Tinfoil hats begone! Seven tips for reaching those open-minded, but hesitant patients.
It’s the conversation doctors in lockdown are having all day, every day: “Have you been vaccinated yet?”
The answers are varied but there are patterns emerging. And in the maze of unknowns around covid, doctors and nurses are finding ways to navigate the vaccination conversation.
Three doctors in Sydney and Melbourne and a nurse working near a region known for its anti-vaccination stance provided their insights into patient concerns about the vaccine and how to address them.
What are the main concerns?
Vaccine development has been rushed
“Some people don’t want the vaccines because they’ve got this idea that it’s all been rushed and it’s experimental,” said Dr Sabina Ciciriello, rheumatologist in Mildura and interim head of unit at Royal Melbourne Hospital.
“I try to convey that while it has been a fast development process, there have been studies done with this vaccine that haven’t been done with vaccines we’ve had for years. I tell them that millions and millions and millions of people have had these vaccines and that if there were any real problems, other than these very rare side effects, we would know about it by now.”
Side effects might affect work, pre-existing conditions and medications
Dr Andrew Jordan, rheumatologist at BJC Health Parramatta, said most concerns were just practical matters.
“Patients ask, ‘Will it impact my disease?’ or ‘Is it safe with my meds and immune system?’.
“To be honest, we can deal with these concerns easily. I advise them that the vaccines have been given to many people with their disease around the world with no problems.
“The guidelines are all up on the ARA website,” he said. “We’ve sent that to all our patients but most people still want to check with their doctor about their individual situation.”
Dr Queenie Luu is a staff specialist rheumatologist at Canterbury Hospital in south-west Sydney. She said that if people ever express concern about having to miss work if they had a side effect to vaccination, she would advise them to let their manager know that they had a date for vaccination so the manager could support them.
“Managers are a little bit more understanding now about taking a day off if staff have reactions,” she said.
The Pfizer fan club
Dr Jordan said many patients were not against vaccination. “They just want Pfizer and they can’t get it,” he said. “The main thing about why they’re not getting vaccinated is they’re scared of AstraZeneca.”
Dr Jordan serves a community comprising largely non-English-speaking backgrounds.
“A big problem was the messaging and the language from the government around the decision making with AstraZeneca,” he said. “People think ‘The government keeps changing its mind’. That’s what they hear and then decide ‘I don’t want AZ’,” he said.
“And the government has been using medical language people don’t understand, regardless of if you speak English or not.”
Extreme anti-vaxxer theories
All of the practitioners experienced a brick wall when broaching conversations with the small number of patients who were true anti-vaxxers.
“Some, very few, are into conspiracy theories they see on social media,” said Dr Jordan. “I ask them if they’re vaccinated and they’ll always get a bit cagey about it. They keep getting fed that information on social media and it’s a positive feedback loop. You can’t often change their minds.”
Dr Ciciriello said: “All I can do with them is keep the conversation open. I say ‘we’ll keep taking about it at your next appointments. As more info comes in maybe you’ll feel more comfortable about it’.”
But despite the small number of resolute anti-vaxxers, most patients did want to discuss vaccination. Here’s the winning advice from our specialists on the front-line:
Top tips to swing the vaccine conversation
Normalise vaccination
Dr Jordan had patients whose whole extended family had not been vaccinated.
“You just normalise the situation,” he said. “I tell them that I have had AstraZeneca, both myself and my wife. The patient goes, ‘Oh, the doctor had it! OK’. I also tell them that all my staff here are vaccinated as well.”
Dr Luu tells patients “the community is getting vaccinated together”. She recommended asking the patient if they could think of friends or family who had been vaccinated and were OK.
“I tell them I’ve been vaccinated, and all the practice staff have been vaccinated,” she said.
Shift the risk
“As soon as people start to talk about the risks of vaccination, I shift the conversation to the risks of covid and the benefits of vaccination,” Dr Ciciriello said.
“Rather than focusing on the vaccine’s rare side effects, I shift the discussion to how effective vaccines are at keeping you out of hospital and keeping you from getting covid.”
Linda Bradbury, a rheumatology nurse practitioner at Gold Coast University Hospital, said it made a difference to look at their family circumstances.
“I saw a chap a couple of months ago and he was a ‘no’ to vaccination,” she said. “I had a bit of a chat with him and discovered his wife had end-stage lung disease. He came back a couple of weeks ago and changed his mind as he didn’t want to put her at risk.”
Do the maths
Dr Jordan has the impression that patients generally couldn’t critically analyse information and risks.
“They hear a lot of information in the media,” he said. “They might hear, ‘There’s a one in 100,000 risk of a clot’ but what they really hear is ‘AstraZeneca causes problems, don’t take it’.”
Ms Bradbury said she looked for risk statistics about side effects that are relatable for the patient.
“I give them easy statistics they can understand,” she said. “I use the incidence of blood clots with smoking or contraceptive pill and then compare it to the covid vaccine risk. Try to find something relatable. Telling a 50-year-old bloke about oral contraceptive pill risk probably won’t work.”
The devil is in the details
“They often come with a specific concern,” said Dr Ciciriello, “so I ask them what it is that they’re worried about and then respond with information – getting a sense of what they know first, and going from there. For some people it’s a family history of clotting. Some people have read funny stuff in the media. Some people are very well informed and some people are very confused.”
Remove barriers to access
“A lot of regional patients are having difficulty getting access to vaccines,” said Dr Ciciriello. “I tell them to keep trying, to keep going on the portal every week because clinics are getting hammered and the Pfizer availability is always changing.
“I also encourage them to speak to their GP as sometimes GPs might know of local clinics that have vaccines. I also say to try the 1800 number. Sometimes if a patient can speak to someone, they find a local clinic that hasn’t been listed yet.”
Clarify health information and cultural barriers
Dr Luu speaks five languages and serves a community of people from non-English-speaking backgrounds. She said that “just because someone can speak a language doesn’t mean they know how to read it”.
She said. “People sometimes need help booking a vaccination. I make sure a family member knows how to do that.”
Dr Luu distinguished the layers of complexity in communicating health information.
“One aspect is the language, the other is the culture,” she said. “Some people also have a community belief or fear. It can help if they speak to someone of their language or of a similar culture. Sometimes that might be their GP. Consultations take a bit more time with these people, who just need support, especially as information has changed over time and getting that translated has not always been easy.”
Myth-bust social media
Linda Bradbury reckons she’s heard it all. “One day every single patient had a different reason,” she said. “Conspiracy theory, the 5G business, that they’d be injected with lung tissue from an aborted fetus, ‘it’s only an experimental drug so I’m not doing it’, ‘covid is not real’. And you get this over and over and over.”
She recalled a conversation with one patient who said, “Oh, I’m not going to have a covid vaccine because it’s going to kill me.”
Ms Bradbury replied: “Well, I’m not sure that’s the case. Let’s unpick that. What makes you think that?”
The patient said: “Oh, well I saw on YouTube the head of the drug company that makes the vaccine saying he’d withdraw it now because it’s so bad and everyone’s going to die.”
Ms Bradbury then provided a bit of digital literacy coaching explaining how YouTube worked.
Dr Jordan has also had to de-bunk a few social media vaccination myths. “The patient will say ‘Oh it can cause seizures’ and I’ll say ‘Oh really? I hadn’t heard that.’ I’ll then ask a few questions to find out that it’s supposed to have happened somewhere in the world and been posted on Facebook and it’s been shared around,” he said.
Despite the frustrations of lockdown, the practitioners we interviewed said they still had the vaccination conversation every day and with every patient. And amid the urgency of vaccination and challenges of telehealth, Dr Jordan is rather philosophical about it all.
“Social psychological factors play into how people make health decisions,” he said. “I find the whole thing quite fascinating.”
