Aug. 29, 2022, 12:27 p.m. Michael Devitt — For some people, no amount of information or reassurance from their family physician or other health care professional will be enough to convince them to get vaccinated against COVID-19 — but that doesn’t mean FPs should stop trying.
That’s one of the main findings in a recently published study on COVID-19 vaccine hesitancy in one rural primary care setting.
“Family physicians play a critical role in promoting all vaccinations as part of routine health maintenance,” said family physician Richard Terry, D.O., M.B.A., associate dean of academic affairs at Lake Erie College of Osteopathic Medicine in Elmira, N.Y., and the study’s corresponding author.
“In regard to COVID-19, I think all we can do is educate our patients that vaccination will most certainly prevent serious illness due to COVID-19 (and) also inform them that as new COVID vaccines are developed, there will likely be greater specificity for the variants that are circulating.”
In the study, researchers analyzed results from an online survey sent to more than 1,200 patients ages 18 and older who visited a primary care clinic in Elmira, the county seat of Chemung County, a rural section of southwestern New York that borders Pennsylvania.
The survey was conducted in November 2021, roughly a year after the federal government first approved the use of the Pfizer-BioNTech and Moderna vaccines and about three months after (then) Gov. Andrew Cuomo announced a statewide COVID-19 vaccine mandate for all health care workers.
Of 118 respondents, 79% said that they had already received a COVID-19 vaccine; the remaining 21% of people said they were not willing to receive it. When asked to explain why they declined to be vaccinated,
Patients who declined the vaccine also were asked what additional information they would want to help them make the decision to get vaccinated and were told they could select any or all of four response options.
Of those options, “no amount of information will change my mind” was selected most frequently, followed by “long-term safety data,” “more educational material” and “further discussion from a health professional.”
In the study’s discussion section, the authors summarized the difficulties many physicians who practice in rural settings face.
“It is much easier to collect data and educate a population about the benefits of vaccination than it is to sway the conviction of an individual firm in the belief that taking a vaccine violates his basic rights to autonomy and beneficence,” they wrote. “In community settings where these convicted individuals abound, herd immunity becomes less an attainable reality than it is a ‘pipe dream’ of improbability.”
The authors also admitted that the findings left them in some instances with more questions than answers, writing, “… for the remaining two-thirds of patients vehemently committed against vaccination for personal and political reasons, simple education measures may not be enough to change minds. The questions then become, how do we remove the politicalized stigma of the COVID-19 vaccine, and is nonpartisan marketing enough? Where appeals to ethos and pathos have failed, what ultimately motivates the individual to set aside his convictions?”
On average, Chemung County has a lower COVID-19 vaccination rate than the rest of the state. According to the New York State COVID-19 Vaccine Tracker, as of Aug. 26, nearly 92% of the state’s population had received at least one dose of COVID-19 vaccine, and more than 78% had completed their vaccine series.
In comparison, the Chemung County COVID-19 Dashboard indicates that as of Aug. 29, 59.6% of the population had been vaccinated against COVID-19, although the dashboard does not indicate whether that figure was for partial or complete vaccination.
Despite the substantial number of respondents who said they would not get vaccinated against COVID-19, the authors implored clinicians to keep trying to connect with their patients.
Health care professionals, they said, “should broach the subject of vaccination with their patients armed with the most current research and a willingness to appeal to what motivates patients on an individual basis.” They added that although this process “requires more of a grassroots effort than can be accomplished with wide-reaching advertisements on television or social media marketing … it may prove to be a local solution to a local problem.”
“These findings are very important to family physicians in practice because despite what we may think, much of the aversion to vaccination, at least for COVID, was based on the mandate and/or political reasons,” Terry said in an email to AAFP News. “Patients’ refusal to get the vaccine was not based on science; though a minority wanted more information about the vaccine, the vast majority who refused it could not have been convinced with any amount of information.”
Terry added that resistance to COVID-19 vaccination has led some patients to question whether they should get vaccinated against other infectious diseases, such as measles and influenza.
“I am seeing some vaccine hesitancy with other vaccinations and, unfortunately, they use COVID as an example sometimes,” he said.
To address vaccine hesitancy, Terry emphasized the importance of “speaking the science” and sharing data that shows the safety and efficacy of vaccines as effective patient communication strategies.
“As family physicians, we need to educate patients on the value of vaccinations and how they prevent serious illness,” Terry said. “The recent polio outbreak is a direct result of patients being either not vaccinated or undervaccinated. We must remind our patients that vaccines have enabled us to live longer and healthier lives, and the COVID vaccines will likely become routine.”