Encouraging reticent Americans to get the COVID-19 vaccine has to steer away from trying to “browbeat” people into getting the shots and must focus on community collaboration and “motivational interviewing techniques” from healthcare providers, experts said.
Former Senate Majority Leader Bill Frist (R-Tenn.), a Bipartisan Policy Center senior fellow, said at a webinar hosted Wednesday by the think tank that “we have a moral imperative to work as hard as we possibly can and as quickly as we can to reach herd immunity,” and “to get there we must continue to build confidence in COVID-19 vaccines.”
A recent Kaiser Family Foundation poll revealed that 13 percent of Americans surveyed said they would “definitely not” be getting a COVID vaccine while 7 percent said “only if required” and 17 percent were undecided. Thirty-two percent reported having received at least one vaccine dose already.
“Throughout the pandemic public trust in the scientific community has unfortunately decreased,” Frist said. “Compounding this, some Americans express skepticism because COVID-19 vaccines received FDA approval faster than many other vaccines in the past, thanks to emergency use authorizations. Moreover, many Americans feel the vaccine approval process has been politically motivated, rather than driven by science.”
Frist emphasized that public health, government, and healthcare officials “must remove the political undertones in these conversations in order to improve trust, in order to increase the uptake of vaccines and to reduce preventable deaths.”
“All Americans who can get the vaccine should — regardless of political affiliation, regardless of political affiliation — get those vaccines,” he added.
Don Berwick, former administrator of the Centers for Medicare and Medicaid Services and now a senior fellow at the Institute for Healthcare Improvement in Boston, called the pandemic “a call to arms for reasserting our commitment to learning and improvement at the core of our work in healthcare.”
Berwick said it’s been “too much the tradition” to employ “command, control, incentive, exhortation, by trying to force or push people into new ways of being, to change processes through simply insisting on change.”
“In the COVID pandemic, we are learning a ton very, very fast. In clinical care around the world, knowledge is speeding from place to place at a pace I’ve never seen before. A sense of humility and curiosity about how to deal with this dreadful tragedy, global tragedy, is leading us to become more and more curious about how to do better,” he said. “But it’s also led to some real crises. Crises of confidence. Do we really know what to do? Can you trust the experts? And through many errors in public policy, in the early phases of the COVID pandemic, we’ve actually enforced a lot of these fears and hesitancy, especially in communities that are quite used to being left out or left behind. People do what makes sense to them. And if trust in science, trust in expertise, trust in the allegations of professionals wanes, then we are in trouble.”
Berwick said addressing the problem through bipartisan cooperation is critical. “The idea that we can somehow browbeat or even convince people to do things that they don’t believe to be in their interest –it’s a bankrupt idea,” he said. “It’s crucial to address fears honestly and with enormous respect, to engage in dialogue, and constant listening so that we can walk in the shoes of the people that we’re in dialogue with.”
“Trust is everything in the pandemic with respect to vaccine concerns, that’s trust in science, trust in expertise, trust in accumulated experience, and trust in the helpers who are trying to reach out to reverse the effects of this pandemic. I think that happens best in communities, in neighborhoods.”
Berwick acknowledged that “some will never agree, some will never find the sources of trust they need, and that’s OK.”
“We just need enough people in dialogue … to build trust at the medical neighborhood level,” he said.
Dr. Karen Remley, former Virginia Commissioner of Health, was formerly deputy incident manager of the Centers for Disease Control and Prevention’s COVID-19 response and now serves as director of CDC’s National Center on Birth Defects and Developmental Disabilities. She said CDC is tackling vaccine hesitancy through a comprehensive framework and robust partnerships that focus on “expanding access to vaccines, identifying addressing barriers to vaccine uptake, and building vaccine confidence among healthcare workers and their patients.”
“Confidence in the vaccines, the vaccinator, and the system all support the decision to get vaccinated,” she said.
Some of the tactics that CDC will be using to “reinforce trust” include communicating “transparently about the process for authorizing, approving, making recommendations for monitoring the safety, distributing, allocating, and administering COVID-19 vaccines, including how is data handled, providing regular updates on the benefits, safety, side effects and effectiveness and clearly communicate what is not yet known.”
“Proactively address and mitigate the spread and harm of misinformation via social media platforms, partners and trusted mesh messengers. Empowering healthcare personnel, promoting competence among healthcare personnel in their decision to get vaccinated and to recommend vaccination to their patients,” Remley continued.
“These are some of the tactics that CDC will be using to empower healthcare personnel, engaging national professional associations, health systems, and healthcare personnel often and early to ensure a clear understanding of the vaccine development and approval process, new vaccine technologies and benefits of vaccination, ensuring that those healthcare systems and medical practices are equipped to create a culture that builds confidence in COVID-19 vaccination, and strengthening the capacity of healthcare professionals to have empathetic vaccine conversations, address myths and common questions, provide tailored vaccine information to patients, and use motivational interviewing techniques when needed,” she said.
“…This is where we’re focused: Building trust and helping people make decisions with those who trust them. So ‘vaccine with confidence’ to the CDC is not an advertising marketing or communications campaign. It is a cohesive framework to support health departments, healthcare providers, immunization partners, and community partners and leaders in their promotion of COVID vaccines.”