Doctors Manitoba hosted a vaccine hesitancy webinar on February 3, 2021 with a panel of experts.

Below is a summary of the key takeaways for physicians.

Advice on Talking to Patients about COVID-19 Vaccines

1. Patient views on vaccines are not black and white — it’s not simply for or against. There is a large proportion who are unsure about accepting or rejecting a vaccine. Sometimes called the ​“moveable middle,” patients will often seek more information from trusted sources – including physicians – to feel more confident about their view. COVID vaccines are new vaccines, so some hesitancy is expected. Patients who have been comfortable accepting other more established vaccines may have concerns about COVID vaccines. These same patients may regularly accept the flu shot, for example, but still have concerns about COVID vaccines.
2. The Communicator Matters. Physicians are the most trusted profession or institution when it comes to vaccines. Your advice will often help patients make a final decision about getting immunized.
3. The Message Matters. Our panel agreed that patients favour a clear and strong recommendation from a physician. This can be accompanied by ensuring patients are aware of the risks of immunization, as well as the risks of the disease which are nearly always greater than the limited risks posed by the vaccine.
4. The Approach Matters. No one likes to hear they are wrong, even if they have misinformation they found online. When information is but a ​‘mouse click’ away, it is very easy to find confusing and conflicting information. Consider using a motivational interviewing approach with patients who may be hesitant or undecided about the vaccines. This includes:
   Inquire: What have you heard?
   Affirm: Let the patient know they have been heard
   Correct, briefly, but avoid ​“that’s not true” statements
   Redirect the discussion to the benefits. ​“We’re seeing even healthy people having problems with COVID. Let’s make sure you are protected.”
5. How can physicians help? Consider each patient individually in how your respond to hesitancy about the vaccine.
   1. Use an empathic and affirming approach. Most patients will already have a ​“vaccine story” formed from what they’ve heard, and sometimes this includes misinformation. Show you understand their concern, and pivot to offering new information responsive to their concern in a supportive manner that is consistent with your clinical judgement. ​“That’s a valid concern” (if you agree) or ​“I understand why you’re worried about that.”
   2. Ensure balanced and informed consent. Like any medical treatment, a vaccine requires informed consent from the patient. This should include a discussion not only about the risks from the vaccine, which are quite limited for most people, but also the risks from COVID-19, which are significantly higher for the majority of patients. Informed consent does not prevent you from offering a clear recommendation to your patient if it is medically advisable for them to get the vaccine. Done right, balanced and informed consent strengthens trust between you and your patient, and increases their confidence about getting the vaccine.The safest choice is usually not taking your chances with COVID-19.
   3. Offer the right amount of information. Gauge each patient’s need for information. Some will only need ​“a bite” while others will want ​“a full meal” with detailed information about the vaccine. For some patients, more information can actually increase their hesitancy, such as too much emphasis on the risks of the vaccine with little to no mention of the risks of the virus, and no clear recommendation from a physician.
   4. Provide a clear recommendation to get the vaccine, if medically appropriate. ​“For what it’s worth, I would recommend the vaccine for you.” You can reassure patients that you have (or plan to) received the vaccine yourself.
   5. Continue the Conversation. A ​“no” today may not be a no in the future. Continue the discussion during your next encounter with the patient, continuing to offer supportive information and a clear recommendation.

Our expert panel’s research and experience confirmed several ​“dissuasive factors,” which can lead people to reject getting a vaccine. These include everything from inconvenient access, advice from family/​peers, habitual non-vaccination, and perceiving the virus itself to be a lower risk than the vaccine. For Indigenous populations, prioritizing their access because they are more at risk may have the risk itself of dissuading them by creating distrust. This distrust may be offset if you and an Indigenous patient already have a good trusting relationship, particularly if you would recommend the vaccine for them, if medically appropriate.

Why are patients hesitant about COVID-19 vaccines? Our panel’s research and experience found several reasons, including:

• The vaccine research/​approval appeared rushed. It was fast-tracked, but corners were not cut.
• These are new products.
• Preference to wait to see what the long term safety issues might be.
• Concern about effectiveness against new variants.

You can learn more about the vaccines and how to respond to these and other concerns using these concise resources:

• Answering questions about COVID-19 vaccines: a guide for healthcare providers, from the Centre for Effective Practice.
• Plan for the COVID-19 vaccine discussion, from the Centre for Effective Practice.
• The Vaccine Hesitancy Guide was developed by a team of researchers out of the University of Calgary’s School of Public Policy.
  

Other Resources

• COVID-19 Vaccine Tracker from McGill University
• COVID-19 Vaccine Tracker from Regulatory Affairs Professionals, a global organization representing those involved in regulating health care and pharmaceuticals.
• Coronavirus Vaccine Tracker from the New York Times
• Listing of COVID-19 clinical trials from Health Canada
• COVID-19 Vaccine Recommendations for Use from the National Advisory Council on Immunization
• Canadian Immunization Guide from Health Canada
• COVID-19 Vaccine Safety in Canada (online weekly reports) from Health Canada

Watch our Vaccine Hesitancy Webinar for more information. Our expert panel included:

• Dr. S Michelle Driedger (PhD), a vaccine communication researcher and Community Health Sciences Professor at the University of Manitoba;
• Dr. Jen Potter, a family physician and assistant professor in the Department of Family Medicine with a research interest in vaccine hesitancy;
• Dr. Amila Heendeniya, an infectious disease specialist who has extensive background on the new and emerging COVID vaccine products; and
• Mr. Andrew Swan, General Counsel for Doctors Manitoba, with expertise about the professional and legal obligations related to informed consent.