Vaccines Q & A

Q&A: People Hesitant To Receive Vaccines Need Empathy From Medical Providers

Among the 41% of U.S. citizens who told researchers last year that they would not receive a COVID-19 vaccine as soon as it was available, African Americans were the least willing. A history of formal medical exploitation and decades of institutional and cultural racism have entrenched that mistrust and fear, according to research co-authored by Rupali Limaye, Director for Behavioral and Implementation Science at the Johns Hopkins International Vaccine Access Center.

Rupali Limaye, Director of Behavioral and Implementation Science
March 12, 2021

What are the traditional reasons why people distrust vaccines?

Before COVID-19 there were four drivers for vaccine hesitancy:

  • The first has been concern about vaccine ingredients.
  • The second centers on questions about the schedules recommended for giving multiple vaccines to babies.
  • The third concern was risk perception – people didn’t feel they were susceptible to the disease that the vaccine is meant to prevent or they didn’t think the disease was severe enough to warrant getting a vaccine. They would say things like, ‘What’s the big deal with measles?’ Yet most people have never seen measles.
  • And the last one is the misperception about a link between vaccines and autism, which has been soundly refuted.

What new reasons have emerged for mistrust related to the COVID-19 vaccines?

We are dealing with a lot of hesitancy among communities of color specifically related to COVID-19 vaccines. With COVID-19 we have seen two new drivers.

The first is the concern that the U.S. response and vaccine development process was politicized. Whether or not that is true, there is still a perception of politicization. Many believe everything about the vaccines is being done for political gain.

The second driver of hesitancy is what we see whenever there is a new product on the market. It’s a reluctance driven by the expedited process used to develop the vaccines. People want to wait and see how others react to it before deciding to get it. Not only are the COVID-19 vaccines new products but their development was expedited. That’s a huge issue in why people say they don’t trust it.

In addition, many do not trust the health care system. Many do not trust their doctors. Many do not trust pharmaceutical companies.

And so all of these reasons come together to lead people to say they don’t want to get the COVID vaccine.

How can mistrust of vaccines be overcome?

As part of my work I’ve been going to eight different African Methodist Episcopal (AME) churches in Baltimore to serve as the resource for people who have questions about the vaccines.

The number one question I get is: Are the vaccines safe for Black people?

I explain how the clinical trial development process and recruitment works and how it was very different this time around with COVID-19, in that far more minorities were recruited to participate.

I also explain just how critical this issue is because communities of color have been disproportionately affected by COVID-19, meaning they’re more likely to have severe cases and are more likely to die from it. It’s even more paramount that these populations get the vaccines.

Many also ask how many African Americans participated in the vaccine trials. How many African Americans who were in the trials have comorbidities like diabetes and high blood pressure, so that they can truly trust the claims of the efficacy and safety.

What can medical personnel do to overcome vaccine hesitancy with patients?

There are several approaches that public health and medical professionals can use to increase vaccinations. We saw these work in a randomized controlled trial that sought to increase maternal immunizations.

The first is to take a more culturally tailored approach such as matching patients with medical personnel who are the same gender and race.

The second is to provide a shared decision-making process by using empathy to gain trust as opposed to a very biomedical model with doctors saying, ‘This is what you need to do, now do it.’ Instead, medical personnel need to really listen to the concerns of patients who have read a lot about vaccines on the internet and be empathetic with those concerns.

The third is to use what we call ‘nudges’ or ‘presumptive communications.’ Rather than asking parents whether they want to schedule a necessary vaccination for their child during a visit, change that conversation slightly by telling them their child is due for a measles shot and we’re getting it ready for them right now. That makes it the norm. That makes it the default that you would automatically accept vaccination. We tested that and found that it was really helpful.

Do other nations experience vaccine hesitancy among their citizens?

I serve as the principal investigator on large grants that are mainly overseas in India, Afghanistan, and sub-Saharan Africa. They’re all related to vaccine decision-making and hesitancy.

The United States has a much longer history of vaccine hesitancy.

But we are seeing it emerge more and more overseas, in sub-Saharan Africa and lower-to-middle-income countries. Part of that is fueled by misinformation that is communicated through social media. I’ve been studying that extensively over the last year.

What can social media companies do to help combat misinformation?

I received a follow-on to my grant to look at what social media approaches could be used to reduce vaccine hesitancy by minimizing people sharing misinformation about vaccines.

I’ve been advising Facebook pro bono on its policies related to misinformation, related to how they label posts that could be untrue. We are working to help them be as vigilant as possible to make sure they are taking down misinformation that could lead people down the wrong path. One tactic Facebook uses is to display a pop-up when you’re about to share something that could contain misinformation. Essentially when you hit share some Facebook algorithm flags the information and deploys a pop-up that says something like, ‘It looks like you’re going to share something that might not be true; please go here to double check.’ And they’ll include a link to the CDC or the World Health Organization. People can still share it. But at least Facebook is flagging this for them.

We are also testing how we can get influencers in different countries to identify misinformation but also to reject it so they’re not sharing it.

Rupali Limaye, Director of Behavioral and Implementation Science

Rupali Limaye, PhD, MPH, is Director of Behavioral and Implementation Science at the International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health