Overcoming Patient, Clinician Vaccine Hesitancy Key to COVID-19 Vaccination Effort

Bridget M Kuehn
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Only about one-third of the staff in the dialysis program at the University of Virginia Health system has been vaccinated against coronavirus infectious disease 2019 (COVID-19) so far, according to the program’s administrator, Debbie Cote, BN, MSN. The main reason for the slow uptake is that many are concerned about the speed of the vaccines’ development process and the lack of information about long-term side effects, Cote said in an interview with Kidney News.

“From my own staff, what I’ve heard is they would take the vaccine, but they don’t want to be first,” said Nancy Colobong Smith, MN, CNN, director of the American Nephrology Nurses Association (ANNA). Colobong Smith said her staff at the University of Washington Medical Center in Seattle are evenly divided among those who will take the vaccine, those who are unsure, and those who say they definitely will not take the vaccine.

Vaccine hesitancy among clinicians and patients is presenting a major challenge to the rollout of COVID-19 vaccines in the United States. A survey by the Kaiser Family Foundation (KFF) found that although 71% of Americans say they will definitely or probably get the vaccine, a substantial number remain skeptical (1). The largest group to report they would probably or definitely not get the vaccine were people who identified as Republicans (42%), according to the KFF survey. Additionally, 35% of individuals living in rural areas and 35% of Black adults also said they would probably or definitely not get the shot, as did 29% of healthcare workers.

“Many who are hesitant are in wait-and-see mode, and their concerns include worries about side effects and whether the vaccine can cause COVID-19, which may dissipate as people get more information and see the vaccine introduced successfully among people they know,” Kaiser Family Foundation CEO Drew Altman wrote in a statement about the survey.

Trust gap

Kathleen Dooling, MD, MPH, co-lead for CDC’s Advisory Committee on Immunization Practices COVID-19 Work Group, acknowledged that historical and ongoing mistreatment of Black people in US medical care has contributed to mistrust of the vaccine in this group. But she noted that vaccine manufacturers have worked to build trust in the vaccines by ensuring that some clinical trials were inclusive.

“There is a trust gap,” she said. But she said she hopes to build trust and “make this vaccine something that everybody wants to get because it is safe and effective.”

Dooling spoke during a recent ASN webinar (2) on “Safety and Efficacy of COVID-19 Vaccines in Dialysis.”

Webinar participant Richard Knight, MBA, president of the American Association of Kidney Patients, emphasized the importance of patient education and healthcare provider credibility and trust in helping overcome vaccine hesitancy among patients who are Black or from other underrepresented groups that have been disproportionately affected by COVID-19.

“We need to come up with a message that will encourage people,” Knight said. He noted the benefits of being vaccinated far outweigh the risks for dialysis patients despite some unanswered questions. He recommended being honest with patients about the unknowns and benefits. He also recommended that dialysis patients be vaccinated by their dialysis providers.

The trust gap extends to some health workers and other groups as well. Some staff have told Cote that they don’t trust the vaccine because it was developed during a certain administration. Others have shared conspiracy theories about the vaccine.

“There’s a lack of trust in the government,” Cote said.

The KFF survey also found that vaccine-hesitant individuals were more likely “to harbor misconceptions about the pandemic and related health measures.”

Beliefs about personal responsibility also factor in. A report from the KFF found that rural residents (3) were more likely to see getting vaccinated as a personal choice rather than a responsibility to help protect the community.

“Effective messages need to be delivered by trusted messengers and take into account these strongly held beliefs in order to have successful vaccine uptake in rural America,” the report’s authors wrote.

Clinician leadership key

Physicians and other clinicians have a key role to play in boosting patient acceptance of vaccines. The KFF survey found that 85% of patients trust their own physicians or healthcare providers to provide them reliable vaccine information, whereas about 70% trust federal authorities like the CDC. But hesitancy among some healthcare workers could undermine this.

“That’s problematic in terms of how they may be advising the patients,” Knight said. “[Patients] will miss out on something that can really have an impact, not just on their quality of life, but on their ability to continue living. It’s very serious.”

Overcoming hesitancy among healthcare workers is “a strong leadership challenge,” Knight said. He emphasized the importance of educating staff about the vaccine and ensuring that clinicians talk with patients about the vaccine from the perspective of “what’s in the best interest of the patient,” regardless of the staff member’s personal views.

Colobong Smith recommended that institutions be honest and transparent with staff about what is known and not known about the vaccines so far and about the devastating effects COVID-19 has had on some patients and staff. She also recommended extra efforts to reach out to groups at elevated risk. She noted that her institutions have held virtual town halls, including some specifically for people of color, led by individuals from those groups, as well as holding some town halls in Spanish.

The Virginia Department of Health’s Office of Health Equity recently featured National Institute of Allergy and Infectious Diseases Director Anthony Fauci, MD, as the keynote speaker about vaccine acceptance during a “Facts and Faith Fridays” webinar. The webinar targeted thought leaders in the faith community who are in a position to reach out to their communities to urge vaccine acceptance.

“All of that is helpful, as well as giving people easy access to quality evidence and sources,” Colobong Smith said. She noted that ANNA (4), the American Nurses Association (5), and CDC (6) all have COVID-19 vaccine information.

The University of Virginia Health system sends daily COVID-19 updates, including information about hospital occupancy and staff vaccination numbers, Cote said. Additionally, leaders and other staff who have been vaccinated are encouraged to share their own experiences with the vaccine. Both Cote and Colobong Smith noted that most reactions to the vaccine are mild and brief.

“People are just trying to get the word out that it is safe and reassure people,” Cote said.

For patients, dialysis patient advocate Elizabeth Fortune recommended using a shared decision-making process that engages physician, patient, and the rest of the care team. She noted that at her dialysis center, social workers routinely provide information, including pamphlets, about many topics. She also recommended sharing information from multiple sources.

“The social workers need to be involved because they do—at least in my clinic—more one-on-one education,” she said.

Some patients may not need much convincing. Many patients who recognize they are at higher risk from COVID-19 are eager to be vaccinated, noted Cote.

“There sometimes is less apprehension in patients than there is in staff,” she said.

However, many healthcare workers have also jumped at the chance to be vaccinated, and even some who were initially hesitant are changing their minds as growing numbers of people are vaccinated, said Colobong Smith. She has been helping to vaccinate healthcare workers in her system, and many are excited to share photos of their vaccinations on social media to help reassure friends and family who worry about their safety during the pandemic.

“It’s about us as healthcare providers, as people, but also about our communities and the people that care about us and that we care about,” she said. “It’s all of that together.”