Vaccine hesitancy is a state of being reluctant or unsure about getting a vaccine.¹⁻³ Importantly, being hesitant about a vaccine is a state that can change and evolve; it is not a trait that is inherent to the individual. Vaccine hesitancy is also a spectrum; people can be more or less hesitant and can also move along the spectrum. Through culturally-appropriate, trauma-informed, and evidence-based dialogue, health care practitioners (HCPs) can reduce vaccine hesitancy and promote vaccine confidence in their patients.³⁻⁵
While there may be cultural and social reasons that could explain an individual’s vaccine hesitancy, it is important to acknowledge that no community is entirely vaccine hesitant. Every individual has a unique history and experience with the healthcare system, which means every vaccine hesitant individual experiences vaccine hesitancy for reasons unique to them. For example, individual’s may have had limited healthcare access, feel unsafe within the healthcare system, and/or find it challenging to seek out and understand complex health information. These factors compounded with widespread misinformation about the COVID-19 vaccines may impact whether an individual is vaccine hesitant.³⁻⁷
To be vaccine confident, individuals need to have information they feel they can trust about vaccine safety, effectiveness, and access.¹⁻³ People may be unsure about vaccines for a number of reasons. We have addressed the common questions and misconceptions about the vaccines here. Importantly, this information needs to be contextualized to the individual and their personal situation. For example, your patient may be worried about the potential side effects from the vaccine. In this case, you would likely discuss the common side effects (i.e., pain at the injection site, slight fever, fatigue). Upon further conversation, you may discover that their actual concern is about having to take time off work due to these side effects. Discussing employment benefits and other strategies to protect them financially if they experience side effects may help to encourage this person to get vaccinated.
Vaccine confidence require individuals being able to²:
Understand and trust evidence about the safety and effectiveness of vaccines
Understand their risk of contracting COVID-19
Determine the risks and benefits of vaccination, keeping in mind both personal and collective impacts of the vaccine
Understand the individual benefits of vaccination for themselves
Understand the collective benefits of vaccination for the larger community
Easily access vaccine booking systems and vaccination clinics without any retribution from family or workplace
TIP 1 - Establish trust – As a HCP you have likely already established trust with your patients. This is a great foundation for productive conversation. You can reinforce this trust by conveying to your patient that it is completely normal to have questions about the vaccine. Clarify that your role is to provide information and not to force them to get the vaccine. You want them to be fully aware about the benefits and the potential risks associated with the vaccine as well as the risks of not getting vaccinated, so they can make an informed decision.
If your patient is from a community that has experienced systemic harms from the healthcare system or has been underserved in the vaccine response, acknowledge that you are aware of the harms and failings of the system, or that you are willing to listen and learn. Follow through and show you care by reading up on the forms of oppression (racism, homophobia, transphobia, and sexism) prevalent in our healthcare system. It is important to realize that this discrimination is not “in the past”; it continues to happen today and directly impacts whether individuals feel they can trust vaccine information coming from health authories. Let your patient know that you are willing to listen and support them in the best way you can.
TIP 2 - Ask open-ended questions – Asking open-ending questions is the best way to get to know what your patient already understands about the vaccine and any misconceptions they may have . To start off, you can ask questions such as:
“How do you feel about the vaccine?”
“What do you think about the vaccine?”
“Why do you feel the vaccine is important?”
“What do you know about the vaccine and how it works?”
To identify misconceptions and worries, ask “If you’re comfortable sharing this with me, what is stopping you from getting the vaccine?” and/or “It is very common to have concerns about the vaccine, if you’d like to share your concerns with me I can do my best to help provide you with relevant information.”
TIP 3 - Listen actively – Once you have asked these starter questions, you are on your way to a productive and rich dialogue. Ensure that you are actively listening to your patient’s response.
You can do this by –
Affirming their knowledge and time:
“You seem to know a lot about “x”...
“You already know a lot about vaccination.”
“Thank you for taking the time to talk to me about vaccination.”
Rephrasing and synthesizing what they have said and what they mean:
“It sounds like you are positive about vaccination in general but you are worried that this vaccine was approved too quickly. Is that correct?”
“You are worried about getting the vaccine while pregnant and you have heard online that the vaccine could harm the placenta. Does that sound right?”
TIP 4 - Share information – Once you have identified your patient’s concerns, you are in a better position to provide them with relevant and contextualized information. Before you start sharing information, make sure you check-in with your patient and affirm their willingness to learn more from you 11. Here are some questions to get you started:
“Can I give you some information based on what you already know [about xxx]?
“Can I provide you some information to build on what you know [about xxx]?
“Can I share some information that might help address your concern [about xxx]?”
If they are willing, share your information in plain language. Avoid using scientific jargon. After sharing, follow up with questions such as:
“Does that make sense?”
“What do you think of this information?”
“Is this information helpful?”
“Is there anything I can clarify?”
TIP 5 - Observe intently – Patients may display their reactions through body language, especially when you are talking and they are listening. Any and all forms of anxiety such as a leg shaking, nail biting, and/or darting eyes should suggest to you that your patient is nervous and potentially in a state of panic. Be prepared to slow down the conversation, re-explain tricky concepts, and reinforce that you are there to support them. Try to address concerns and answer questions as best you can without overwhelming them with information.
TIP 6 - Reinforce autonomy – While trying to promote vaccine confidence, it is important to recognize that each individual must decide on their own to get vaccinated. Unintentionally making your patient feel coerced or shamed into getting vaccinated can break trust and create animosity between you and your patient.
Avoid using language like “should”, “must”, or “need” when referring to vaccination.
Do not scare your patients into vaccination by exaggerating the negative impacts of COVID-19. Instead, empower your patients through evidence-based information about the vaccine and the positive impact of vaccination.
When you don’t know something or there isn’t enough evidence to make a definite conclusion, be transparent rather than trying to hide it. This prevents loss of trust in case conflicting evidence or unforeseen events occur. Reiterate that the current evidence strongly supports vaccination.
Reinforce that your role is to share information about the vaccine, and not to make them get the vaccine.
Ask questions like “How can I help you make an informed decision about vaccination?”
TIP 7 - Engage respectfully – The aim of all the previous tips is respectful communication. As a HCP, you have access to health information and scientific knowledge. Engaging with respect means that you recognize that this knowledge is a privilege that others may not have. Vaccination can be a difficult decision for many people, especially those who are underserved and/or harmed by the healthcare system. Engaging respectfully means sharing your knowledge when asked, listening carefully, and supporting your patients as they need to be supported.
Oftentimes, your patient may be coming in for a reason other than vaccination. While having conversations about the vaccine is important, make sure to ask your patient if they are willing and ready to have this conversation before getting started.
We hope these tips help you foster meaningful discussions with your patients about COVID-19 and vaccination!
Our identity impacts our understanding of health and healthcare, our experience of the healthcare system, and our ability to conceptualize health information. Unfortunately, some communities have been underserved in Canada’s pandemic response.¹⁴⁻¹⁶ This means it is more difficult for members of these communities to find accessible and culturally appropriate information about COVID-19 and vaccination. Furthermore, certain communities have faced, and continue to face, long-standing harms and barriers to healthcare due to inequitable access and delivery. Individuals from these communities may be justifiably skeptical of health information coming from a system that has harmed them or failed to meet their needs.²,⁹,¹⁰
Racialized people do not have equitable access to healthcare. This is not a new issue and it is pervasive, extending from primary care, mental health services, sexual & reproductive health services, and yes, COVID-19 vaccines. For example, racialized people, especially those who have immigrated to Canada, may not have accessible information about vaccines in their language. This can make it very difficult to become vaccine confident. (If your patients are looking for trusted COVID-19 Vaccine Information, we have COVID-19 Vaccine Information pages in over +14 languages on our portal - click here to start.)
Additionally, there may not be enough vaccine clinics in underserved communities. Racialized people are also more likely to work in low-income essential services, which not only increases their risk of exposure to COVID-19, but can make it difficult for them to attend a vaccine clinic at regular hours.⁴,¹⁶ They may fear retribution for taking time off work to get vaccinated. In Ontario, the job-protected infectious disease emergency leave protects workers from being fired to go and get the vaccine or stay at home from any side effects from the vaccine for three days. You can read more about it here.
Racialized individuals also continue to face discrimination and racism in the healthcare system which can lead to fear and mistrust of the system and HCPs. This can translate to beliefs that the COVID-19 vaccine is a form of scientific experimentation or reproductive control.¹⁷⁻¹⁸ Importantly, these beliefs are founded in historical fact, as many experiments and unethical measures have been done in the past (learn more here, here, and here).
Over-criminalized communities, such as sex workers, unhoused people, undocumented people, and people who use drugs, also face barriers to access the healthcare system. Individuals from these communities may not have safe, respectful, and regular access to a HCP, like a family doctor. For many people in these communities, going to a hospital or seeking medical help is a last resort. Oftentimes, when these individuals do seek help, they face judgement and discrimination from HCPs and the healthcare system. These are forms of trauma that can further ostracize these communities from the healthcare system.¹⁹⁻²² Having specialized vaccine clinics for these communities that are easily accessible and that do not require identification are extremely important.²³ Myths that can spread in these communities are those that claim that the vaccine is a tracking device.²⁴⁻²⁵ Again, these myths take hold because they are based on historical and continued truths, where individuals from these communities are tracked and criminalized by authorities (learn more here, here, and here).
As a HCP, you are a trusted source of medical information. However, medical information must be personalized and contextualized to the individual. Keeping in mind that individuals and communities have different experiences of the healthcare system can help you deliver information in a way that is culturally-appropriate and trauma-informed. Oftentimes, this is simply being aware of the needs and responses of your patient so you can communicate with them in a way that makes them feel safe, comfortable, and understood.
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