Vaccine hesitancy seminar primary care february 2021 v2
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Jim McManus is the Director of Public Health for Hertfordshire. The document discusses strategies to address vaccine hesitancy for the COVID-19 vaccine. It defines vaccine hesitancy and outlines approaches for building confidence in the vaccine, including providing accurate information, acknowledging concerns, and promoting peer influence and role models. Barriers to vaccine uptake are addressed at both the organizational and individual level.
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Vaccine hesitancy seminar primary care february 2021 v2
- 1. Public Health Covid Briefings Jim McManus Director of Public Health, Hertfordshire Chair, Behavioural Science and Public Health Network Jim.mcmanus@hertfordshire.gov.uk Strategies to reduce vaccine hesitancy Webinar for Primary Care in Herts 11th February 2021
- 2. Public Health Covid Briefings Jim McManus is Director of Public Health for Hertfordshire, Vice- President of the Association of Directors of Public Health and Chair of the Behavioural Science and Public Health Network Jim is a member of the national Vaccine Deployment Steering Group and of the National Vaccine Equalities Board representing ADPH Jim is a registered Public Health Specialist, a Chartered Psychologist and Chartered Scientist and a Fellow of the British Psychological Society
- 3. Public Health Covid Briefings Where does a Vaccine fit into our strategy? It looks like, for the foreseeable future, Covid isn’t going away. While it does like every virus, mutate, it hasn’t yet evaded vaccines. So we need to articulate a future with covid, for now We also know that while the Vaccine does reduce risk of series illness and death we don’t YET know that it stops transmission, like other vaccines. So a vaccine is a part of our strategy.
- 4. Public Health Covid Briefings Where does a Vaccine fit into our strategy? 2 The key things we have to continue to do for some time are: 1. Reduce the circulation of the virus as much as possible through testing, contact tracing and successful isolation of infected people and close contacts. This will also help reduce the number of new variants 2. Keep on with the prevention measures for a world where the virus will circulate for some time (distance, coverings, hygiene, safe working practices) 3. Roll out the vaccine to as many people as possible
- 5. Public Health Covid Briefings Keep going with prevention & control
- 6. Public Health Covid Briefings Vaccine Hesitancy Defined The SAGE Working Group on Vaccine Hesitancy: "Vaccine hesitancy refers to delay in acceptance or refusal of vaccination despite availability of vaccination services. Vaccine hesitancy is complex and context specific, varying across time, place and vaccines. It is influenced by factors such as complacency, convenience and confidence." Vaccine, 2015 Accept all Refuse all Accept some, delay some, refuse some Accept but unsure Refuse but unsure
- 7. Public Health Covid Briefings What is vaccine hesitancy? Vaccine hesitancy is NOT the same as being anti vaccine It’s often a catch all term for people having questions, or concerns, about a vaccine. These range from safety to religious or ethical concerns and also people who have been misinformed. It is one of the biggest challenges in getting people to take up vaccines. Most people who are hesitant are looking for accurate, trustworthy information that can help them make an informed judgement There is a significant amount of mis-information out there, and most vaccine myths have been repeated for years There are organisational aspects to it as well as individual
- 8. Public Health Covid Briefings 8 Willingness to accept a vaccine falls on a continuum Source: US CDC
- 9. Public Health Covid Briefings Vaccine Hesitancy Review of reasons / types of objections ‒ Safety ‒ Too many vaccines, pain with injections, severe adverse reactions ‒ Necessity ‒ Disease is "natural", VPD are gone/rare/not that severe ‒ Distrust ‒ Vaccines aren't well tested, research inadequate ‒ Societal "norm" ‒ Other children unvaccinated ‒ Religious / personal choice ‒ Right to choose, parent knows what is best, disallowed by religion
- 10. Public Health Covid Briefings Vaccine Hesitancy Tips Acknowledge concerns Remain non-judgmental Be knowledgeable Provide science / evidence-based information Discuss risk / benefit Remind / educate: ‒ Vaccines are extensively studied prior to licensure ‒ Vaccine safety monitoring does not end at licensure
- 11. Public Health Covid Briefings 11 From Hesitancy to Confidence Vaccine confidence is the trust that patients, parents, or providers have in: ‒ Recommended vaccines ‒ Providers who administer vaccines ‒ Processes and policies that lead to vaccine development, licensure, manufacturing, and recommendations for use Source: US CDC
- 12. Public Health Covid Briefings Getting to Confidence We want to go from hesitancy to confidence ‒ Structural Factors ‒ Barriers to Access ‒ How you behave as clinicians ‒ Know the vaccine, Know the facts, Engage ‒ Quality and Trustworthiness of Information ‒ Quality of Information
- 13. Public Health Covid Briefings A National Strategy to Reinforce Confidence in COVID-19 Vaccines 21
- 14. Public Health Covid Briefings 14 A component of the National Strategy to Reinforce Confidence in COVID-19 Vaccines Tactics Engage local and national professional associations, health systems, and healthcare personnel often and early to ensure a clear understanding of the vaccine development and approval process, new vaccine technologies, and the benefits of vaccination. Ensure healthcare systems and medical practices are equipped to create a culture that builds confidence in COVID-19 vaccination. Strengthen the capacity of healthcare professionals to have empathetic vaccine conversations, address myths and common questions, provide tailored vaccine information to patients, and use motivational interviewing techniques when needed. US National Strategy Source: US CDC
- 15. Public Health Covid Briefings 15 Top 6 strategies for building COVID-19 vaccine confidence among healthcare personnel 1. Encourage senior leaders to be vaccine champions. 2. Host discussions where personnel at different levels can provide input and ask questions. 3. Share key messages with staff through emails, breakroom posters, and other channels. 4. Provide information and resources to healthcare teams about COVID-19 vaccines, how they are developed and monitored for safety, and how teams can talk to others about the vaccines. 5. Talk to non-medical staff about the importance of getting vaccinated. 6. Make the decision to get vaccinated visible and celebrate it! Source: US CDC
- 16. Public Health Covid Briefings How do I address Hesitancy? Top Tips 1. Act as a role model – show that you use information only from accurate sources like NHS, science, medical or public health and if you are having the vaccine, say so apologetically and why. Don’t get into allowing people to question your reasons for having the vaccine, they are valid 2. Listen and show you take their questions seriously. That doesn’t mean you have to agree with them. Be open and above all non confrontational. 3. Provide accurate, well trusted sources of information (the purpose of this toolkit) 4. Never repeat or share misinformation, only provide accurate information 5. If you don’t know the answer to a question, say so, and try to find out 6. Peer influence – A well informed peer from the same job role or community can be as powerful if not more powerful than an expert. Personal stories people can identify with are hugely important. 7. Q and A sessions live or virtual with people who really know their facts on local media, radio or social media 8. Promote sharing of accurate information 9. Push Techniques
- 17. Public Health Covid Briefings A framework for driving uptake Organisational Individual Cohort • Accurate registers from which to call people • Understanding issues your cohort may have • People like ME getting vaccine Call • Letter? Phone? Language? Advance information? • Language? Style? Confidence During • Information on hand in right language • Listen and Answer • Push not Pull “It’s time for” Reminder • Systems for reminders across text AND call AND letter • The Personal touch • Push techniques Recall • As per call • Deal with any adverse reactions they’ve had EAST – Easy, Attractive, Social, Timely
- 18. Public Health Covid Briefings Anti-vaxxers and vaccine skeptics These are two very different phenomena. Vaccine skeptics are sceptical of science for a variety of reasons. They may come round. Anti-vaxxers or vaccine denialists are ideologically opposed to vaccines and will quote their understanding of science Unless you really know your science, the best way to respond is not to engage, don’t acknowledge conspiracy theories and stick to the facts and promoting vaccine information. You will rarely win here and there is more to be gained from putting out accurate information. https://theconversation.com/4-ways-to-talk-with-vaccine-skeptics-125142
- 19. Public Health Covid Briefings Thank You! We have a toolkit of messages and images we can use
- 20. Public Health Covid Briefings Appendix 1: More on hesitancy
- 21. Public Health Covid Briefings Where do I learn more? Some good reads https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)30218-1/fulltext Catalogue of hesitancy reduction requirements https://www.ecdc.europa.eu/sites/default/files/documents/Catalogue-interventions-vaccine- hesitancy.pdf https://www.ecdc.europa.eu/en/publications-data/catalogue-interventions-addressing-vaccine- hesitancy https://www.mayoclinicproceedings.org/article/S0025-6196(20)31487-7/pdf https://www.who.int/immunization/sage/meetings/2014/october/3_SAGE_WG_Strategies_addressing _vaccine_hesitancy_2014.pdf
- 22. Public Health Covid Briefings Where do I learn more? Some materials on vaccine hesitancy here Short read https://www.local.gov.uk/our-support/guidance-and-resources/comms-hub- communications-support/covid-19-communications/covid-8 Longer reads ‒ https://www.hertfordshire.gov.uk/services/health-in-herts/professionals/covid-19-behavioural- science-resources.aspx ‒ https://www.ecdc.europa.eu/en/immunisation-vaccines/vaccine-hesitancy A podcast here https://www.bsphn.org.uk/719/Coronavirus-Mini-Series-8---Behavioural-Science-to- Increase-Vaccine-Uptake-Jim-McManus-Wayne-Bateman-Paul-Chadwick A useful video resource here https://www.ama-assn.org/delivering-care/public-health/covid-19- vaccine-hesitancy-10-tips-talking-patients https://www.hcpa.info/guideline/covid-19-vaccinations/
- 23. Public Health Covid Briefings Appendix 2: Some Resources to share with communities
- 24. Public Health Covid Briefings Resources for Sharing A video on what vaccines are (5 mins) https://www.youtube.com/watch?v=rb7TVW77ZCs A video from Nature journal on how they work https://www.youtube.com/watch?v=4SKmAlQtAj8 Celebrating Vaccines – a public web resource from the British Society for Immunology https://www.immunology.org/celebrate-vaccines Throughout this toolkit you will see graphics designed for public use by the British Society for Immunology. Check out their website for regular updates
- 25. Public Health Covid Briefings Faith and Covid The majority of faith leaders from most faiths support people getting the vaccine. Muslim, Catholic and many other official leaders have been particularly prominent here. FaithAction, a multi-faith agency, has a series of blogs and information pages on faith and the vaccine which you can find here ‒ https://www.faithaction.net/blog/2021/01/28/covid-19-vaccine-early- data-hesitancy-and-faith/
- 26. Public Health Covid Briefings British Sign Language Resources SignHealth is a registered Charity and have produced a range of videos in British Sign Language on Covid and the vaccine https://signhealth.org.uk/campaign/covid-19-vaccine-information/
- 27. Public Health Covid Briefings NHS Videos and Leaflets Videos in a range of Languages can be found here https://vimeo.com/user132203718 Government leaflets for older adults in multiple languages can be found here
- 28. Public Health Covid Briefings Easy Read Materials https://www.oxfordhealth.nhs.uk/news/easy-read-resources-on-covid- vaccine/ https://www.mencap.org.uk/advice-and-support/coronavirus-covid- 19/coronavirus-help-stay-safe-and-well https://suffolkordinarylives.co.uk/covid-19-vaccine-information-from- camden-learning-disability-service/ https://www.easyhealth.org.uk/index.php/health-leaflets-and- videos/covid-19/ https://www.keepsafe.org.uk/vaccine-questions
- 29. Public Health Covid Briefings
- 30. Public Health Covid Briefings References Ames HMR, Glenton C, Lewin S. Parents' and caregivers' views and experiences of communication about routine childhood vaccination: a synthesis of qualitative evidence. Cochrane Database of Systematic Reviews, 2017, Issue 2. Art. No. CD011787. doi: 10.1002/14651858.CD011787.pub.2 Bernstein HH, Bocchini JA, Committee on Infectious Diseases. Practical approaches to optimize adolescent immunization. Pediatrics, 2017; 139(3): e1- 13. doi: 10.1542/peds.2016-4187 Centers for Disease Control at cdc.gov de St. Maurice A, Edwards KM, Hackell J. Addressing vaccine hesitancy in clinical practice. Pediatr Ann, 2018; 47(9): e366-e370. doi: 10.3928/19382359- 20180809-01 Delamater PL, Pingali SC, Buttenheim AM, et al. Elimination of nonmedication immunization exemptions in California and school-entry vaccine status. Pediatrics, 2019; 145(6): e20183301. doi: 10.1542/peds.2018-3301 Edwards KM, Hackell JM, Committee on Infectious Diseases. Countering vaccine hesitancy. Pediatrics, 2016; 138(3): e20162146. doi: 10.1542/peds/2016-2146 MacDonald NE, the SAGE Working Group on Vaccine Hesitancy. Vaccine hesitancy: definition, scope and determinants. Vaccine, 2015; 33: 4161-4164. doi: 10.1016/j.vaccine.2015.04.036 Mbaeyi, S.A. Serogroup B meningococcal vaccines booster doses: Work Group interpretation, considerations for policy options, and next steps. (Available at: https://www.cdc.gov/vaccines/acip/meetings/downloads/slides-2019-02/Meningococcal-5-Mbaeyi- 508.pdf. Accessed August 15, 2019)Advisory Committee on Immunization Practices Meeting; February 28, Atlanta, GA; 2019 Nowak GJ, Cacciatore MA. Parents' confidence in recommended childhood vaccinations: extending the assessment, expanding the context. Human Vaccines & Immunotherapeutics, 13(3): 687-700. doi: 10.10802/21645515.2016.1236881 Omar SB, Allen K, Chang DH, et al. Exemptions from mandatory immunization after legally mandated parental counseling. Pediatrics, 2018; 141(1): e20172364. doi: 10.1542/peds.2017-2364
Editor's Notes
- Definition intended to encompass the full continuum of hesitancy that falls between complete acceptance of all vaccines/no doubts and complete refusal of all vaccines – the continuum will start on the end of "accept but unsure" with "accept some, delay, refuse some" in the middle and end at "refuse but unsure"
- In order to curb the pandemic, it is critical to increase demand for a COVID-19 vaccine. This slide shows how the willingness to accept a vaccine falls on a continuum. The vaccine demand continuum illustrates behaviors, whereas confidence is both a feeling and can be acted on. Most people may fall in the middle of this spectrum with a wait-and-see approach. We want to move people toward the right. The closer you get to active demand on the right side of the continuum, the increasing confidence the person likely feels in the vaccine, the vaccinator, and the health system, because they actively chose vaccination. This requires effort. People vote with their feet. If there is sufficient confidence and trust and ability, then people will seek out vaccines, overcoming barriers to do so. People with less confidence or motivation or ability may have trouble overcoming barriers, such as transportation or getting time off work. It’s also important to note that where a person falls on the continuum may depend on whether the person is considering this relative to themselves or others that they care about such as minor child, adult child with disabilities, an older adult parent, etc.
- So how can we address vaccine hesitancy? By building vaccine confidence, which is a multi-faceted concept, based largely on trust. Vaccine confidence is the trust that patients, parents, or providers have in: recommended vaccines; providers who administer vaccines; and processes and policies that lead to vaccine development, licensure, manufacturing, and recommendations for use. A person must have trust in all three of these items to feel fully confident in their decision to get vaccinated. The foundation of trust is critical, and this is something that must be built over time. This is a critical concept to think about when working with patient populations who may have a history of mistrust in the medical establishment or the government. As providers, you obviously have an impact on the second sub-bullet – helping patients to trust you in your role as vaccine administrators. It’s important to note, though, that you can also help build trust in vaccines as well as the processes and policies by helping your patients to understand new vaccine technologies, what to expect in terms of vaccine side effects, and how these vaccines are being continuously monitored for safety. Being honest about what you don’t know is also important for building trust.
- This slide shows CDC’s Vaccinate with Confidence strategy, which aims to build confidence in COVID vaccine, the providers who vaccinate, and the vaccination system. It’s not a communication campaign, but rather a framework for thinking about interventions to increase vaccine confidence. There are three components to the framework. The first aims to build trust by sharing clear, complete, and accurate messages about COVID-19 vaccine in collaboration with federal, state, and local agencies and partners. The second aims to empower healthcare personnel by helping them to feel confident in their own decision to get vaccinated and to recommend vaccination to their patients. This is the element that is most important for our discussion today. The third focuses on how to engage communities in a sustainable, equitable, and inclusive way in order to increase collaboration. This is closely related to the first element about building trust.
- These are some of the tactics that CDC will be using to empower healthcare personnel. Engaging national professional associations, health systems, and healthcare personnel often and early to ensure a clear understanding of the vaccine development and approval process, new vaccine technologies, and the benefits of vaccination. Ensuring healthcare systems and medical practices are equipped to create a culture that builds confidence in COVID-19 vaccination. Strengthening the capacity of healthcare professionals to have empathetic vaccine conversations, address myths and common questions, provide tailored vaccine information to patients, and use motivational interviewing techniques when needed. As an immunization coordinator, you have an important role to play in all three of these tactics. We will talk more about this in the coming slides.
- The idea of building COVID-19 vaccine confidence may seem daunting, but there are concrete steps you can take, as outlined in this slide. Encourage senior leaders to be vaccine champions. Host discussions where personnel at different levels can provide input and ask questions. Share key messages with staff through emails, breakroom posters, and other channels Provide information and resources to healthcare teams about COVID-19 vaccines, how they are developed and monitored for safety, and how teams can talk to others about the vaccines. Talk to non-medical staff about the importance of getting vaccinated. Make the decision to get vaccinated visible and celebrate it! We will go through each of these steps in depth.