This blog post highlighting Episodes 64, 65, 69, 70, 73 of the Epidemic podcast is sponsored by RubiconMD.
“Every generation has generated its own anti-vaccinationism,” says Jonathan Berman, Assistant Professor of Basic Sciences at the New York Institute of Technology’s College of Osteopathic Medicine, and author of “Anti-vaxxers: How to Challenge a Misinformed Movement.” As Berman explains, hesitation around vaccines is as old as vaccination itself. As early as the 19th century, during smallpox outbreaks in England, widespread movements against inoculation were fueled by concerns similar to those expressed today.
Although vaccine science has transformed since the 1800s, concerns around immunization have lingered. Yet vaccines are critical to diminishing COVID’s threat. So in order to buoy confidence in vaccines, medical professionals and public-health advocates are raising awareness about vaccine safety and efficacy, and trying to allay concerns in culturally sensitive ways.
What are the origins of vaccine hesitancy?
In the late 18th and 19th centuries, smallpox was one of the world’s most feared diseases, killing about one-third of those infected. Eventually, Dr. Edward Jenner discovered that inoculating people with pus from cowpox sores conferred immunity to smallpox. In the 1850s, when England was suffering from repeated smallpox outbreaks, the government made Jenner’s vaccine mandatory — triggering widespread vaccine hesitancy and resistance.
While some of those concerns are now irrelevant — some people feared that being inoculated with cow pus would give them bovine traits; others dreaded the invasive lancet-based technique of inoculation — many other concerns reverberate today. Some opposed what they saw as government overreach into health decisions, or considered the vaccines dangerous — views that have resurfaced in current conversations. Others objected to the smallpox vaccine on the basis of religion, and saw medicine itself as a meddlesome practice. Nadja Durbach, a history professor at the University of Utah, describes in Season 1 Episode 64 of EPIDEMIC this notion of vaccines “polluting” the body.
How can I effectively listen to people who have expressed concerns about vaccines?
Heather Simpson grew up receiving all the routinely scheduled childhood vaccines; until she was pregnant, she did not think twice about immunizations. Then, she saw an ad for a video about vaccines and children. After watching the nine-hour film — which blamed various disabilities and diseases on vaccines –– Simpson became a vocal member of the anti-vaccination movement.
In Season 1 Episode 65 of EPIDEMIC, Simpson explains how she came into her opposition to vaccinations — and how she eventually became pro-vaccination once again. For Simpson, conversations with a friend of hers — a nurse — changed her mind. Simpson’s friend confided that she “had the opposite fear: She didn’t want to take her son out until he was vaccinated.”
As their conversation continued, Simpson recalls, “I was defensive at first.” But eventually, the nurse explained that she shared Simpson’s trepidation — that, in fact, many parents dread vaccination appointments. “She talked me through each one of my fears,” says Simpson. “Slowly — I mean, it took two years. That, sometimes, is what it takes.”
Simpson’s friend’s capacity to listen — to take the necessary time to hear and process Simpson’s concerns, and to normalize and defuse her worry — made all the difference in changing Simpson’s views.
Dr. Anna Loge, a practicing general internist in the small city of Dillon, Montana, reinforces the importance of listening. Loge discusses her pandemic experience serving a rural community in Season 1 Episode 70 of EPIDEMIC. She has spoken to community members for hours on end about COVID vaccinations, and while she has not changed the mind of every person she’s met, she has reached a lot of them. “I really have gotten to a point where the best way to have the conversation is… one-on-one,” Loge says.
Both Simpson and Loge — a patient and a doctor who’ve spent time on opposite sides of COVID conversations — suggest that careful, compassionate listening has the potential to ease concerns about getting vaccinated.
What are effective communication strategies I can use when speaking with those who are hesitant about vaccines?
In Season 1 Episode 73 of EPIDEMIC, Gounder spoke with former New Jersey Governor Chris Christie and with Brian Castrucci, president and CEO of the de Beaumont Foundation — a public-health think tank — about a focus group they hosted in hopes of boosting vaccine confidence among people who’d voted for former President Donald Trump.
The group consisted of 19 people who weren’t confident in the COVID vaccines, who identified as conservative Republicans, and who voted for Trump in 2020. Towards the beginning of the discussion, the conversation stalled. Castrucci recalls thinking, “‘Oh dear God, we’re not going to change these folks’ minds.’”
Castrucci turned to Dr. Tom Frieden, former Director of the Centers for Disease Control and Prevention, who shared four facts about COVID vaccines. “It was things like, ‘If we get enough people vaccinated, we can prevent a hundred thousand deaths or more,’” says Castrucci.“That nearly all doctors who have been offered the vaccine have taken it. [That] the speed of the vaccines’ development was due to cutting red tape, not corners. That the vaccines are more effective than the flu vaccine. And that the trials for these vaccines had tens of thousands of people in them.”
This simple list of facts swayed several in the group. “When you gave those facts,” recalls Castrucci, “it then opened up the focus-group participants to hear other messaging — like the reason you would take the vaccine is the same reason you put your seatbelt on any time you’re driving: It’s not because you know you’re going to get into an accident; you do it to prevent harm, should something happen.”
Later in the focus group’s meeting, Christie shared his personal experience of contracting COVID. He spoke of how the virus laid him low; and how his cousin, a healthy adult, died from it. These stories affected focus-group participants. As one guest reflected, “I would say I was probably 80 percent against [the COVID vaccine] when this started today. Now I’m probably 50/50ish, between the numbers Dr. Frieden gave and, honestly, the story Governor Christie told about a healthy adult that passed away from it… It really has made me think a little bit.”
The persuasive techniques of logos and pathos — logic and feeling — allowed for effective communication and productive dialogue, effectively swaying some vaccine-hesitant conservative Republicans.
How can I respond to people’s questions and concerns about vaccination in a culturally sensitive way?
On December 14, 2020, Sandra Lindsay, director of nursing for critical care at Long Island Jewish Medical Center, made history as the first person to receive a COVID vaccine outside of a clinical trial. Since then, Lindsay has used her position as a Black health-care worker to convey the safety and efficacy of COVID vaccines.
For many Black Americans in the United States, access — both to the vaccines themselves and to accurate information about them — is the biggest obstacle to vaccination. As Dr. Rhea Boyd, a pediatrician and public-health advocate, explains on Season 1 Episode 69 of EPIDEMIC, “We have spent, as a health-care system, tens of millions of dollars on trying to address vaccine hesitancy in Black communities, instead of actually getting to the root of the problem — which is that folks need access to the vaccines and they need access to credible information about the COVID vaccines.”
When providing that information, Lindsay explains, “We have to be nonjudgmental and culturally humble. Because for some people, it’s history that still looms darkly over them. For some, it’s a knowledge deficit. For some, it’s just that they’ve been so heavily influenced by the misinformation and the conspiracy theories that are out there. So you really have to take time to assess and engage in conversations with people as to why they are so anti-COVID-19 vaccine.”
Providing information in a culturally sensitive manner can be done in a variety of ways. A campaign called The Conversation: Between Us, About Us, which Boyd has helped lead, demonstrates the power of Black healthcare workers’ voices in reaching Black communities. Tierra Rich, a sexual-health educator and activist, used her own experience to connect with vaccine-questioning people. After receiving the Pfizer vaccine, Rich broadcasted her immunization experience on Facebook Live. While some of her friends weren’t sure about whether to get vaccinated, many have since told her, “‘Just seeing you go through it, and you talk about it more openly, makes me want to go get it.’”
Concerns about vaccines are often deeply rooted — in fear, worry about government overreach, and caution around medical risk — and have persisted for nearly 200 years. Yet they are not immutable. Responsive dialogue, consideration, and compassion — along with widespread access to the vaccines themselves — can go a long way in fortifying our collective defense against COVID.
“It is undeniable that there is a history of vaccine hesitancy and that there are ongoing concerns about the COVID-19 vaccination. Communicating effectively amongst different communities and cultures is pivotal for our world, especially with the Delta variant; this episode shares the appropriate communication tips, strategies and responses to tackle any challenges.”— Gil Addo, CEO/Co-Founder of RubiconMD
Launched in 2013, RubiconMD advances its mission to democratize medical expertise by connecting primary care clinicians to top specialists. Through its digital platform, RubiconMD enables the remote exchange of insights between clinicians that eliminates unnecessary referrals and services, reduces patient wait time and travel burdens, and allows primary care to practice at the top of their license. For more information, please visit www.rubiconmd.com.
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