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Acknowledge, Respect, Inform: Discussing the COVID-19 Vaccine with Hesitant Patients

Delana Wardlaw, MD

By Delana Wardlaw, MD

We are all anxious to see COVID-19 take a back seat to other concerns—especially those of us who have seen the greatest impact from the pandemic in our communities. I have been a prominent voice for vaccination in my practice, including receiving the vaccine on a featured news segment. Yet many of my patients still say they’re not planning to get vaccinated against COVID-19. Rather than be judgmental or confrontational, I tell them, “Let’s discuss it.”

As physicians, we must understand and address the hesitancy our patients may have when it comes to vaccination. It is important to keep cultural sensitivity at the forefront, as well as an awareness of the challenges our patients face in their day-to-day lives. Here are some tips to consider:

Acknowledge present and past injustice

Many of my patients are Black and Brown, and are aware of the history of medical discrimination, abuse and neglect toward their communities—from the high maternal mortality rate among Black women to the abuses of the Holmesburg Prison and Tuskegee experiments, to ongoing systemic racism. It’s important to acknowledge this reality, and to make sure the patient knows every step of the way that you are their partner, and you won’t try to make a decision for them.

Focus on marginalized communities

It may also be helpful to note that the vaccine is attempting to mitigate an effect of systemic racism. Black, Native American, and Latinx/Hispanic communities all have higher COVID-19 morbidity and mortality rates, in large part due to the effects of systemic racism (including higher rates of poverty; lack of access to quality health care, housing and education; etc). While we work to address the social determinants of health and create a more equitable society, we must keep our communities alive now.

Encourage and recommend the COVID-19 vaccine to your patients

  • Patients need to hear directly from you. Personal physicians are still the most trusted source for vaccine information
  • Many adult patients indicate they are likely to receive a vaccine if their physician recommends it, according to a 2008 study in the American Journal of Medicine titled, “Barriers to Adult Immunization.”

Discuss how we got the vaccine so fast

Some patients may distrust the rapidity with which the COVID-19 vaccine was developed. The following points are important to note:

  • The mRNA technology used to develop some COVID-19 vaccines may be new, but it has been studied extensively for more than a decade.
  • Part of the reason the vaccine was developed quicker than usual was that governments and companies across the world made this their top priority. Increased funding and collaboration between many government agencies helped shorten the vaccine development and testing time substantially.
  • Vaccine development is a tried-and-true process. Vaccines go through rigorous protocols to ensure they are both safe and effective. No protocols were abandoned, despite the urgency of the pandemic.
  • It’s true that full FDA approval of a vaccine takes time; however, the FDA only issues an emergency authorization such as this if it’s clear—based on results from large clinical trials—that the benefits outweigh risks. Tens of thousands of people received these vaccines before they were authorized for delivery to the public. While some people have had side effects or allergic reactions to the vaccine, these symptoms are greatly outweighed by the potential damage from COVID-19. 

Address other vaccine myths as needed

  • The mRNA vaccines cannot give you COVID-19. They do not inject you with the SARS-CoV-2 virus. Rather, they teach your cells how to make a protein found on the outside of the virus, which causes your body to create an immune response by developing antibodies. In the future, if your body is infected by COVID 19, your body recognizes it and mounts a defense to protect you. It’s like teaching your cells to recognize the “fingerprint” of the virus.
  • They don’t alter your DNA—the set of genetic instructions/message never enters the nucleus of your cells where DNA is housed.
  • The mRNA does not live in the cells indefinitely, it is degraded shortly after the cell is finished using the instructions.
  • Only the vaccine ingredients are injected—nothing is taken from your body.
  • They also don’t contain any tracking devices (or, for that matter, latex, preservatives, or eggs). You can find the ingredients lists for the Pfizer-BioNTech and Moderna vaccines here:

Avoid trigger words/terms

Patients who are aware of the history of medical exploitation of people of color may not welcome terminology that suggests they are part of a mandated experiment. That includes terms like “lab rat,” “test dummy” or “guinea pig” but also terms like “research participant”. Avoid using the phrase Operation Warp Speed without explaining that this process allowed experts from government and private entities to work together to allow for effective production of the vaccine at an accelerated rate without compromising safety. 

Put risks and failures into perspective

  • Acknowledge that COVID-19 vaccines are very effective, but there is always a chance of contracting COVID-19. As with any immunization, patients should know that COVID vaccines will reduce disease severity and decrease the likelihood of death even if they do get sick.
  • The potential vaccine side effects of headaches, muscle aches, fatigue, etc., are far less significant than the potential side effects of COVID-19: respiratory failure; renal failure; heart attack; stroke; long-lasting effects on the heart, lungs and memory; and even death. The risk of serious, long-term damage from the vaccine is almost certainly minimal, while the risk of contracting COVID-19 is clearly very high for many patients. Help your patient walk through the risks they’re willing to take.
  • Make sure patients know that data are still being gathered. If they experience any side effects that bother them, you or they can report it through V-safe (a smartphone-based health checker for people who’ve received the vaccines) or the Vaccine Adverse Event Reporting System (VAERS).

Focus on the positive

In order to be able to return to normal activities—kids going to school; dining out; attending sporting events, graduations, or proms—we need to contain the COVID-19 pandemic. The best way to do that is to get a significant proportion of the population vaccinated. Highlight this as a goal.

Be an example

If you have received the vaccine—especially if you and your patient share a racial/ethnic/ linguistic group—you can speak to the reasons you did so, and why it is important for protecting your community. You might mention other people who prominently received or worked on the vaccine and/or its distribution—for example, many Black and Brown physicians (like the Black Doctors COVID-19 Consortium, Twin Sister Docs, Dr. Sanjay Gupta, and Dr. Kizzmekia Corbett, who was key to developing the Moderna vaccine) and public figures (such as Tyler Perry) have raised their voices in support of vaccination.

In addition, historically black institutions and organizations (National Medical Association, Morehouse College of Medicine, Howard University, Meharry Medical College) have been monitoring the development of the vaccines and support it. If you’re not part of the same community as your patient, you can work with trusted community partners or messengers to help get the word out; just make sure the messengers have accurate information. This allows patients to make an educated and informed decision.

Listen

It is vital to demonstrate that you care and that you are hearing your patient—this is especially true if you don’t share racial/ethnic/linguistic traits with them. Like all such medical encounters, discussing vaccination works best when the patient and the provider work as a team. Give patients your time, answer their questions, and discuss their concerns.

Address challenges to access

Some patients face greater barriers to getting the vaccine than others—for example, access to technology to sign up for vaccines or get alerts. If your clinic or community partners offer resources to help in those sorts of situations, you can help your patient connect.

No matter what, be honest, center the patient, and respect their decision-making—with good teamwork, we can all start making progress.

These resources may be helpful references for common questions asked by your patients:

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