• Paper Explores Reasons Behind COVID-19 Vaccine Hesitancy

    AAFP Resources Can Help Clinicians Establish Trust, Overcome Barriers

    Aug. 24, 2023, News Staff — For much of the COVID-19 pandemic, certain patient populations have experienced worse clinical outcomes and higher mortality rates.  As a result, although disparities in COVID-19 vaccination and booster rates by race and ethnicity have narrowed (and even reversed) over time, family physicians and other health care professionals remain concerned about vaccine hesitancy.

    A recent BMJ Open paper sheds light on some of the reasons behind this hesitancy. A review of findings indicated that self-described vaccine-hesitant adults in Black and Latinx communities shared similar concerns about safety and efficacy, as well as the effects of structural racism on a community’s risk of infection and vaccine access. The paper’s authors also suggested steps to help clinicians overcome misperceptions and improve vaccine uptake.

    The authors conducted two secure online bulletin boards: one each for Black and Latinx communities. Each community consisted of 30 people who were not categorically opposed to vaccines, but were undecided about whether it was safe to receive a COVID-19 vaccine.

    Researchers asked each participant a series of open-ended questions. After answering, participants could see how others answered the same question and were free to respond to what the rest of the community had posted. Participants were reminded to log back in periodically for possible follow-up questions over three days, with different sets of questions posted each morning and afternoon.

    Comments Reveal Shared Concerns

    The authors categorized responses into five main themes, which they noted “were remarkably similar” among Black and Latinx participants: 

    • safety concerns, including concerns about vaccine ingredients and belief that the vaccines are directly responsible for some deaths;
    • skepticism about vaccine efficacy, based on stories about new variants, breakthrough infections, and people who were already vaccinated against COVID-19 passing the virus on to others;
    • risk versus benefit, with participants suggesting that COVID-19 vaccines are unnecessary, are riskier than the virus itself, or are only for the people most vulnerable to infection;
    • limited trust in institutions such as physicians, public health authorities and the government; and
    • concerns about health outcomes differing by race or ethnicity.

    Story Highlights

    Although participants in both groups acknowledged structural racism as a factor that could influence a community’s risk of infection or ability to access COVID-19 vaccines, they did not cite structural issues as contributing to their own personal risk of infection or their individual decision to be vaccinated. Moreover, the public health benefits often associated with vaccination (such as protecting vulnerable communities or reducing the spread of disease) were not mentioned as motivating factors for receiving the vaccine.

    It should be noted that the bulletin boards were conducted in July 2021, before the FDA gave full approval of COVID-19 vaccines and before COVID-19 booster shots became available. Despite the age of the comments, the study authors said that the results remain important because they “provide insight into important drivers of vaccine hesitancy in Black and Latinx communities” and “may help inform strategies to support future vaccine demand as new health care challenges inevitably arise.”

    Address Individual Concerns, Focus on Community Benefits

    The authors proposed several strategies for improving vaccine uptake, including:

    • using the influence of trusted sources like friends and family members to challenge misconceptions about vaccine safety and efficacy, and to emphasize the personal and communal benefits of vaccination;
    • emphasizing, emphatically and with unambiguous language, both the benefits of vaccination and the risks associated with COVID-19 from a community-level perspective; and
    • leveraging partnerships between public health officials and trusted messengers to reach members of marginalized communities, which could include better access to vaccines and training for primary care clinicians to increase trust among community members.

    “In summary, bulletin boards with COVID-19 vaccine-hesitant people from the Black and Latinx communities revealed that the major factors influencing vaccine hesitancy involve fears of lack of safety and efficacy of the vaccines,” the authors concluded. “Future research will focus on strategies to improve vaccine acceptance that do not rely only on providing facts but account also for the anxieties and fears that motivate vaccine hesitancy.”

    AAFP Resources Offer Guidance

    As COVID-19 hospitalizations and ER visits continue to trend upward, it’s important that clinicians have a variety of tools to support conversations with patients about the vaccines. A good starting point is a recent FPM feature article that offers several tips for effective conversations with vaccine-hesitant patients.

    Family physicians also have access to the AAFP’s educational series on improving vaccine confidence, which features more than a dozen on-demand sessions.

    Other resources include an FPM supplement on COVID-19 vaccines, a collection of fact sheets and patient educational materials on the AAFP’s Immunizations and Vaccines webpage, a familydoctor.org Doctors’ Notes feature on talking with patients about COVID-19 vaccines, and an updated familydoctor.org article on the importance of vaccinations.