The Vaccine Blog
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The Vaccine Blog
youmevaccines@gmail.com
What People Aren`t Saying About Vaccine Hesitancy, and why people really view vaccines dubiously
Disclaimer: Please note I am not a medical professional and am not an authority on the issue, I am expressing my own opinions in this article. This is not a substitute for medical advice. For accurate scientific information about vaccines, please visit the WHO website.
You look at your child in the physician`s waiting room. They`ve been up all night again. You got no sleep, and also have a work deadline to manage. Raising a child is a huge emotional burden, and healthcare decisions can be particularly emotionally charged. So scientific education, although vital, is not the only predictor of vaccine acceptance. Or indeed other healthcare interventions. So, what are the other factors, and how can we address them to increase vaccination rates specifically? In this article, I`d like to explore why this isn`t just an important issue to address, it`s an urgent one. The first thing to do is explore the background of vaccine hesitancy, the limitations of our current approaches towards it, and what are the challenges of vaccination?
Consider the term "hesitant". It`s a distinct word from "anti", which implies a very polarized negative view of an issue. The WHO website captures this complexity in their definition of vaccine hesitancy as a "delay in acceptance or refusal of safe vaccines despite availability of vaccination services". It is important to note that "acceptance" or "refusal" can be selective. According to a 2015 paper by Noni E. McDonald, and the SAGE Working Group on Vaccine Hesitancy, a minority may accept or delay some vaccines, but are unsure about the decision. Therefore, like personality traits, vaccine hesitancy is present in varying degrees among people. It is therefore represented as a continuum, ranging from completely resisting all vaccines, to hesitant, to completely accepting all vaccines.
I have a background in Microbiology, and it's true that the scientific/medical community can be guilty of classifying anyone questioning vaccines as "anti-vaxxers", dismissing them, and invalidating their concerns. They are stigmatized as uneducated, scientifically illiterate, and stubborn. I know I have been guilty of this at times. However, these people are not unidimensional. They don't all view vaccines and traditional healthcare dubiously for the same reasons. They are scientists, educators, and scholars. They can be found in all sectors, and in all echelons of society. Not having intellect or curiosity is not true for most vaccine-hesitant patients.
In what is perhaps the most hurtful stigma of all, they are seen as callous and uncaring. They are accused of demonstrating a lack of empathy towards others. Of neglecting their children`s, family`s, and even their own health. However, the most common reason for parents approaching vaccination dubiously is that they are worried about their child's and family`s health. In fact, the reason that people are vaccine hesitant is because they want to make the best decision for their child`s and family`s health. People are vaccine hesitant because they care about the health of their families so much. Arbitrary information and statistics are unlikely to help here. All this shows that the cliché of the ignorant “antivaxxer” is not the reality of people who approach vaccinating dubiously.
Therefore, it is time to stop presenting this cliched idea of them in media, comedy, and promoting this damaging rhetoric. It is time we change our approach to discussions with vaccine-hesitant people, and those unsure about any medication or medical procedure.It`s crucial that we start demonstrating an understanding of the set of issues linked with low vaccination rates.
However, why is this important? Further, what are the challenges of vaccination? Vaccines have such a large-scale impact on people`s lives, and indeed during the COVID-19 pandemic we experienced life without just one vaccine. People lost jobs, and businesses closed permanently. We were isolated and lonely; couldn't communicate in-person with our friends and other support networks. Family members may have become ill, and even possibly hospitalized. Other loved ones passed away. Although sounding dire, these can be the consequences of making decisions related to vaccination. Lack of a vaccine can impact every aspect of everyone`s life. If we don`t communicate about the hesitancy issue, this scenario is likely to keep repeating itself in future pandemics. Many people will likely continue to view vaccines and other public health measures somewhat dubiously. It will therefore impact the health of not just this generation, but the health and wellbeing of future generations. During climate, political or economic crises trust erosion also fuels conspiracy theories. Therefore, re-establishing trust between the public and government and other authorities will also impact other sectors of society.
This should help in demonstrating that vaccine hesitancy is not solely about vaccines. There are a variety of reasons for vaccine hesitancy
Complacency, convenience, and confidence are cited by the World Health Organization website as key reasons for vaccine hesitancy. Of course, these are valid. Time off work, cost, and access to transportation may be an issue. This is particularly true for those in more isolated rural areas, and those who are elderly and/or disabled, and cannot access health services. This can lead to a domino effect in that lack of access to healthcare services can prevent access to accurate information. What these communities remain with is internet resources to rely on, with no way of demonstrating the accuracy of any piece of information. Other communities do not even have the internet to rely on. Scientific papers often use inaccessible language, , further demonstrating why some people approach discussions around vaccines more dubiously.
These pragmatic challenges are valid and are key to address.
However, the reasons for vaccine hesitancy are also quite diverse. It is also about people, their cultures, identities, and value systems. These factors can make the decision to vaccinate very emotionally charged, and can make it difficult to communicate about difficult issues like this. If someone has grown up in a community where natural medicine was a heavy part of their culture, they will be reluctant to accept anything that might conflict with that. If the social group that a person engages with every day is hesitant about vaccines, they will probably develop a perception that makes them see traditional medicine dubiously. If a family member has had an adverse reaction to a vaccine in the past, that can make the decision particularly complicated. This problem is worse if they have had bad experiences with doctors or other healthcare professionals. Like any relationship, if someone feels they have been mistreated repeatedly, mistrust will grow, making it more difficult to communicate Scale that up to the level of millions, and this helps with demonstrating why a large proportion of people approach vaccinating dubiously.
This can also cause stigma against certain vaccines. During my undergraduate degree, I wrote an essay on HPV vaccination. There is controversy around the vaccine in that it would make girls promiscuous, and irresponsible around their sexual health, a claim not supported by numerous studies.
My personal theory for this is that if someone is considering getting the vaccine to protect them against contracting HPV, they are likely careful about sexual health anyway. Why invest time, energy and resources into getting a vaccination against an STD, if sexual health is not a priority? In this case, however, the underlying issue was that human papillomaviruses are a sexually transmitted disease, and people feel vulnerable when they try to communicate about sexual health. So perhaps normalizing dialogue around sexual health could be one factor in addressing this issue. This is particularly an issue in developing nations and among certain religious groups. In other words, the information people were receiving isn`t always the problem. It is often the stigma and cultural context in which people are receiving it. This is a critical point.
If we are to look in the past, science was always politicized. It doesn't exist in a vacuum, so to speak. Think of why the first caveman discovered fire. They cooked food, and possibly scared off predators. It served the interests of the group, demonstrating that we need to stop detaching science from politics, law, and sociology. Society defines what areas of science are most relevant, and resources are directed into it. Again, there is a pattern. Scientific research addresses the most important interests of society at the time.
Lack of control is also among the reasons for vaccine hesitancy. People may emphasize the importance of demonstrating their sense of freedom.. Few things frustrate people more than lacking control over their lives. Some people are pro-vaccination, but view vaccine mandates more dubiously. This is an important distinction to make, as it distinguishes those who are against the vaccine formulation itself from those who feel that their freedom is restricted. This is highly relevant. Approaches to conversations with them should differ hugely. As the underlying cause of the issue is different, the solution should be different.
Therefore, there are many reasons for vaccine hesitancy, or why people approach vaccines dubiously. It also sheds light on why it is difficult for many people to communicate about the topic. The factors in people's lives making them vaccine hesitant can differ between people demonstrating that it is not always logical to group all vaccine hesitant individuals together, or to try to make comparisons between them. An important part of addressing the issue is addressing concerns on an individual basis, and tailoring the approach to each person accordingly. This requires the ability to relate to a variety of people. This means considering their situation in an objective way to prevent emotional involvement. Remember, frustration at individual doctors, scientists, or vaccine advocates is often frustration at institutions they represent. It is rarely personal. This is key in regulating your emotions when engaging with people.
So how do you communicate with someone who sees vaccinating dubiously? In my experience, what you give is what you get. Meaning, if you make a point of demonstrating empathy and understanding to people, they respond in kind. They will be more receptive to hearing new ideas and facts, and this principle is generally true of people. Being genuinely empathetic can really open doors, in terms of the quality of relationships you can form. It`s vital to have genuine curiosity about their perspective and experience, as opposed to wanting to jump to spreading your information and sharing your perspective. This allows you to connect with people with diverse experiences and backgrounds, no matter where in the world you are. Empathy is a universal language. In my opinion, it is an underutilized skill in our current culture, which can be individualistic. It is for these reasons that it is so applicable to this topic, because vaccines affect the lives of everyone you see. When you do this, people can be vulnerable with you, and are comfortable discussing sensitive issues. It validates them. This is absolutely key in establishing positive long-term relationships. I believe that this is a principle that could be applied between vaccine hesitant groups and scientific/medical, and governmental authorities. This is easily achieved with our hyper-connected society. It simply requires a willingness to shift perspective on both sides. If we can use our technology to divide, we can use it to unify.
However, it's not always vaccines themselves, but how we communicate about them, that can be the issue. This principle can also be applied when trying to communicate about any difficult issue. Using language that affirms their concerns rather than criticizes them is key, and also letting them know that you understand their perspective “I know what you mean…etc”, shows a genuine desire to understand. Now people are receptive to hearing information. In some cases, they may be open to scheduling an appointment with their healthcare provider to discuss vaccines, whether they do or don't accept the vaccine. Even in the case where they do not engage with the information at the time, it plants the seed for them to think about it more. They may still see vaccines dubiously at first, but on further thought may spread provaccine information to others in their community. Never underestimate the potential for large-scale effects from small acts of empathy. The butterfly effect also applies to human behaviour. In fact, this process can be accelerated with the rapid transmission of data, information, and ideas online.
Sharing your own experience can also engage people in a conversation. This is particularly true if you focus on emotive language by explaining how much relief it gave your family to finally be vaccinated. Also, if a member of your family is immunocompromised or at high-risk of contracting disease, mentioning them can be helpful. The reason for this is that it makes the risk of disease and the benefits of vaccination relatable and relevant to them in a context everyone understands. Family. The same can also apply to explaining how many people in your local community or school got vaccinated, or are planning to. Both of these approaches resonate with people much more deeply than facts and statistics - this may make them see the topic less dubiously. It also helps with demonstrating that you are making an effort to understand their point of view.
People are also much more comfortable discussing sensitive topics when they feel integrated into a community. This can be achieved by engaging with their cultural background. Engaging with religious leaders, and culturally sensitive messaging have all been successful in increasing vaccination rates for this reason. In addition, including members of a hesitant community in discussion panels, and campaign brochures are also ways of demonstrating cultural sensitivity. People need to hear voices they can relate to. Cultural sensitivity is a hugely under-addressed aspect of the issue. However, I believe it is a vital element of any successful vaccination campaign, regardless of where in the world it is used.
Also, giving people a sense of control over healthcare-related decisions will be important in helping them approach these decisions less dubiously. Few things frustrate people more than lack of control. However, there are ways to address reasons for vaccine hesitancy related to control. Motivational interviewing involves asking the person questions that prime them to think about how their behavior will affect their future. It involves guidance-based communication, rather than authoritarian-steering by physicians and scientists. Therefore, this patient-driven approach addresses the freedom element of the issue.
This is a serious issue that impacts the health our ourselves, families, communities and countries. Unfortunately, it will continue if we do not address the problem. It is a psychological, and by extension, a social issue. Understanding social dynamics around vaccine discussion is critical. This does not mean we reject scientific facts. There is not a debate around whether ot ot vaccines are effective - they are. There is a discussion to be had around people`s perceptions of vaccines and why some approach vaccinating dubiously. It simply means an acceptance of the fact that there are diverse reasons for vaccine hesitancy. It means asking good questions like “what are the challenges of vaccination?” It also means addressing their cultural background, past experiences, and validating their concerns. Even language use and communication style play a key role in how we interact with vaccine hesitant patients. Of course, we can't always control other people's reactions to it. There are absolutely a proportion of people who are dogmatic and have attitudes that may never shift. Some always have and always will view traditional healthcare as a whole dubiously - and so will see vaccines dubiously as an extension of that.
However, spreading stigma and shame that are so common against these groups is unlikely to be a way forward. Divisiveness between pro and anti-vaccine groups will never solve the issue of vaccine hesitancy. You cannot reach a common goal (i.e. high vaccine uptake rates) by dividing people. So, we have to stop taking this dogmatic attitude towards our groups. It will only create more division.
We cannot get a different result using the same approach. I am confident this will be key to addressing the hesitancy issue, not creating more division between "pro-vax" and "anti-vax" groups. This is a trust issue. An empathy issue. A very human issue, as opposed to a scientific one.
Copyright @Irish Medical Times 2023
