EXECUTIVE SUMMARY

As the COVID-19 vaccine was rolled out in the United States, many healthcare workers refused vaccination. Reproductive healthcare centers will need to obtain staff buy-in as they begin a vaccination program.

  • Some people may not want to be vaccinated until more people receive it.
  • Other people hold strong antivaccination feelings and distrust.
  • One method to gain vaccine acceptance is to present it as something healthcare workers should do to protect patients and their older family members.

New COVID-19 vaccines offer great hope for healthcare facilities in 2021. But, the next challenge is obtaining employees’ and patients’ buy-in to become vaccinated.

According to early reports, many healthcare workers refused the first doses of the vaccine. A survey revealed that half of hospital and public officials on the frontlines of the pandemic were refusing the vaccine. The governor of Ohio said that 60% of nursing home staff turned down the shot.1

Every family planning and healthcare leader should know that vaccine hesitancy or reluctance varies.

“We know there are four to five reasons why individuals are reluctant,” says Ken Resnicow, PhD, Irwin M. Rosenstock collegiate professor of health behavior and health education at the University of Michigan School of Public Health.

For some groups, there might be a sense of not wanting to be the first people vaccinated, Resnicow says.

“The thought might be, ‘We want to wait and let other people go first,’” he explains. “It’s not that this group is anti-vax; they’re just anti-first.”

Another group might hold hardcore feelings against vaccines, related to their distrust of the pharmaceutical industry and distrust of all vaccines. “That group might be more difficult,” he adds.

For people who have received other vaccines and do not necessarily subscribe to the anti-vaccine movement’s philosophy that all vaccines pose health threats, a good tactic to ease them over to vaccine acceptance is to affirm their concerns.

For example, when someone points out that the vaccine was developed quickly and has not completed Phase III clinical trials, the leader could say, “Yes, the first two coronavirus vaccines were developed in record time, mostly because of work scientists started more than a decade ago when earlier coronaviruses and similar viruses caused outbreaks and epidemics in some parts of the world.”

The key is not to argue or offer a counterargument to everything the vaccine skeptic says, Resnicow says. “Instead, agree as much as you can. If they say it was done fast, then say, ‘You’re right.’”

Use motivational interviewing, in which the leader rolls with resistance. “Just agree, don’t argue, and that will soften the resistance,” he adds. “Agree that years of abuse on studies happened to Black Americans. Some agreeing can be helpful in interpersonal communications.”

Another tactic is to offer staff a parameterized choice, similar to what parents will offer their children. For instance, instead of telling staff that they must receive the vaccine on a specific day or week, the leader can offer them the choice of taking the vaccine on a specific week or scheduling their shot for a month later.

“We do this with kids: ‘You can have fast food once a week; you can go to McDonald’s or to Burger King, but you can’t go to both,’” Resnicow explains. “With the vaccine, it might be powerful to say, ‘If you choose not to go first, we’ll hold your place for you,’ although that could be difficult.”

Leaders also can repeat the person’s concern, offering affirmation without fully agreeing with everything the person says, Resnicow says. For instance, the leader could say, “You’re worried about getting COVID-19 from the vaccine. We hear that a lot.”

Resnicow and the University of Michigan’s work with Yale School of Public Health and the University of Southern California Norman Lear Center uncovered findings about COVID-19 deniers, as well as people who could be moved into the vaccine acceptance bucket. Their work focused on obtaining compliance with mask-wearing and vaccination.

“Our team believes the way to handle this is to make the motive outside of self,” Resnicow says. “It’s not about protecting yourself — it’s about protecting the vulnerable in your life.”

What sticks with people who are hesitant and resistant is the message that they should do this for their grandma. “You can say, ‘You’re right; you’re invulnerable, and the pharma company is blah, blah, blah, but do it for grandma,’” he explains.

The message to staff also can be this: “We need healthcare workers to get vaccinated because they cannot help people if they get sick.”

But providers and leaders should be prepared for some small number of staff that will refuse the vaccine. “There is a percentage we can’t move, but we want to make that percentage as small as possible, which is something we do in smoking cessation research,” Resnicow explains. “There are some people we won’t persuade, but some others can be brought along by early adopters, social norms, and pressure.”

There also is value in giving staff a forum where they can ask questions. This could be a virtual town hall, he suggests.

“Have a person skilled in communication field the questions and describe the rationale for the vaccine schedule,” Resnicow says. “Giving people a forum to hear your reasons, and then time to question them, can do more good than harm.”

Another tactic is to market vaccination as a bundle that includes vaccination, mask-wearing, hand hygiene, and social distancing. “In Australia, they had a very successful skin cancer campaign, called Slip-Slop-Slap, which people saw as a bundle,” he says. People knew the words were a shortcut for slipping on long-sleeved clothing, slopping on sunscreen, and slapping on a hat.

Since there is a realistic fear that people will stop wearing masks once they become vaccinated, the bundled marketing message could reinforce the importance for staff and patients to continue to wear masks and stay distant, even after they receive the vaccine.

If a facility decides to mandate COVID-19 vaccination because of the risks to staff, there is another message the family planning director can impart to staff. “If you want to be here in the trenches, your being vaccinated and having immunity to the virus is going to make you a better healthcare provider, and it will allow you to keep working,” Resnicow says.

REFERENCE

  1. Beer T. Large numbers of health care and frontline workers are refusing COVID-19 vaccine. Forbes. Jan. 3, 2021. https://www.forbes.com/sites/tommybeer/2021/01/02/large-numbers-of-health-care-and-frontline-workers-are-refusing-covid-19-vaccine/?sh=40733de3c962