Conversations that matter: Building vaccine confidence
In 2019, before the world had heard of COVID-19, the World Health Organization named vaccine hesitancy as one of ten key threats to global health. Little did they know how salient that prediction would be.
A year into the pandemic, with vaccination thought to be our best chance at ending COVID-19, understanding and building vaccine confidence is critical.
According to a January 2021 poll, 60% of Canadians said they would get vaccinated as soon as possible. However, not everyone is enthusiastic: a further 19% prefer to wait before getting the vaccine, while 14% said they would not get the vaccine and 7% were undecided.
There is a spectrum of vaccine confidence: most people fall somewhere in between acting as strong vaccine advocates, and staunch vaccine refusal. It is influenced by the 3 C’s: complacency – a perception that vaccine-preventable diseases are low; constraints – such as physical access, availability and affordability; and confidence – trust in vaccines, the delivery system and the policy-makers who decide they are needed.
Canadian health care professionals and vaccine experts see confidence as the main issue influencing uptake of vaccine in Canada.
“Having questions and concerns about a new vaccine is very reasonable,” says Dr. Tara Kiran, the Fidani Chair in Improvement and Innovation and Vice-Chair Quality and Innovation at the University of Toronto Department of Family and Community Medicine (DFCM). “People want to make the best decision for themselves and their families. But for good reasons they are sometimes distrustful of medical science and governments. As family doctors we are in a unique position. We already have a foundation of trust with our patients that we can build on – and we know that trust is really the key for building vaccine confidence.”
Among racialized and historically marginalized communities, this lack of trust in governments and institutions is accentuated by a legacy of unethical treatment from the medical community and neglect of public health problems that communities have prioritized. For example, the roots of COVID-19 vaccine hesitancy and medical distrust among Indigenous communities in Canada can be traced back to the 1940s and 1950s, where Canadian healthcare professionals were complicit in colonial violence and medical experimentation in residential schools.
Addressing these layers of distrust in often emotionally charged conversations will be a challenge that primary care providers need to prepare for.
“There is evidence that advice from a trusted healthcare professional improves the vaccine uptake. But how we have that conversation matters,” says Dr. Noah Ivers, an Associate Professor in DFCM, family physician at Women's College Hospital and Canada Research Chair in Implementation of Evidence-based Practice. “When patients ask questions or express concerns about the COVID-19 vaccine, it’s easy to dive into facts to answer. But if you don’t spend a moment to understand and validate where people are coming from, conversations about vaccines can get unnecessarily heated and may not be as effective as we hope them to be.”
To help physicians approach these conversations more thoughtfully and effectively, Dr. Ivers and colleagues at the Centre for Effective Practice and the Alberta Department of Pediatrics developed the PrOTCT Framework to support positive interactions that build vaccine confidence. This and other resources are also included in the free COVID-19 vaccination modules developed by DFCM and the Ontario College of Family Physicians (updated with new content March 11) .
Family doctors are in a privileged position of trust: they build long-term relationships with their patients and as a result, people value the advice they give. Family physicians and other primary care providers will play a key role in building confidence and advocating for widespread vaccination by addressing the concerns of patients with clear and accurate information.