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The Pharmacist's Role in Promoting Vaccine Acceptance
by Karen Davidge, PharmD PGY2 Infections Diseases Pharmacy Resident Advocate Lutheran General Hospital; Mary Palmer, PharmD, BCPS PGY2 Infectious Diseases Pharmacy Resident Advocate Lutheran General Hospital; Jen Phillips, PharmD, BCPS, FCCP, FASHP Professor of Pharmacy Midwestern University College of Pharmacy, Downers Grove
According to the World Health Organization (WHO), vaccine hesitancy - defined as the reluctance or refusal to vaccinate despite the availability of vaccines - is considered one of the top ten threats to global health.1 In a systematic review of vaccine acceptance rates worldwide completed in December 2020, a range from 23.6% to 97% of people reported they would be willing to receive a COVID-19 vaccine.2 Surprisingly, the United States is among those countries with lower vaccination acceptance rates, with 56.9% of the population willing to receive a COVID-19 vaccine if given the opportunity. A recent survey in April 2021 assessing vaccine hesitancy among the U.S. population revealed that hesitancy rates vary widely across the U.S., ranging from as low as 4.5% to up to 25% of the population living within a specific geographic area. In Illinois specifically, between 6.8% to 9.5% of the population reported having some degree of hesitancy regarding the COVID-19 vaccine in April 2021. Fortunately, overall rates of vaccine hesitancy in the U.S. have been declining in recent months. Per the Centers for Disease Control and Prevention (CDC), predictors of higher vaccine hesitancy rates include female gender, age 25-39 years old, no college degree, lower income, and being uninsured or having Medicaid. The lowest vaccine hesitancy rates are among those aged 65 years or older and of Asian (non-Hispanic) descent. Rates of vaccine hesitancy tend to be lowest on the West Coast and in the Northeast, and highest in the South, Great Plains, and Alaska.3
Given such high rates of COVID-19 vaccine hesitancy, both in the U.S. and worldwide, it is vital to identify and address factors contributing to vaccine hesitancy. Some of the most commonly cited reasons for vaccine hesitancy include concerns about the safety profile of the COVID-19 vaccines and mistrust of the government or other organizations that recommend mass vaccination programs. Individuals may also be reluctant to get vaccinated if they believe they are at low risk of harm due to COVID-19 infection. An online survey of U.S. residents conducted in September 2020 found that 68.6% of respondents planned to be vaccinated against COVID-19 once a vaccine became available. However, most respondents (63.5%) said they were worried about the possible side effects of a COVID-19 vaccine, indicating this is a concern even for those who are willing to accept the vaccine. This was likely related to the perception that the vaccine testing and approval process was occurring too quickly, as 73.1% of respondents expressed concern that “the rushed pace for testing for a new COVID-19 vaccine will fail to detect potential side effects or dangers.” When presented with three different hypothetical levels of efficacy (50%, 75%, or 99% protection against COVID-19 infection), respondents were significantly more likely to indicate a willingness to be vaccinated if the vaccine's efficacy was higher.4 Similar results were reported in a survey of Medicare beneficiaries conducted in October and November 2020. The most common reasons for unwillingness to accept a COVID-19 vaccine were “not trusting government” (42.1%), “side effects” (41.3%), “the vaccine not preventing COVID-19” (11.3%), and “the vaccine causing COVID-19” (10.1%).5 These survey results suggest that educational campaigns to promote uptake of the COVID-19 vaccines should emphasize the high efficacy and low rates of severe adverse effects associated with the COVID-19 vaccines while also outlining the strict requirements for vaccine approval and post-marketing monitoring of vaccine safety.
A large randomized controlled trial performed in the United Kingdom during January and February 2021 measured the impact of different educational interventions on willingness to be vaccinated among individuals who endorsed COVID-19 vaccine hesitancy. The investigators determined that for strongly hesitant study participants, providing information on the personal benefits of vaccination had a higher impact compared to providing information on the collective benefits of vaccination (or providing information on both personal and collective benefits).6 A recent commentary on evidence-based strategies for addressing COVID-19 vaccine hesitancy proposed that clinicians should tailor their vaccine recommendations to better connect with the priorities and concerns of each patient. The authors recommend that healthcare providers correct vaccine misperceptions by (1) affirming the patient’s personal values or worldview, (2) explaining the motivation behind vaccine misinformation, and (3) repeating factual information about the vaccines.7
As one of the most accessible healthcare providers, the pharmacist is pivotal to help reduce vaccine hesitancy and help guide patients towards vaccine acceptance. Changing the terminology from “vaccine hesitancy” to “vaccine acceptance” to help frame the issue in a more positive perspective is one way to do this. Other strategies are outlined below.8,9
Prevent/Correct Misinformation. There is an abundance of information available to consumers and patients related to vaccines. Some sources provide helpful and objective information, whereas others contain “myths” or misinformation. Pharmacists can help steer patients towards more reputable sources of information. Websites, social media, and apps with content written by the government or scientific agencies or by credible experts are more likely to contain accurate information. Other sources such as blogs, social media posts, and unreferenced content may not be accurate or up to date. Did you know that the FDA has vaccine information available in more than 20 different languages? https://www.fda.gov/emergency-preparedness-and-response/coronavirus-disease-2019-covid-19/multilingual-covid-19-resources
Use Two-Sided Conversations. It is essential to listen to the patients' concerns. By asking open-ended questions, pharmacists can determine the primary barrier to getting vaccinated. Instead of asking, “Why haven’t you received your vaccine yet?” try “What are your thoughts about the COVID-19 vaccine?” Acknowledge fears and concerns, but steer the conversation back towards objective, credible evidence. Using motivational interviewing concepts, you can also tailor the message you provide based on the specific reason(s) acknowledged for vaccine hesitancy.
Have a Balanced Discussion. When discussing the vaccine with patients, the conversation should include objective information on both efficacy and side effects. Be honest about what is known and what is unknown. Do not “oversell” the benefits or “undersell” the risks.
Keep Current. Find a way to keep up to date on new information and treatment strategies that become available. Also, understanding the latest “misinformation” might help you gather evidence to dispute unfounded claims.
Champion the Issue. One critical way pharmacists can help advance the COVID-19 vaccine initiative is to lead by example. If you’ve received your vaccine already, let people know. Some workplaces offer stickers or buttons to wear. You can also use social media to help propel the cause. Let your friends and followers know that you are available as a resource to answer any questions and post credible information on your social media pages/apps.
Vaccine hesitancy is not unique to COVID-19. What’s more, people are generally not on “one side” or the other. Acceptance of vaccination is best considered in terms of a continuum. Some refuse all vaccines, others accept all, and many may refuse or accept, but with some concerns. Pharmacists are in a great position to serve as an objective resource on COVID-19 and other vaccines. Hopefully, our profession can help educate the public on vaccines and serve as a valuable resource in the process by utilizing some of the strategies outlined above.
- World Health Organization. Ten threats to global health in 2019. Available at: https://www.who.int/news-room/spotlight/ten-threats-to-global-health-in-2019. Accessed 20 Jun 2021. Accessed 17 Jun 2021.
- Sallam M, Gori D. COVID-19 vaccine hesitancy worldwide: a concise systematic review of vaccine acceptance rates. Vaccines (Basel). 2021;9(2):160. Doi: 10.3390/vaccines9020160.
- Centers for Disease Control and Prevention. Estimates of vaccine hesitancy for COVID-19. Available at: https://data.cdc.gov/stories/s/Vaccine-Hesitancy-for-COVID-19/cnd2-a6zw/. Accessed 17 Jun 2021.
- Pogue K, Jensen JL, Stancil CK, et al. Influences on attitudes regarding potential COVID-19 vaccination in the United States. Vaccines (Basel). 2020;8(4):582. Doi: 10.3390/vaccines8040582.
- Luo H, Qu H, Basu R, et al. Willingness to get a COVID-19 vaccine and reasons for hesitancy among Medicare beneficiaries: results from a national survey. J Public Health Manag Pract. 2021; epub ahead of print. Doi: 10.1097/PHH.0000000000001394.
- Freeman D, Loe BS, Yu LM, et al. Effects of different types of written vaccination information on COVID-19 vaccine hesitancy in the UK (OCEANS-III): a single-blind, parallel-group, randomised controlled trial. Lancet Public Health. 2021;6(6):e416-e427. Doi: 10.1016/S2468-2667(21)00096-7.
- Rutten LJF, Zhu X, Leppin AL, et al. Evidence-based strategies for clinical organizations to address COVID-19 vaccine hesitancy. Mayo Clin Proc. 2021;96(3):699-707. Doi: 10.1016/j.mayocp.2020.12.024.
- Terrie YC. The role of the pharmacist in overcoming vaccine hesitancy. US Pharm. 2021;45(4):28-31.
- Banner L. COVID-19 provides opportunity to rethink vaccine hesitancy. Innovations. 2021;27(5):26-31. Doi: 10.1016/j.ptdy.2021.04.011.