Talking to Patients About COVID-19 Vaccines: 5 Do's and Don'ts

Aug. 11, 2021 - Eden McCleskey

Early in 2021, when all anyone was talking about was when they'd be able to get the COVID-19 vaccine, former FDA Commissioner Dr. Scott Gottlieb predicted, "At some point very soon, supply will start exceeding demand. The challenge won't be how to ration a scarce resource, but how to reach patients reluctant to get vaccinated."

Half a year later, we're there. So …. what now?

As previously noted, the Delta variant has made it increasingly clear that a "wait and see" approach to converting the unvaccinated isn't cutting it. Cases have surged again, hospital beds are filling up with COVID-19 patients and people are dying.

Understandably, the freedoms and sense of normalcy we've been enjoying thanks to the vaccines now feel precarious once again.

"As long as COVID-19 is circulating, it's evolving," says Dr. Wesley Long, associate professor of clinical pathology and genomic medicine. "The main concern is that a mutation or set of mutations might develop that will impact the level of protection currently offered by the vaccines."

The concern not only threatens to put words like lockdown back in our vocabulary, but it could also affect treatment options.

"The vaccines we have, and many of the therapies we have, like monoclonal antibodies and convalescent plasma, are based on the body recognizing the spike protein," says Dr. Long. "If we wind up with a variant that has the right combination of mutations in spike, it could potentially impact many of the effective therapies we have right now, as well as the vaccines."

To be fair, that is a worst-case scenario, and, for now, the vaccines still offer strong protection against hospitalization and death from COVID-19.

But given the risks, medical professionals are feeling the pressure and responsibility to engage, educate and develop effective strategies to get more people fully vaccinated.

To that end, we've gathered advice from a variety of experts and sources to help kick-start the discussion and keep it from stalling out before the desired result — vaccination — is achieved.

#1) DO ask the question.

The message from patients is remarkably consistent. The deciding factor for people on the fence about getting a COVID vaccine is whether or not they have discussed it with their doctor. Why? That's who they trust.

Important point: if they are sitting in your office or exam room, they trust you.

The de Beaumont Foundation, which sponsors focus groups on vaccine hesitancy, says health care providers are a key part of the next phase of getting more people vaccinated. "It needs to become a new vital sign," says Brian Castrucci, president of de Beaumont. "What's your height? What's your weight? Do you smoke? Have you been vaccinated against COVID? Every physician, every visit, needs to ask that question."

Dr. Joshua Septimus, primary care internist and medical director of Houston Methodist Primary Care Group Same Day Clinics, says he always starts off by asking, "Have you had the opportunity to get the vaccine?"

If they simply say "No," ask if they have any questions and try to keep it as an open-ended conversation, says Dr. Septimus. If they say "NOPE!" and you can tell they have no interest in discussing it, Dr. Septimus recommends saying, "I understand you are not really interested. I just want you to know that I strongly recommend it, and I think it will be beneficial to you and anyone around you."

Research shows that one-on-one conversations between patients and a trusted health care provider is one of the most effective ways — if not the most effective way — to change someone's opinion about getting the vaccine. Keep at it. Persistence pays.

#2) DON'T assume people know the basics.

"The people who I have the most success in convincing to get the vaccine are the people who have already had COVID," says Dr. Septimus. "Their reason for not wanting to get the vaccine isn't that they're against it; they just mistakenly believe they already have full protection."

Other populations who may not realize that the vaccines are recommended for them include pregnant women and healthy patients under 30. Because many parts of the world are still rationing vaccines and prioritizing distribution by age and risk factors, there's a common perception that's the case in the U.S. too. Simply discussing it with young adults often alleviates their concerns or doubts.

Likewise, for pregnant patients, there has been some mixed messaging about getting the vaccine, because the original trials did not specifically study pregnant women. But now? There are many tens of thousands of pregnant women in the national registry who have safely received the vaccine.

"Our OB-GYNs are strongly recommending to all of their patients that they get vaccinated because pregnancy is in itself a significant risk for COVID," says Dr. Marc Boom, president and CEO of Houston Methodist.

In some populations where there's an element of confusion over whether vaccines are needed or appropriate, opportunities abound to educate and convert unvaccinated patients into vaccinated ones.

It's low hanging fruit that still happens to be out there. Grab it.

#3) DON'T assume it's a job for the PCP.

If you're not a primary care provider, is it appropriate to ask your patients about their vaccine status? Absolutely. Remember, physicians and nurses are the messengers people trust most. Just because you're a dermatologist or a surgeon or a psychiatrist is no reason to miss an opportunity to reinforce the message that patients should get vaccinated.

For all you know, your patient trusts you more than their primary care provider. Or your patient rarely sees his or her primary care provider.

"I think many of our cardiologists, internal medicine specialists, oncologists, etc., are mentioning vaccines to their patients, because they know it's highly relevant to their patient's health," Dr. Septimus says. "Every physician I know spends a significant portion of their time on and off the clock discussing this with people, whether they're your patient or not."

Parents of his children's friends often call him up to discuss issues they've heard about the vaccine. "Just giving them the facts is really helpful," says Dr. Septimus. "A lot of it is just basic education. They just want to hear that their doctor recommends it for their child."

Pediatricians tell parents it can take up to 10-12 exposures to a new food before a child will accept it. Similarly, it may take 10-12 trusted health care providers to ask patients why they aren't vaccinated before they're convinced they need to do it.

It's a numbers game. The important thing is not to pass up an opportunity to get some points on the board.

#4) DO choose your message points wisely.

There are a lot of good messages and data points about the vaccine. Unfortunately, not all of them work equally well. Some that seem like they should be highly effective — talking about how dangerous and deadly COVID-19 is, for example — fall far short of the mark. Paradoxically, the same message framed a little differently — talking about the personal benefits to one's health after receiving the vaccine — gets a lot more mileage than you'd expect.

What gives?

Researchers at the University of Wyoming studying these messages found that political polarization is playing a role and submit that some people respond better to the private benefit message than to the reduction of harm message. It's similar to the different responses pollsters elicit just by rephrasing survey questions about say, gun control.

So what are the talking points that tend to work? Experts cite personal health benefits and the established safety of vaccines.

According to the CDC, the personal health benefits of being fully vaccinated (two weeks after the final dose) include:

  • The freedom to resume pre-pandemic activities.
  • A prevention of serious illness in the small percentage of people who nevertheless contract the virus.
  • A strong boost in protection in people who have recovered from COVID-19.
  • The protection of unvaccinated family members, such as those under age 12 or those with compromised immune systems.

As far as the safety messaging goes, Houston Methodist experts suggest these talking points:

  • "We've given hundreds of millions of doses of these vaccines within the first six months," says Dr. Septimus. "That's an unprecedented amount of early clinical data compared to any vaccine ever developed. And we've seen no safety concerns."
  • "I think it's important to tell people that in the entire history of vaccines, there's never been a side effect that occurred more than two months after the vaccine was administered," says Dr. Long. "People are worried that some unknown side effect will occur 10-15 years down the line, but the truth is, that's never happened."
  • "Over 96% of physicians in the United States are fully vaccinated, with 98% intending to be soon," says Dr. Septimus. "What does that tell you? People who have looked at this data with more knowledge than anyone else are all fully vaccinated. And that means you should be too."

#5) DON'T lose hope.

There is reason to believe the COVID-19 surge caused by the Delta variant is motivating more people to get vaccinated.

"Houston Methodist vaccine clinics administered more than 1,750 first doses and 2,404 total vaccines in one week, both significant increases," says Dr. Rob Phillips, executive vice president and chief physician executive of Houston Methodist. "The daily average of first doses was 600, a 50% increase over the prior week. Our three busiest vaccine locations saw walk-ins increase from 35% to 75%."

In addition to the Delta variant, vaccine mandates covering a large percentage of college students, federal workers, health care workers and private businesses are either in the works or already in effect, and that's having an impact on vaccine demand as well.

Keep your eye on the news and your ear to the ground and you may find that as things change, people will become more amenable to vaccination over time.

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