• Survey Measures COVID-19’s Impact on Vaccine Confidence

    Family Physicians Can Play a Vital Role in Combating Misinformation

    November 5, 2021, 4:05 p.m. Michael Devitt — Less than a decade ago, Canadian researchers published a widely cited paper that concluded that “individual decision-making regarding vaccination is complex and involves emotional, cultural, social, spiritual and political factors as much as cognitive factors” and that vaccine hesitancy “can be heightened by the current changing scientific, cultural, medico-legal and media environments.”

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    In that context and in light of constant news updates regarding COVID-19 and COVID-19 vaccines, the results of a recent survey conducted by the AAFP’s 2020-2021 Vaccine Science Fellows are somewhat expected. The survey found that while confidence in vaccines has increased for many people, a surprising number of people have less confidence in vaccines now compared with the start of the pandemic.

    On a more positive note, the survey also found that having a usual source of care such as a family physician had a significant impact on an individual’s confidence in vaccines and their willingness to get vaccinated — a finding that demonstrates the role FPs can play in explaining the benefits of vaccines and alleviating patient concerns.

    “The survey highlights the importance of family physicians in educating the public about vaccines and vaccine-preventable illness,” said Michele Zawora, M.D., an assistant professor and chair of physician assistant studies at Thomas Jefferson University in Philadelphia and one of the Vaccine Science Fellows who developed the survey and authored the report on its findings.

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    “We also have a critical opportunity to address the public on their preferred platforms, whether social media or TV, radio or print,” Zawora added. “Combating misinformation is critical in moving vaccine efforts forward and improving vaccination rates.”

    Methods and Analysis

    The survey was conducted on SurveyMonkey using an online panel designed to represent the general population of the United States. It launched on March 4, 2021, and closed the following day. During that time, 2,232 responses were received.

    The survey consisted of 50 multiple-choice questions, ranking questions and fill-in-the blank responses. The questions focused on confidence in vaccines prior to and since the COVID-19 pandemic, along with questions on confidence in public health organizations, the medical community and government organizations, and general demographic information.


    Overall, about 40% of respondents reported no change in vaccine confidence since the start of the pandemic. Nearly 30% of respondents said their confidence in vaccines had increased, while almost 21% reported that their confidence had decreased.

    This change in vaccine confidence may have been linked with an increase in the use of alternative sources of information. Before the pandemic, most participants reported getting information on vaccines from a trusted medical professional such as their physician. During the pandemic, however, the number of people who got vaccine information from their usual source of care decreased by about 10%. At the same time, increases in vaccine information from television, print or radio news increased by about 10%, while information from the internet and social media increased by nearly 4% and 3%, respectively. Participants also reported increases in vaccine information from public health organizations and medical organizations during the pandemic.

    Having a usual source of care appeared to make a significant difference in whether an individual was more likely to get vaccinated against COVID-19. Nearly three-quarters of all respondents (72.6%) said they had a usual source of care; 61.5% of those individuals said that they intended to get vaccinated compared with less than 29% of individuals without a usual source of care.

    The survey also revealed a number of interesting findings based on demographic information:

    • Participants age 65 years and older, individuals with a Master’s degree or higher, and those with household incomes of $200,000 all expressed a much higher intent to receive a COVID-19 vaccine than individuals age 18 to 24 years, those with less than a high school education, and those with a household income of less than $25,000.
    • Participants who had or knew someone who had COVID-19 expressed a greater intent to receive a COVID-19 vaccine than those who did not.
    • Participants who received a flu vaccine during the 2019-2020 influenza season were much more likely to intend to get vaccinated against COVID-19 compared with those who did not get a flu vaccine.

    Authors Suggest Ways to Fight Misinformation

    The authors stated their concern over the nearly 21% of respondents whose confidence in vaccines decreased in a discussion of the survey results.

    “If we assume that confidence translates into action and lack of confidence translates into inaction, then 21% of people choosing against immunization — whether for COVID-19 vaccines or routine immunizations — puts the United States below levels necessary to maintain herd immunity for many vaccine-preventable diseases,” they wrote.

    The authors suggested that a variety of factors, many of which were beyond the control of clinicians, could be responsible for the decrease in vaccine confidence among some patients.

    “The general public has had a front-row seat to watch science and vaccine development in action, and there have been expected changes in recommendations as we learn more about SARS-CoV-2 and the vaccines. For many, especially for those without a science or public health background, this has been a source of frustration and confusion,” the authors wrote.

    “Additionally, the timing of the pandemic and vaccine development, which occurred during a highly polarized presidential election year, resulted in the unfortunate politicization of both the virus and the vaccines meant to prevent it,” they continued. “In hindsight, it is not surprising that such factors would negatively impact some people’s confidence in vaccines.”

    The authors also found it understandable, based on the decreased availability of medical care in the early stages of the pandemic, that some people would obtain vaccine information from sources other than a primary care clinician. Unfortunately, turning to those sources also brought with it an increased likelihood that people would encounter both misinformation and disinformation about vaccines in general and COVID-19 vaccines in particular.

    To combat these issues, the authors called for a concerted effort among those in health care and in other industries to ensure that the public receives information they can rely on.

    “It is incumbent upon physicians and other health care professionals (particularly in family medicine and other primary care specialties), scientists, those in public health, news outlets and social media platforms to work together to ensure that accurate and reliable information is being shared with the public,” they wrote.

    Additional Comments

    Zawora told AAFP News that family physicians could use the survey’s findings to frame the way they talk to patients not just about vaccines for COVID-19, but also other vaccine-preventable diseases.

    “Family physicians have a skillset of being able to connect with their patients, gain their trust, and work through concerns, fears and questions,” she said. “While the process can be tedious at times, we are in a unique position to ask patients about vaccines and ensure we offer support, guidance, and the correct information for them to make informed decisions about their health and the health of the community.”

    Given that the initial survey was conducted in March 2021, only a few months after the Pfizer-BioNTech and Moderna vaccines received emergency use authorizations from the FDA, Zawora was asked whether the results might be different if the survey was conducted at the present time, when vaccines are more readily available.

    “It would be great to have longitudinal, ongoing survey data with resampling every two to three months,” said Zawora. “It would be interesting to see if the emergence of vaccine mandates for employment, social activities, transportation, etc., would affect the intent to vaccinate and how that would affect the confidence in government and public health organizations.

    “Many in our population are experiencing a dangerous combination of distrust and pandemic fatigue, which is concerning for ongoing trust for future public health issues,” Zawora continued. “Particularly with the COVID-19 vaccines, the public is sitting front-row and witnessing science and research methods playing out in real time. The natural process of the scientific method, with knowledge and recommendations continuing to evolve, may have led to further distrust and lack of confidence in vaccines.”

    As family physicians continue to seek ways to increase vaccine confidence and speak with their patients about the importance of vaccinations, Zawora recommended that individuals visit the Academy’s COVID-19 Vaccine and Immunizations & Vaccines webpages, along with resources from familydoctor.org, the CDC and the Advisory Committee on Immunization Practices.