Can healthcare providers leverage concerns about a vaccine into an opportunity to regain public trust?
As it relates to the coronavirus (COVID-19) pandemic and its impact on society, the use of “unprecedented” has probably been inaccurately overused. The world has previously experienced pandemics. There have been quarantines to endure, masks to wear, and new vaccinations to be received at various points throughout history.
But if there’s one thing that could truly be defined as unique given the ongoing consequences of today’s pandemic, it would absolutely be the politicized dialogue of seemingly everything associated with the coronavirus, up to and including the newly approved vaccines, says Cassandra Pierre, MD, MPH, an infectious disease physician who serves as the acting hospital epidemiologist and medical director for public health programs at Boston Medical Center.
“There usually is not this much politicization about a vaccine and its evaluation,” said Pierre. “In years past, we could simply say, ‘this is approved by the Food and Drug Administration (FDA).’ They are probably the most rigorous body in the world to evaluate and authorize vaccines, medicines, and medical devices. Their bar is higher than anyone’s. We know that they look at science, the efficacy, and have to be satisfied on a number of levels. But today, they are perceived as being co-opted by some to be convey political messaging.”
Yes, the seemingly endless debate surrounding COVID-19 in the United States has shifted from the believability of its severity and death rate to the validity of its vaccinations that have been developed less than one year since most major restrictions and lockdowns in this country took effect.
From various angles, this is a public trust issue, said Pierre, the likes of which needs to be addressed in the short term but may take years to overcome. What’s more, the lack of trust that the healthcare community is seeing today, specifically when it comes to COVID-19 and vaccination against it, is really the tip of an iceberg solidified in a deep-rooted mistrust among some individuals and populations that needs to be addressed en masse, said Pierre and others who recently spoke with ADVANCE.
Matters of vaccine trust
It’s not completely unheard of that there be at least some trepidation when a new vaccine is released during a pandemic or epidemic. More recently, the ebola virus caused quite a stir when an outbreak occurred in Western Africa from 2013–2016, explains Pierre. “There was a lot of misinformation about how it was spread,” she said. “The target population also had a lower health literacy and lower access to healthcare. “There really was a leap of faith that was being asked of people who may have been participants in a broken healthcare system with the ebola vaccine.”
To a lesser extent, domestically, vaccination for the human papillomavirus (HPV) was met with some controversy due to the need to immunize young girls against a sexually transmitted disease (STD). “That required more of a logistical leap, asking parents to vaccinate their kids for an STD,” Pierre said. “But pediatricians, which is where many vaccines are disseminated from, tend to be trusted ambassadors.”
As such, the outbreaks of polio, measles, and mumps were not met with much dissension regarding the vaccine or the conditions themselves. “I think most people would agree that polio, smallpox, the measles, and the mumps are undesirable—and they rarely lead to death,” Pierre said. “There’s also a lot less rhetoric around these conditions, especially regarding the mistrust of the ambassadors distributing the vaccines. So there’s a collective understanding that we want to prevent these types of infectious diseases and the discomfort they cause.”
The COVID-19 pandemic has not been met with the same widespread grace as these vaccines, however, which Pierre attributes to the social unrest currently being seen first and foremost.
“There’s just a low level of trust right now—in government, in public health, in law enforcement—in authority in general,” she said, “in the institutions that we rely on for trust, integrity, and unbiased investment in the health of citizens. People are afraid that these institutions may be corruptible, when the truth is really that this is the first good news we’ve had in such a long time for so many people.”
Beyond the political cracks that COVID-19 has fallen into, Pierre also believes that hesitancy among some to receive the vaccine is a symptom of deep mistrust specifically toward the medical community and that some patients will question the safety of the vaccines for them in what has become a long line of questions and concerns they have about the delivery of their healthcare.
“Many people have had trust eroded during the pandemic, but many people have had feelings of being marginalized, unheard, disrespected, neglected, and misinformed for many years,” she said. “I think we are still struggling with systemic racism, and coming to terms with this is important because there are individuals who do not have an existing relationship with a physician because they distrust the medical institution as a whole.”
Building trust in healthcare
As Pierre sees it, healing any future mistrust long term will require focus now in the short term. Not all mistrust will be vaccine-related, she says. Something as “basic” as not adhering to blood pressure medication could signal a trust problem, especially in populations of people of color, she said.
Small steps that providers can take to help build public trust can include discussing similar lived experiences they may share with patients, and asking patients why they find it difficult to take their medications or attend office visits as opposed to “challenging” them into adherence. “They may reveal social determinants of health and things that might be lacking in their lives,” Pierre said. “They may also reveal a hesitancy toward medical messaging. But if you can make contact with them, they can be encouraged.”
Pierre also suggests that health systems make more effort to include well-known community activists and celebrities to participate in their healthcare marketing messaging, which has become a focus of the COVID-19 vaccine already.1
“At the same time, for some people, it is not enough to have that type of endorsement or for a provider to say ‘the FDA has approved this,’” she said. “Sometimes the message needs to be ‘I’ve reviewed the source material, and I suggest that you receive the vaccine as your provider.’”
According to Anjali Kataria, chief executive officer of Mytonomy, an organization that seeks to help providers empower patients to actively engage in their health, more healthcare systems are turning to consumer video to offer information without having to go into the office. “I’m talking about real information that a layperson can consume in a way they will understand,” Kataria said. “This creates a better patient experience and a more knowledgeable patient, especially after this pandemic.”
Officials at Mytonomy have developed videos on “COVID-19 Vaccine 101”2,3 information for frontline staff and patients. “We are covering topics such as potential side effects and addressing myths with facts,” Kataria said. “We made these videos free and accessible to the public in addition to providing them to all of our healthcare partners.”
Vaccine next steps
Anna H. Chacon, MD, FAAD, a board-certified dermatologist based in Florida, believes vaccines will remain a controversial topic in our society. “Why some individuals choose to not vaccinate is complex, but appears to be driven by a lack of confidence, safety concerns, and concerns about side effects,” she said.
Chacon encourages providers to consider themselves as role models. “I was vaccinated when the vaccine arrived in our state,” she said. “I have informed many of my patients and have answered their questions regarding the vaccine as best as I can. I think once they start seeing that their healthcare providers and people close to them have had it and have not had many issues with it, they will gain confidence in receiving it. I think most would prefer the small sting of a needle than to have the COVID-19 swab test, which was very uncomfortable.”
Patients should also be reminded that some 70,000 people were willing to participate in the COVID-19 trials, that there was a bit of a head start to developing these vaccines, and that many drug manufacturers worked diligently to be part of the discovery, said Pierre. “When you already have the genetic sequence of a target that you’re looking for, in this case the spike protein for covid,4 it does not take that long to make a vaccine. So we know quite a bit about safety and efficacy already. But there’s no way that we can know all of the data right now.”
Education should continue, but differences of opinions will very likely continue to exist, she adds.
“Different cultures will have different beliefs about medicine,” Pierre said. “Some cultures have a strong history of paternalism and others will take whatever is recommended. It’s understandable for anyone to be skeptical. But we need to ask people to put their faith in the translation of the science and the translation of the need for a public health benefit. We’re asking for people to trust the interpretation of the data—to trust those who they turn to for medical information, if you’re not relying on general mainstream media. That much we also know.”
- Bushnell H. Could athlete vaccinations help america beat the pandemic? Yahoo Sports. 2020. Accessed online: https://sports.yahoo.com/could-athlete-vaccinations-help-america-beat-the-pandemic-031053025.html
- Fact check: answers to covid-19 vaccine questions. Mytonomy. 2020. Accessed online: https://vimeo.com/493800603/1e4055c5f6
- Why healthcare personnel and hospital staff should get the covid-19 vaccine. Mytonomy. 2020. Accessed online: https://vimeo.com/493794856/6099a53f25
- Trafton A. Explained: why rna vaccines for covid-19 raced to the front of the pack. MIT News. 2020. Accessed online: https://news.mit.edu/2020/rna-vaccines-explained-covid-19-1211