Are you struggling to have effective conversations about COVID-19 vaccines with your patients? There may be a better approach than simply telling a patient to get the shot—especially when that can be at times uncomfortable or contentious. And strategies like lecturing and shaming not only aren’t effective, they often backfire.1
Instead, create conversations based on the trusted relationships you’ve built with patients to educate and motivate them to get vaccinated. As COVID-19 cases have risen dramatically and the vast majority of people dying today from COVID-19 are unvaccinated,2 these conversations are crucial.
4 tips to help build patient COVID-19 vaccine acceptance
Since patients depend on you—and your entire staff—to provide nonjudgmental health guidance, use these strategies to have conversations that sensitively address their COVID-19 vaccine concerns and also reflect the views of health experts.
1. Provide a clear, direct recommendation to each patient
Talk to your patients about how the vaccine can reduce health risks for them and their families. Some people may not be motivated by the idea that vaccines protect the larger community.
“We recommend that you get the COVID-19 vaccine, especially because your [condition] puts you at a higher risk for severe illness from COVID-19. What questions or concerns do you have?”
“We recommend that your child gets the COVID-19 vaccine. It will help keep your child safe, especially now that they’re going back to school. What questions or concerns do you have?”
A specific vaccine directive makes it clear that you recommend a vaccine for them or their child—and will make it more likely that they’ll follow through.
2. Use positive language to normalize vaccines and highlight benefits
Use positive messaging related to uptake and prevention of diseases—they’re more effective than negative messages of non-uptake or rates of disease. Using language that normalizes the vaccine may encourage patients to get it if they know many of your other patients are getting it.
“Vaccines protect you from severe illness and death. Very few COVID-19-related hospitalizations and deaths in the U.S. are from vaccinated people, and many of those hospitalized who are vaccinated never have to go on a ventilator.3”
Emphasize positive benefits associated with the vaccine—such as the primary benefit of avoiding sickness, along with potentially reducing limitations on work, travel, and other events.
3. Make it easy, convenient, and reassuring to get vaccinated
Even with a goal of COVID-19 vaccine equity, social, geographic, political, economic, and environmental factors can create challenges to vaccination access and acceptance. Communities of color have been disproportionately affected by the pandemic, and history shows Black adults have more concerns about the COVID-19 vaccine compared to their White counterparts.4 This may be due to people of color having been underrepresented in clinical trials in the past however, there have been efforts to increase racial diversity within trials associated with the development of the COVID-19 vaccines.4
Ask your patients what’s personally challenging for them when it comes to getting vaccinated, and offer convenient options so they’re more inclined to do so.
“Where do you live or work? Let’s see which vaccination sites are closest to you.”
“We have vaccines right here. I can give you the first dose now and the second dose during a follow-up visit. (Or: “We have the Johnson & Johnson (J&J) vaccine here, it only requires one dose.”)
Addressing logistical barriers such as transportation, child care, being homebound, time constraints, and even financial barriers—all COVID-19 vaccines are free—can improve patient vaccination rates.
4. Address COVID-19 vaccine misconceptions nonjudgmentally with health literate facts
Even when you provide patients with accurate information about the vaccine, some studies have shown that doing so unsolicited can have the opposite intended effect—causing people to tune out. The key for discussing vaccination with patients is to do so in an honest, objective manner. Ask open-ended questions to identify concerns and then listen and share your expertise about the concerns, one at a time, keeping in mind that it’s important to explain things in a way that your patient can understand.
“Have you considered getting a COVID-19 vaccination?”
“What questions do you have about the COVID-19 vaccination?”
“What are your hesitations about getting vaccinated?”
“It sounds like you have some concerns about the vaccine. Can I share some things that may be helpful to you?”
Validating fears with empathy and compassion may help people open up and has the potential to change some minds.
Here are some common COVID-19 misconceptions and facts you can use to address them.
Development of the mRNA vaccine seemed so rushed
While the development of messenger ribonucleic acid (mRNA) vaccines may seem fast to the public, researchers have worked with them for many years. The COVID-19 vaccines went through a rigorous clinical trials process with thousands of diverse volunteer participants to make sure the vaccines are safe. Significant and timely funding allowed the vaccines to be manufactured in large numbers while trials were in process—unlike vaccines not typically mass produced until later in the vaccine development process—so that many doses of vaccine could be available as soon as the US Food and Drug Administration (FDA) gave emergency use authorization (EUA).5
Different from traditional vaccines, mRNA vaccines don’t expose people to any real virus. Instead, they’re made with mRNA, a molecule that gives instructions to the cell on how to make different kinds of protein.
These molecules are a natural part of our cells. They’re made more easily and safely in a lab than a vaccine that uses a virus and, because of this, can also be made faster. Additionally, this type of vaccine has been studied in people before for rabies, Zika, and flu.6
The vaccine changes your DNA
A COVID-19 mRNA vaccine is injected into a muscle in the upper arm. Muscle cells take the mRNA instructions in the vaccine and make a harmless piece of a protein called a spike protein—found on the outside of the SARS-CoV-2 virus that causes COVID-19. The muscle cells then destroy the instructions for how to make the spike protein. The mRNA never goes into the nucleus of the cells where DNA is stored.6
The newly made spike protein sits on the surface of the muscle cells. The immune system senses the spike protein as a foreign threat to destroy. It starts making antibodies to fight anything with that spike protein on it. This helps the body’s immune system recognize and fight the real virus if it shows up.6
Share this easy-to-understand video with patients to explain how the mRNA vaccines work.
The vaccines are still considered experimental
The FDA granted full approval to the Pfizer/BioNTech COVID-19 vaccine for people age 16 and older on August 23.7 The vaccine also continues to be available under EUA for people 12 through 15 years of age and for the administration of a third dose in certain immunocompromised people.7 This is the first coronavirus vaccine approved by the FDA.
All COVID-19 mRNA vaccines have passed many tests in labs and in thousands of people. They meet strict standards from the FDA for being administered under EUA because they’re an effective, safe tool to urgently combat the deadly pandemic. The FDA uses EUA as a means to quickly give people access to potentially lifesaving medicines during a national crisis. Somehow, emergency use has been confused with experimental. While it may seem like it took a long time to start obtaining full FDA approval, the COVID-19 vaccines have actually been fast-tracked.
The vaccines can cause dangerous side effects
Many are concerned about some of the more serious side effects and adverse events that have been reported after COVID-19 vaccination. These include:
- Anaphylaxis after COVID-19 vaccination has occurred in approximately two to five people per million vaccinated in the U.S. These reactions can occur after any vaccination. Patients receiving a vaccine should wait at the vaccination site for at least 15 minutes, longer for those with a history of allergic reactions, in case a reaction occurs and treatment is needed.8
- Thrombosis with thrombocytopenia syndrome (TTS) after Johnson & Johnson’s Janssen (J&J) COVID-19 vaccination has been reported in 39 people with more than 13 million doses of vaccine given in the U.S. as of August 6, 2021. Women younger than age 50 should be aware of side effects to watch for in case this rare adverse event occurs. If this is a concern, recommend the Pfizer or Moderna vaccines.8
- Reports of Guillain-Barré Syndrome (GBS) in people who’ve received the J&J COVID-19 vaccine are being monitored by the CDC and FDA. While most fully recover from GBS, some suffered permanent nerve damage. As of August 6, 2021, only 0.00001% of J&J vaccine recipients have reported identification of GBS. These cases have largely been reported mostly in men 50 years and older about two weeks after vaccination.8
- Reports (1,253) of myocarditis and pericarditis among people ages 30 and younger who received a COVID-19 vaccine have been received by the Vaccine Adverse Event Reporting System (VAERS). Most cases have been reported after Pfizer or Moderna vaccinations, particularly in male adolescents and young adults. The CDC and FDA have confirmed 762 reports of myocarditis or pericarditis through follow-up, including medical record reviews.8
Millions of people have gotten the COVID-19 vaccines safely, but it's important to have these discussions with your patients. The CDC and FDA are continually monitoring the safety of the vaccines.
Long-term side effects of the vaccine are unknown
Since COVID-19 vaccines are new, some people wonder about long-term side effects. Evidence is strong that these vaccines won’t cause long-term harm. The history of vaccines shows that delayed effects following vaccination can occur but, when they do, they tend to happen within six weeks of receiving a vaccine dose. This is why the FDA required each of the authorized COVID-19 vaccines to be studied for at least two months after the final dose.9
Breakthrough infections mean vaccines aren’t working properly
A breakthrough case means that a vaccinated person has tested positive for COVID-19. It doesn’t necessarily mean that they will become symptomatic or that they will give the infection to someone else. Most vaccinated people who get COVID-19 are asymptomatic or only have mild illness.10 It’s rare that a vaccinated person is hospitalized or dies due to COVID-19.
People who’ve already had COVID don’t need a vaccine
Health experts say that even people who’ve recovered from COVID-19 should get vaccinated. A recent study shows that unvaccinated people are more than twice as likely to be reinfected with COVID-19 than those who were fully vaccinated after initially contracting the virus.11 The CDC adds that people who had COVID-19 previously get better, broader protection when they’re vaccinated.12
Young, healthy people don’t need a vaccine
Not getting vaccinated puts even a young, healthy person at a higher risk of severe COVID-19. Health experts are still learning why COVID-19 causes severe illness in some people. We can’t predict whether exposure will lead to a mild or serious case.13
COVID-19 is starting to impact patients who are younger and fitter. At the start of the 2021, the disease mostly affected older adults—with people aged 65 and older making up 53% of COVID-19-related hospitalizations and people ages 18 to 49 making up 20.5%.14 With the emergence of the Delta variant, those numbers have changed, indicating that younger patients are being hospitalized for COVID-19. As of August 2, 2021, people 65 and older make up 26% of COVID-19-related hospitalizations and people 18 to 49 make up 41%.14
The vaccine may affect future or current pregnancy
It’s understandable that people are cautious during their childbearing years. The CDC recommends COVID-19 vaccination for people who are pregnant, planning to be pregnant in the future, and breastfeeding.15 The American College of Obstetricians and Gynecologists agrees that COVID-19 vaccines are safe before, during, and after pregnancy.16
A rumor related to COVID-19 vaccines incorrectly warns that the vaccines prompt the body to make a protein that can harm the development of the placenta. This is a dangerous rumor because unvaccinated pregnant people run a higher risk of severe illness and pregnancy complications from COVID-19 illness, including possible preterm birth and pregnancy loss.17 But vaccination rates are low among pregnant people, with only about 22% having received at least one dose.16 Although pregnant people weren’t included in studies that led to the EUA of COVID-19 vaccines, many pregnant people have since been vaccinated safely. COVID-19 vaccines given to pregnant people may also offer some protection to newborns.15
References
1 Gagneur A and Tamerius K. Your friend doesn’t want the vaccine. What do you say? The New York Times. May 20, 2021. https://www.nytimes.com/interactive/2021/05/20/opinion/covid-19-vaccine-chatbot.html. Accessed August 10, 2021.
2 Johnson C and Stobbe M. Nearly all COVId deaths in U.S. are now among unvaccinated. AP Web site. https://apnews.com/article/coronavirus-pandemic-health-941fcf43d9731c76c16e7354f5d5e187. June 29, 2021. Accessed August 17, 2021.
3 Gamble M and Masson G. 7 ways this COVID-19 surge is different. Becker’s Hospital Review Web site. https://www.beckershospitalreview.com/hospital-management-administration/7-ways-this-covid-19-surge-is-different.html?origin=QualityE&utm_source=QualityE&utm_medium=email&utm_content=newsletter&oly_enc_id=9207J7402278F9N. August 3, 2021. Accessed August 12, 2021.
4 Artiga S, Kates J, Michaud J, Hill L. Racial diversity within COVID-19 vaccine clinical trials: key questions and answers. https://www.kff.org/racial-equity-and-health-policy/issue-brief/racial-diversity-within-covid-19-vaccine-clinical-trials-key-questions-and-answers. January 26, 2021. Accessed August 17, 2021.
5 Developing COVID-19 vaccines. CDC Web site. https://www.cdc.gov/
6 Understanding mRNA COVID-19 vaccines. CDC Web site. https://www.cdc.gov/
7 FDA Approves First COVID-19 Vaccine. U.S. Food and Drug Administration Web site. https://www.fda.gov/news-events/press-announcements/fda-approves-first-covid-19-vaccine. Updated August 23, 2021. Accessed August 23, 2021.
8 Selected adverse events reported after COVID-19 vaccination. CDC Web site. https://www.cdc.gov/coronavirus/2019-ncov/vaccines/safety/adverse-events.html. August 2, 2021. Accessed August 10, 2021.
9 Safety of COVID-19 vaccines. CDC Web site. https://www.cdc.gov/coronavirus/2019-ncov/vaccines/safety/safety-of-vaccines.html. August 12, 2021. Accessed August 17, 2021.
10 Willingham E. 'Breakthrough infections do not mean COVID vaccines are failing. Scientific American Web site. https://www.scientificamerican.com/article/breakthrough-infections-do-not-mean-covid-vaccines-are-failing. August 4, 2021. Accessed August 12, 2021.
11 Cavanaugh A, Spicer K, Thoroughman D, Glick C, Winter K. Reduced risk of reinfection with SARS-CoV-2 after COVID-19 vaccination—Kentucky, May–June 2021. https://www.cdc.gov/mmwr/volumes/70/wr/mm7032e1.html. August 6, 2021. Accessed August 17, 2021.
12 New CDC study: Vaccination offers higher protection than previous COVID-19 infection [media release]. August 6, 2021. https://www.cdc.gov/media/releases/2021/s0806-vaccination-protection.html. Accessed August 12, 2021.
13 I’m a healthy, young person. Why should I get a COVID vaccine? Johns Hopkins Bloomberg School of Public Health Web site. https://www.jhsph.edu/covid-19/articles/im-a-healthy-young-person-why-should-i-get-a-covid-vaccine.html. July 21, 2021. Accessed August 10, 2021.
14 Masson G. Americans under 50 make up 41% of COVID-19 hospitalizations. Becker’s Hospital Review. https://www.beckershospitalreview.com/patient-safety-outcomes/americans-under-50-make-up-41-of-covid-19-hospitalizations.html. August 4, 2021. Accessed August 17, 2021.
15 COVID-19 vaccines while pregnant or breastfeeding. CDC Web site. https://www.cdc.gov/
16 ACOG and SMFM recommend COVID-19 vaccination for pregnant individuals. ACOG Web site.https://www.acog.org/news/news-releases/2021/07/acog-smfm-recommend-covid-19-vaccination-for-pregnant-individuals. July 30, 2021. Accessed August 17, 2021.
17 Pregnant and recently pregnant people at increased risk for severe illness from COVID-19. CDC Web site. https://www.cdc.gov/
