Author: Cara Carter, PharmD
As we delve deeper in to flu season, we are reminded of one of the greatest public health advances but also one of the biggest controversies of our time: immunizations. In the aftermath of Andrew Wakefield’s falsified article linking the MMR vaccine to autism as well as the support of the anti-vax movement from celebrities like Jenny McCarthy and Jim Carey, we are seeing a resurgence of diseases once deemed to be eradicated.1 As the winter season sets in and people spend more time indoors, they will be in close quarters with many people whose immunization and infection status may be unknown to them. It is important that we, as healthcare providers, are diligent in protecting our patients and doing our part to help prevent outbreaks. We can be actively involved in this effort by being prepared to mitigate vaccine hesitancy.
Vaccine hesitancy is a delay in acceptance or refusal of vaccines despite availability of vaccination services.2 Though reasons for vaccine hesitancy are many, they fit in to 3 categories: confidence, complacency, and convenience. Confidence is the trust in the effectiveness and safety of vaccines, the system that delivers vaccines, competence of healthcare professionals, and the motives of those who establish policies on necessary vaccines.3 Being honest about vaccine side effects and reassuring parents of their safety can have an impact on confidence. This builds trust in the provider which is also shown to have a positive effect on vaccine compliance.4 In order to be successful in this endeavor, we, as health care providers, must be intentional in remaining current on vaccine information and providing reliable sources of information to patients and families who may be struggling with confidence.
Complacency is the perception that risks of vaccine-preventable diseases are low and vaccines are not a necessary preventative action.3 Honest conversations about acute and chronic complications of vaccine preventable diseases and personal anecdotal evidence are appropriate measures for combatting complacency. Cases of measles have been reported in the state of Missouri just this year with outbreaks also being reported in El Paso, TX; Rockland County, NY; New York City, NY; Los Angeles County, CA; and multiple counties in the state of Washington.5 Anecdotal evidence that includes what the provider would do or has personally done for his or her children and prior experiences with vaccine safety have been shown to be effective according to a survey of primary care physicians in the United States.4
Convenience is the extent to which vaccines are available, affordable, accessible, understood (language and health literacy), and appealing.3 Offering vaccine services at every clinic visit, before hospital discharge, and during prescription pick-up as well as informing patients of community resources such as immunization clinics and free or reduced cost immunization programs are a few ways that we can help overcome the issue of convenience. If additional issues related to convenience arise, such as lack of transportation, consider social work consultation to aid in resolution of the issues.
From physicians to nurses, pharmacists to social workers, we all play a vital role in reducing vaccine hesitancy. Vaccine hesitancy is not an easy issue to combat, and may take more than one visit and assistance from more than one provider to put parents and patients at ease. We should not find this as a point of frustration or discouragement but, rather inspiration to keep growing and learning as practitioners. Did the patient have a question you could not answer? Was an issue brought up that you were unsure how to address? Use those as starting points of a literature search or questions to pose to colleagues for their insight. It is important for us to remember that the goal is to put parents and patients at ease while assuring them that they, too, are a part of the team. Our collective goal as a healthcare team is to do what is in the best interest of the patient because, as American author John C. Maxwell has taught us, “Teamwork makes the dream work.”