Given the role that vaccines have played as a cost-effective intervention to eradicate disease and improve health all over the world, it’s surprising that vaccines remain a controversial and polarizing topic. Vaccine hesitancy is defined by the World Health Organization Strategic Advisory Group of Experts (SAGE) as a “delay in acceptance or refusal of vaccines despite availability of vaccination services” (WHO, 2014). This sentiment is shaped by three main factors (Anderson & Bryson, 2020):

• Complacency: belief that the risks of the disease are low
• Convenience: availability, affordability, and accessibility of vaccines
• Confidence: lacking in the safety and effectiveness of vaccines, health care system, pharmaceutical companies and the leaders who recommend them

As of the writing of this article, three vaccines have received emergency use authorization (EUA) for use against coronavirus disease-2019 (COVID-19) and several more are in development. A survey conducted by the Pew Research Center last September 2020 found that nearly 49% of U.S. adults definitely or probably would not get vaccinated against COVID-19 (Tyson, Johnson & Funk, 2020). Demographics (cultural, social, religious) as well as political affiliation play major roles in perception. Now, six months later, we are witnessing a growing trend toward vaccine acceptance which could be linked to the belief that the vaccination effort will help improve the U.S. economy. A new survey conducted by the Pew Research Center in February 2021, found 19% of adults have already received at least one dose of coronavirus vaccine and approximately 50% stated they definitely or probably plan to get vaccinated (Funk & Tyson, 2021). That equates to almost 70% of the public that either has already been vaccinated or intends to get the vaccine, a significant shift compared to last fall. The Pew survey cited several factors that are positively correlated with the decision to get vaccinated:

• Trust in the vaccine research and development process
• Advocates of community health
• Habits and practices with the seasonal influenza vaccine 

However, the survey also found that 30% of Americans do not plan to get the vaccine for the following reasons:

• Concerns about side effects
• Feel the vaccines were developed and tested too quickly
• Need to know more about how well they work
• Experienced too many mistakes from the medical care system in the past
• Don’t think they need it
• Don’t get vaccines in general

Building Vaccine Confidence

Vaccine confidence is the trust that patients, their families, and providers have in the recommended vaccines, the people that administer vaccines, and the processes and policies that lead to vaccine development, licensure or authorization, manufacturing, and recommendations for use (CDC, 2021 March 1). How do we build vaccine confidence in individuals with vaccine hesitancy? As health care providers, we need to listen to their concerns, answer their questions, and help them feel good about their decision to be vaccinated.
 
The CDC outlines six ways to help build COVID-19 vaccine confidence:

1. Encourage leaders in your community or organizations to be vaccine champions.
2. Provide opportunities where people can openly discuss their views and ask questions about the COVID-19 vaccines.
3. Share key messages through a variety of channels that people trust.
4. Help educate people about COVID-19 vaccines, how they are developed and monitored for safety, and how individuals can talk to others about the vaccines.
5. Look for credible sources. When you find COVID-19 information, verify it with sources such as CDC.gov and learn how to respond to misinformation with facts.
6. Be a role model, lead by example and promote your decision to get vaccinated. Let others know that you trust the scientific process and believe in the safety and efficacy of the COVID-19 vaccines.

Dispelling the Myths

There’s a lot of misinformation on the internet, in the media and in the news. You’ll be asked many questions – be prepared and arm yourself with the facts. Here are six common myths regarding COVID-19 vaccines in this infographic. Use this information to answer questions from patients, colleagues, family and friends. Danielson et al. (2019) describes the most effective approach to addressing vaccine hesitancy is through engagement in conversation in a nonconfrontational manner, by providing factual, evidence-based information, recognizing your patients’ beliefs about vaccination, building trust, addressing health literacy, and getting involved in public health initiatives.


 
What has your experience been with vaccine hesitancy? Do you have effective strategies to share? Please comment below.

References
 
Anderson, P. & Bryson, J. (2020). Confronting vaccine hesitancy: What nurses need to know. Nursing2020, 50(8), 43-46. https://doi.org/10.1097/01.NURSE.0000668436.83267.29
 
Centers for Disease Control and Prevention (2021, March 1). Vaccinate with confidence: Strategy to reinforce confidence in Covid-19 vaccines – Building confidence in COVID-19 vaccines. https://www.cdc.gov/vaccines/covid-19/vaccinate-with-confidence.html
 
Centers for Disease Control and Prevention (2021, March 8). Key Things to Know About COVID-19 Vaccines.
https://www.cdc.gov/coronavirus/2019-ncov/vaccines/keythingstoknow.html

Danielson, L., Blima, M. & Boyle, L. (2019). Special feature: Countering vaccine misinformation. AJN, American Journal of Nursing, 119(10), 50-55. https://doi.org/10.1097/01.naj.0000586176.77841.86

Funk, C. & Tyson, A. (2021, March 5). Growing share of Americans say they plan to get a COVID-19 vaccine – or already have. Pew Research Center.  https://www.pewresearch.org/science/2021/03/05/growing-share-of-americans-say-they-plan-to-get-a-covid-19-vaccine--or-already-have/
 
Tyson, A., Johnson, C., & Funk, C. (2020, September 17). U.S. public now divided over whether to get COVID-19 vaccine. Pew Research Center. https://www.pewresearch.org/science/2020/09/17/u-s-public-now-divided-over-whether-to-get-covid-19-vaccine/
 
World Health Organization (2014). Report of the SAGE working group on vaccine hesitancy. https://www.who.int/immunization/sage/meetings/2014/october/1_Report_WORKING_GROUP_vaccine_hesitancy_final.pdf