Vaccine Champion Training Course, Module 3, Be a Vaccine Champion, Immunization Challenges and Vaccine Hesitancy. The American College of Occupational and Environmental Medicine Vaccine Initiative is supported by the Centers for Disease Control and Prevention of the U.S. Department of Health and Human Services as part of a financial assistance award to the Council of Medical Specialty Societies with 100% funded by CDC and HHS. The contents are those of the authors and do not necessarily represent the official views of nor endorsement by CDC, HHS, or the U.S. government. Hello, my name is Arthur Sanchez and I'm a nurse informaticist and nurse practitioner at UC San Diego Health. I have a background in occupational medicine and health informatics. As part of this project, I am collaborating with the American College of Occupational and Environmental Medicine to develop these educational modules to help you become a vaccine champion. In the past 24 months, I have not had any financial relationships with any ineligible companies. In this module, we will describe vaccine hesitancy, its prevalence, and the characteristics of patient groups that are likely to have hesitancy. We will detail the challenges of vaccinations in occupational health settings. We will discuss disparities and bias in immunizations. We will review commonly reported reasons for vaccine hesitancy. We will evaluate interventions and strategies that effectively improve vaccine hesitancy. And we will describe the roles and responsibilities of a vaccine champion. At the end of this module, you will be able to describe vaccine hesitancy, its prevalence, and the characteristics of patient groups that are likely to have hesitancy. Understand the challenges of vaccinations in occupational health settings. Describe interventions and strategies that effectively improve vaccine hesitancy. And encourage others to be a vaccine champion. What is vaccine hesitancy? Vaccine hesitancy refers to a delay in acceptance or refusal of vaccines despite the availability of vaccination services. Prevalence of vaccine hesitancy varies by country, region, vaccine type, and population demographics. Some factors that affect prevalence include cultural beliefs and distrust of healthcare systems, age and education levels, and socioeconomic status. For example, in lower income countries, hesitancy is often related to lack of vaccine access and misinformation. This map illustrates hesitancy to the COVID-19 vaccine based on geographical location. It is based on data published by the CDC using the United States Census Bureau's Household Pulse Survey. During the data collection period between May 26, 2021 and June 7, 2021, those surveyed were asked if once a vaccine to prevent COVID-19 is available to you, would you get a vaccine? Responses were categorized as strongly hesitant, hesitant, and hesitant or unsure. Please note the regional variability. One of the factors that can affect vaccine hesitancy is whether the vaccine is new or established. A person that is hesitant may think about how fast the vaccines were developed, whether or not sufficient testing was conducted, and is there greater fear and uncertainty surrounding safety, efficacy, and long-term side effects of newer vaccines? It's important to note that all of these questions and concerns are valid. What are some of the characteristics of a vaccine-hesitant person? Individuals of lower socioeconomic status might be associated with higher rates of vaccine hesitancy. Individuals that believe in conspiracy theories. Individuals with mistrust in institutions. Those that have had prior negative experiences. People who live in rural areas. Younger persons. Individuals with less education. And women making decisions for their children. The occupational medicine setting presents some unique challenges that you should be aware of. Some of these challenges include workers with varied beliefs and backgrounds. Different language barriers. Different perceived risks of exposure. Workers of different ages and vulnerabilities. Misinformation and distrust. Workers that are exposed to different workplace policies. For example, those that have mandatory vaccination requirements versus voluntary. Workers with access issues, especially those that work night shifts or irregular hours. Workers that are concerned with time off work due to side effects. And workers that are overloaded with information. When considering hesitancy, you must consider your own hesitancy as a healthcare professional. Healthcare professional vaccine hesitancy can be grouped into three influence domains as represented by this graphic. The first is the contextual influence domain. Examples of these influences are the media, current political landscape, and historical influences. The second is the individual and social group influence domain. Examples of these influences include experiences with past vaccination, cost concerns, beliefs, attitudes, and motivation about health and prevention. The third domain is vaccine and vaccination specific issues. Influences in this domain could be related to training and information, scientifically based risks versus benefit, questions about effectiveness of a vaccine, and concerns about the introduction of a new vaccine or formulation. We as healthcare providers play a critical role in shaping vaccine confidence and uptake. However, our biases, whether positive or negative, can influence patient decisions. Examples of positive influences include strong pro-vaccine recommendations, empathy, and trust building. Examples of negative influences include skepticism or neutrality towards vaccines, implicit bias, use of overly scientific language, and time constraints. In this slide, we will review different types of bias. The first type of bias we'll look at is negativity bias. This is where more trust is given to negative information than positive information. An example of this might be focusing more on rare adverse events than overwhelming positive benefits. Authority bias is where more weight is given to the opinion of persons in authoritative positions. An example of this might be a physician giving anti-vaccination information which could influence persons to not be vaccinated. Optimism bias. This is a propensity to view a health issue with optimism. An example of this might be, I'm healthy, it's just the flu, my body will fight it off on its own. The final type of bias is appeal to nature bias. This is suggesting something is good because it's natural and bad because it's not. An example of this might be placing higher value on innate immunity versus artificially induced immunity. Why does bias matter? Bias is important because it affects thoughts, behavior, and decision-making abilities. It can cause some to avoid information that is upsetting or challenging. It can cause some to see correlations with ideas or concepts that are not real. And bias can make it hard to communicate. The SAGE 2014 workgroup divided patient reasons for vaccine hesitancy into three specific influence domains. These are the same domains we reviewed earlier, however, these are from the patient perspective, not the healthcare provider perspective. Examples of contextual influences include communication in the media environment, influential leaders, anti- or pro-vaccine lobbies, cultural beliefs, and politics. Examples of individual and group influences include perceived risk versus benefit, health system and provider trust, past personal experiences, and social norms. Examples of vaccine and vaccination-specific issue influences include risk versus benefit, and this is from the scientific perspective, introduction of a new vaccine, strength of recommendations or knowledge base, and costs. The 5C model of vaccine hesitancy is a framework used to understand why individuals may be hesitant to receive vaccines. It identifies five key psychological and behavioral drivers that influence vaccine decision-making. The first is confidence. Do we trust the safety, effectiveness, and necessity of vaccines? Do we trust healthcare providers and public health authorities? Hesitancy may arise from fear of side effects, misinformation, or lack of trust in pharmaceutical companies or government agencies. The second is complacency. Perception that vaccine-preventable diseases are not a serious threat. Some people believe they are not at risk or that natural immunity is better than vaccination. This is common in societies with low disease prevalence due to successful vaccination programs. The third is convenience. Accessibility of vaccines which includes location, cost, and availability. Ease of access, which could be related to difficulties getting appointments or long wait times. How much time and effort is required to get vaccinated? Examples of solutions include workplace vaccination programs, mobile clinics, and walk-in appointments. Calculation. These are individuals who engage in deliberate risk-benefit analysis before deciding to vaccinate. They may seek information from multiple sources, including scientific studies, social media, and personal networks. If misinformation dominates their sources, they may overestimate risks or underestimate benefits. Number five is collective responsibility. What is the willingness to protect others through herd immunity? Some may refuse to vaccinate if they believe others are already vaccinated, reducing the perceived necessity. Understanding these five factors helps healthcare professionals tailor interventions to address specific concerns. What are some strategies that can help improve vaccine hesitancy? Before we discuss these individual strategies, it's important to note that no single strategy works best. One such strategy is power of the story. This is where somebody shares their experience with vaccination or hesitancy to vaccinate with others. Social media, mass vaccination campaigns, and vaccine mandates, all of these can be helpful to improve vaccine hesitancy, but again, no single strategy works best. When discussing vaccine hesitancy with your patients, it's important to remember that communication is key. Access to healthcare workers increases presence and develops trust. Remember to respect and understand patient autonomy and show empathy to help reduce bias. Remember communication is key. The following are some actions you can take at your clinical encounters to help decrease hesitancy and increase vaccine uptake. The first action is to recommend needed vaccines at every clinical encounter. Tailor message based on vaccines that the patient needs, their eligibility, risk factors, and willingness to get more than one vaccine at a time. Use a presumptive approach. Providing vaccines at the current visit is key. Vaccine uptake drops when patients are referred. Communicate why we vaccinate. Tailor message by discussing patient-specific risk factors for severe disease as well as other family circumstances that make it important for them to get vaccinated. Communicate the unpredictability of respiratory viruses. Most viruses circulating in the community and the risk of bacterial co-infections. Keep it simple. Focus on one vaccine at a time during your discussion. Another tool that might be helpful is called the share method. Share the reasons why the vaccination is right for the patient. Highlight positive experiences with vaccination. Address patient questions and concerns in plain language. Explain to patients that vaccines help protect them and their loved ones. Explain the potential cost of getting sick. For example, time away from work, missed family obligations, extra visits to the doctor. How can we handle misinformation? Understand the source and context of the misinformation. Build trust with your patients. Use clear and accurate communication. Address misinformation directly. Research social media and other digital platforms. Foster critical thinking. What is vaccine fatigue? Vaccine fatigue is people's inertia or inaction towards vaccine information or instruction due to perceived burden and burnout. What causes vaccine fatigue? Exhaustion from repeated campaigns, overexposure to vaccine messaging, conflicting information, and inconvenience. What are some things we can do to combat vaccine fatigue? We can tailor our messaging. We can reduce barriers to access by offering vaccines in convenient locations and at convenient times. Rebuild trust and promote vaccination. Promote positive narratives. Reduce overexposure by avoiding constant reminders and lengthy explanations. What are the roles and responsibilities of a vaccine champion? As a vaccine champion, you should promote and advocate for vaccination. You should set an example, get vaccinated, and share your positive experiences. Educate and counter misinformation. Know your audience and tailor your messaging accordingly. Build trust by engaging in dialogue, promoting transparency, and using your expertise and status. Increase vaccination accessibility, support pro-vaccine policies, and engage with policymakers. Here are some key takeaways from this module. Vaccine hesitancy refers to the delay in acceptance and varies per region. There are various challenges occupational medicine providers encounter while educating about immunizations. Bias can affect healthcare providers as well. The SHARE method can provide strategies to improve educating patients on immunizations. Vaccine fatigue has created inaction towards vaccine information. And finally, occupational medicine healthcare providers should become vaccine champions.

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immunization challenges

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