated by bacteria and make them work better. Chemicals such as aluminium found in vaccines are useful in boosting the immune system. In fact, the amount of aluminium found in the vaccine is like the amount present in breast milk and infant formula”

6) Physicians should respond to questions such as “Isn’t herd immunity or natural immunity better than vaccination?”, as follows; whilst natural immunity might provide better immunity than vaccines the risks associated with it are far higher. Which also increases the risk of complications associated with natural immunity such as permanent brain damage and death. Being vaccinated will enable us to fight off infection without serious consequences.

7) Counselling vaccine-hesitant parents who immunize their children and individuals with doubts should be priorities for counselling over individuals with firm anti-vaccine beliefs who have refused before and have not vaccinated their children as well.

Although the shift to consult Dr.Google for information about any medical concern isn’t going anywhere in the future, Physicians remain the most trusted information source hence there should be policies in place to validate health care professional’s knowledge of, and skills in, vaccine administration and counselling. Comprehensive, competency-based training before administering vaccines should be compulsory for all health care staff. Facts are not enough to change the views of vaccine-hesitant individuals. This area of expertise depends on physicians to be emotionally strong, honest, and well prepared to answer commonly asked questions and know where to find answers to unfamiliar questions. Credible resources and written guides should be provided to parents in understandable simple language especially if they ask and seem to be interested in doing their research.

Conflict of interest statement

none

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References:
1.Shen SC, Dubey V. Addressing vaccine hesitancy: Clinical guidance for primary care physicians working with parents. Can Fam Physician. 2019;65(3):175-181
2.Ingrid, volkmer, social media & COVID-19: A global study of digital crisis interaction among Gen and Millennials ISBN 978 0 7340 5669 6

About the author

Sadia Khalid, Junior researcher, and a PhD candidate at Tallinn University of Technology (TalTech), Estonia. She has been working on her research project  “The role of Helicobacter pylori intestinal microbiota in the development of liver diseases. under supervision of Dr. Pirjo Spuul at Faculty of Science, Institute of Chemistry and Biotechnology.,TalTech. Previously, she has worked as a research specialist in biomedicine and translational medicine department in the university of Tartu, Estonia. She obtained her MD in emergency medicine in 2017 from the Dalian Medical university, China and MBChB in 2013 from the Weifang Medical university, China. Her current research interests include infectious diseases, bacteriology, hepatology, and gastroenterology.