November 30, 2021, 8:55 a.m. Michael Devitt — A new report on COVID-19 vaccines from the Kaiser Family Foundation emphasizes the challenges family physicians and other health care professionals are facing as they try to combat misinformation and increase vaccine confidence.
The report, based on a survey of more than 1,500 vaccinated and unvaccinated U.S. adults, found that a substantial number of people either believe or are unsure about several common misconceptions about COVID-19 and the vaccines used to prevent it. This includes statements about the vaccine’s effects on pregnancy and infertility, and statements that the federal government is lying about the number of deaths caused by COVID-19 vaccines and by the disease itself.
“Misinformation is widespread and is a recognized public health crisis,” said Sarah Coles, M.D., chair of the Academy’s Commission on Health of the Public and Science, and an assistant professor in the Department of Family, Community and Preventive Medicine at the University of Arizona College of Medicine – Phoenix Family Medicine Residency.
“Family physicians are key to combating misinformation for our patients and communities,” Coles added. “Misinformation can make it hard for our patients to know what to believe and what not to believe. Fear and questions are appropriate responses to uncertainty. We must listen to concerns with empathy, acknowledge their emotions and experiences, provide accurate information and resources, and be a safe place to ask questions without judgement.”
The survey was conducted Oct. 14-24 among a nationally representative random sample of 1,519 adults ages 18 and older living in the United States. Participants were contacted by phone and asked questions on several COVID-related topics, including vaccination status, COVID-19 vaccine requirements and exemptions, and whether they had any serious health conditions.
In one section of the survey, participants were asked whether they had heard or read about eight common falsehoods concerning COVID-19 and vaccines. These were:
Participants who answered “yes” to hearing about the false statement were then asked whether they thought it was true or false to the best of their knowledge, or whether they were unsure.
Questions on infertility, the ability to get COVID-19 from the vaccine and changes to one’s DNA had been asked in previous surveys conducted earlier in the year.
Overall, 78% of participants had heard at least one of the false statements and either believed they were true or were unsure. Nearly one-third of the participants believed or were unsure about at least half of the false statements.
There appeared to be a strong correlation between individual vaccination status and belief in misinformation. Almost two-thirds of unvaccinated adults (64%) believed or were unsure about at least half of the false statements, compared with 19% of vaccinated adults.
Focusing on specific statements, 38% believed the government is exaggerating the number of COVID-19 deaths, while 22% didn’t know whether the statement was true or false. Another 18% believed the government was intentionally hiding the number of deaths caused by COVID-19 vaccines.
Perhaps the most concerning finding showed that over time, an increasing number of people had heard that COVID-19 vaccines have been shown to cause infertility. In January 2021, only 17% of people taking the survey said that they had heard the statement and either believed it or did not know whether it was true. By April 2021, that number had increased to 21%. By October, 31% of participants had heard that COVID-19 vaccines caused infertility and either believed it or were unsure, and in each survey, the percentage of adults who believed the statement increased.
In addition, 39% of participants had heard that pregnant women should not get the COVID-19 vaccine and either believed the statement or weren’t sure if it was true.
Returning to vaccination status, 72% of adults surveyed reported that they were partially or fully vaccinated against COVID-19, while 27% reported they had not received a vaccine. Of the unvaccinated adults, 75% said they would definitely not get the vaccine, or would get it only if they were required to do so for work, school or other activities.
Finally, the survey asked participants about where they received their information on COVID-19 and how much they trusted those sources. Of all the choices presented, the local TV news station was the only source that people viewed favorably: 47% of respondents said they trusted the local TV news a great deal or fair amount, while 43% did not trust their local station much or at all.
Coles told AAFP News that while she was surprised respondents identified local TV stations as a more trusted media source, she also considered that finding an opportunity.
“This highlights another avenue for family physicians to fight misinformation,” Coles said. “Family physicians can engage with local media to debunk myths and misinformation that are circulating in their community. We can use our knowledge of the specific cultural contexts, perceptions, beliefs, motivations and barriers faced by members of our community to help tailor our message to be most effective.”
Asked whether FPs may need to change the way they communicate with patients, Coles offered a number of recommendations.
“Messaging about COVID-19 should be consistent, accurate and specific to the audience we are addressing,” she said. “We must use person-centered communication to understand and address the concerns of our patients with empathy and compassion to help them overcome hesitancy to accept vaccination.
“Messaging about the dangers of COVID-19 infection and the safety and efficacy of vaccination should be reiterated frequently and without judgment,” she continued. “Though it can be challenging, we need to continue to invite questions and discussions with individuals who are hesitant or have strong belief in misinformation to create a safe space for them to explore their beliefs and build trust.”
Connecting with those individuals who have not yet been vaccinated and seemingly refuse to do so, however, may require slightly different approaches.
“We need to continue to work to improve vaccination rates and help people overcome vaccine hesitancy or refusal,” said Coles. “One strategy to frame the discussion is the SHARE method, which consists of:
“We also need to leverage our relationship with patients as their trusted family physician. We can foster trust by being timely in our messaging, open to discussion, being transparent, acknowledging uncertainty when present, using health literacy communication best practices, and partnering with our patients to address their values and goals. We need to keep our doors open and invite opportunities to readdress this over time.”
Finally, for FPs looking for more information, Coles recommended a recent advisory from Surgeon General Vivek Murthy, M.D., M.B.A. Titled “Confronting Health Information,” the advisory includes a section on how health care professionals and health organizations can combat health-related misinformation, along with advice for other individuals and agencies.
The Academy is continually developing tools and materials for family physicians to fight COVID-19 misinformation and disinformation. In September the AAFP launched Improving Vaccine Confidence, an ongoing comprehensive educational series that includes livestream events, on-demand courses and an online community of practice. The series is free and allows participants to claim CME credits based on their level of participation.
The Improving Vaccine Confidence series is one of several ways the AAFP is confronting false and misleading statements about COVID-19 vaccines head-on. The Academy’s COVID-19 Vaccine webpage contains links to FAQ documents and other resources to help FPs ease patients’ concerns, while a recent AAFP Virtual Town Hall helps members address misinformation.
On the policy side, the Academy has approved recommendations from the CDC’s Advisory Committee on Immunization Practices that allow for the use of the Pfizer-BioNTech COVID-19 vaccine in children ages 5 to 11 years and the use of single booster doses of mRNA COVID-19 vaccine in adults.
And in advocacy, the AAFP in September submitted a letter to the White House requesting that the Biden administration focus its COVID-19 vaccination efforts on primary care practices without making it more difficult for FPs and others to provide patients with the care they need. In addition, the Academy voiced its support for a Sept. 9 joint statement from the American Board of Family Medicine, American Board of Internal Medicine and American Board of Pediatrics calling for potential disciplinary action against physicians who provide misinformation about COVID-19, including vaccination.