By Melinda Young

Many Americans and healthcare workers have doubts and skepticism about the first vaccines for COVID-19, despite the need for a rapid end to the pandemic surge that began to overflow hospitals before the December holidays.

“The truth is that healthcare workers are not immune from vaccine hesitancy,” says Tinglong Dai, PhD, associate professor of operations management and business analytics at Johns Hopkins University Carey Business School in Baltimore. “It’s a phenomenon with real public health impacts.”

In hospitals that have mandated a COVID-19 vaccine for all staff, it is a good idea to communicate to employees why they should be vaccinated, says Amelia Burke-Garcia, PhD, MA, program area director of digital strategy and outreach, public health, NORC at the University of Chicago.

“If you are forcing someone because of their job or role to get a vaccine, and you do not explain why this is important and why everyone in the same position has to be vaccinated, then there’s a risk people will feel they are being pushed between their livelihoods and [concerns],” Burke-Garcia explains.

This approach is unfair and does not recognize the fear, grief, and loss employees have experienced, she adds.

Approaching a mandated vaccination program from a buy-in perspective can empower employees and reduce the risk of people taking a hard line against vaccination and leaving their position over it.

Dai and other healthcare professionals and vaccine researchers offer these suggestions for how leaders can help their staff become receptive to the vaccine:

• Case management administrators can lead the way. “Leaders need to set examples,” Dai says. Vaccinating department or peer leaders in front of staff or showing photos of their vaccination on social media can inspire people: “That’s brilliant messaging,” Dai says. “We’re all social animals, and we learn a lot of things by observing what other people do.”

• Understand vaccine hesitancy nuances. “Vaccine hesitancy is nuanced and has a lot of different roots,” says Kate Strully, PhD, MA, associate professor of sociology at the University at Albany, State University of New York. “It is context-specific. Interventions that are found to be the most effective tend to be multilevel and community-engaged.”

This means the healthcare department takes a distribution plan and comes up with culturally appropriate information and outreach to staff, she says.

“You are understanding people’s concerns and trying to come up with interventions that address those specific concerns,” Strully says.

For instance, some staff may be concerned about new vaccines, especially those that are distributed through an emergency use authorization. They might have heard about historical medical abuses that disproportionately affected Black Americans or other groups, she explains.

Administrators can acknowledge and address these concerns by pointing out these COVID-19 vaccines were given to thousands of volunteers from all age, racial, and cultural backgrounds.

“Generally, there’s a need for plain and transparent information about where things have been sped up [in research] and where they have gone according to normal procedures,” Strully says. “Giving people information allows them to feel informed about the process that has led to the current vaccine, as well as previous vaccines.”

• Know and respect influencers. Researchers found that online influencers can affect people’s attitudes toward vaccines. The study revealed that influential mothers with motherhood blogs can spread antivaccine messages on social media.1

“While some of the influencers felt resistant to outwardly talk about vaccines on their platform, they’d highlight these technologies [used by anti-vax groups],” says Amy E. Leader, DrPH, MPH, associate professor of population science and medical oncology, and associate professor of community integration at Sidney Kimmel Cancer Center, Thomas Jefferson University in Philadelphia. Leader is the first author of the vaccine hesitancy study.

“Anecdotal stories were very powerful,” Leader says. “We noticed that sometimes they would tell a story about vaccination and call it their data.”

If an influencer knew someone who experienced a negative physical reaction to a vaccine, that was enough to turn them against vaccination.

Among the 15 online influencer mothers who participated in the study, not one had a personal, proven, negative experience with vaccines, says Burke-Garcia. “Most heard stories from others, and that was compelling enough to them,” she adds.

The influencers also used the Centers for Disease Control and Prevention database on vaccine injuries to back up their belief of vaccine injury. Those incidences were powerful to them, Leader says.

Case management leaders who understand how influencers come to their beliefs and how influencers can sway others in their beliefs can take actions that ensure staff compliance with vaccination policies, but also obtain their buy-in.

“There are multiple channels from a behavioral change communication perspective,” Burke-Garcia says. “Clearly, there is an enforcement angle you can take with mandates and asking staff to show proof they had their COVID-19 vaccine.”

However, another approach is for leaders to ask influencers and thought leaders among staff to become vaccinated and share the positive aspects of their experience with other employees, she adds.

“I don’t think we can rely on just the effectiveness data around vaccines to compel people to get vaccinated,” Burke-Garcia says. “It’s going to take a number of actors at a number of levels to let people know it’s safe and effective and also good for their community.”

It will involve peer-to-peer work, especially when there are employees who express distrust or vaccine hesitancy, she adds.

• Address fears. “It comes down to crafting key messages,” Burke-Garcia notes.

“I would take a health communication science approach to it, understanding what people’s fears are and crafting messages to address those fears,” she explains. “From a workplace safety perspective, help people understand why certain policies are being implemented.”

Have conversations about their fears. Leaders need to be armed with messaging on why the vaccine is important. They should provide staff with information on efficacy and scientific safety data, but don’t stop there, she adds.

“There is a lot of evidence that just providing data is not enough,” Burke-Garcia says. “Allow people to be heard and give them space to express their emotions and their fears.”

Then, leaders should respond with empathy and explain why the mandate is crucial, based on the population employees work with, she adds.


  1. Leader AE, Burke-Garcia A, Massey PM, et al. Understanding the messages and motivation of vaccine hesitant or refusing social media influencers. Vaccine 2020; Dec 3. S0264-410X(20)31533-4. doi: 10.1016/j.vaccine.2020.11.058 [Online ahead of print].