Public Health Researchers: MDs Will Need to Help Convince Their Patients to Get Vaccinated

A team of public health experts believes that the intervention of practicing physicians, working directly to influence their patients to become vaccinated, will be absolutely key to convincing a firm majority of Americans to become vaccinated against the COVID-19 virus, and that one absolutely key element in convincing the vaccine-hesitant to change their minds will be the persuasion of people’s personal physicians, not the exhortations of government officials, politicians, pharmaceutical companies, or even the news media.

Writing in The New England Journal of Medicine in a “Perspectives” op-ed article published on April 22, Gillian K. Steel Fisher, Ph.D., Robert J. Blendon, Sc.D., and Hannah Caporello, all affiliated with the Department of Health Policy and Management at the Harvard T.H. Chan School of Public Health in Boston, make the case in their article, entitled “An Uncertain Public—Encouraging Acceptance of COVID-19 Vaccines,” that it is important to look at the nuances of public polling, and findings that reveal that many of those Americans polled have been stating that they have not yet fully decided to become vaccinated, to understand the complexity of the moment here in the United States.

“Polls suggest that much of the U.S. public is currently undecided about whether to take a Covid-19 vaccine,” they write. “This point is often overlooked, since interpreters of several recent polls have predicted that a majority will get vaccinated. But these interpretations are missing an important detail: reporting of poll results often involves collapsing various categories of responses. For example, reporting combines people who say they will “definitely” get vaccinated (40 percent) with those who say they ‘probably’ will (23 percent). Polls using other wording reveal similar patterns, with substantial proportions of respondents indicating that they are ‘somewhat likely’ to take a vaccine, for example. But evidence from political polling suggests that people who say they will ‘probably’ or are ‘somewhat likely’ to take an action do not always do so. Moreover, many people, when offered the choice, say they are ‘not sure’ or that they will ‘wait until it has been available for a while to see how it is working for other people.’”

Those findings, they argue, are concerning. And, in looking into the weeds in terms of the nuances of public perceptions around vaccination, they argue that bold new approaches must be taken, and that it will be the arguments of their own personal physicians that will help to sway many Americans still hesitant to become vaccinated, to finally agree to do so.

As the article’s authors write, “First, although the broader literature on Covid-19 vaccine adoption in the United States indicates that perceived effectiveness is an important motivator, poll findings warn that public perceptions of effectiveness may not align with expert views. In particular, the public may expect that an effective Covid-19 vaccine means not only strong protection against the virus, but also immediate changes in their daily experience. Indeed, when asked about reasons they would take the vaccine, many people said it would allow them “to go back to normal activities like work or school” (52 percent) or “feel safe around other people” (75 percent). Such perceptions may conflict with expert warnings that getting a vaccine — however effective it may be in preventing infection — does not warrant a return to normal.”

And, “Second, and also in keeping with other research on Covid vaccine uptake in the United States, polling shows that safety is a key consideration in individual decision making. Safety-related issues are consistently the top reasons for hesitancy regarding Covid-19 vaccination cited in polls, with 71 percent of respondents in one recent poll, for example, citing concerns about side effects. However, despite scholarship emphasizing the role of trust in institutions to provide relevant information, polls suggest that sources of technical information about safety are not greatly trusted. Specifically, there is limited trust in the media or pharmaceutical companies to provide Covid-19 vaccine information: as few as 16% and 20 percent of respondents, respectively, say they have “a great deal/quite a bit” of trust in these organizations to provide such information. The public also has only moderate trust in information provided by the Food and Drug Administration. More people, however, trust their own doctor or even health professionals as a group. This finding is consistent with polling about other health information, which reveals that doctors are frequently more trusted or viewed more positively than other sources, including elected officials, government agencies, and medical scientists.”

Indeed, they write, “Third, willingness to be vaccinated varies among U.S. communities. Black adults are less likely than White adults to say they will take a Covid-19 vaccine. In a recent poll, 31 percent of Black adults as compared with 46 percent of White adults said they would “definitely” get vaccinated. In the context of what is known about well-justified distrust among Black adults owing to historical and current racism in the U.S. biomedical enterprise, polling provides insights about how this distrust plays out in relation to Covid-19. For example, Black adults are less confident than White adults that vaccines have been properly tested for safety (67 percent vs. 76 percent), and less confident that medical scientists act in the public’s best interest (33 percent vs. 43 percent).”

What’s more, “For different reasons, though also related to distrust, Americans who identify as Republicans are less likely than Democrats to say they will get vaccinated. A quarter of Republicans (26 percent), as compared with half of Democrats (52 percent), say they ‘definitely’ will. This finding reflects a more recent polarization in the United States that affects responses to nearly every facet of contemporary policy. Regarding Covid-19, polls show that Republicans have less confidence than Democrats do that medical scientists will act in the public’s best interest (36 percent vs. 54 percent), and less trust in every source of vaccine information polls have asked about, with the exception of former President Donald Trump. Republicans thus have had little trust in President Joe Biden regarding such information (23 percent vs. 93 percent).”

As a result, the authors write, “Having explored multiple polls, we believe that there is great potential for public willingness to receive Covid-19 vaccines but that effective public education and outreach are needed to maximize the proportion of the population that will do so quickly. We also believe that clinical physicians, rather than pharmaceutical companies, political leaders, or even medical scientists, should be at the fore of education and outreach strategies. Featuring clinicians in messaging is particularly important given that many people will not see their own physician when making vaccination decisions: current vaccine policy and cold-chain logistics mean that people will largely be attending mass-vaccination clinics. To reach communities that are less trusting of vaccine efforts, outreach should be led by, or should meaningfully incorporate, physicians reflecting the diversity of the relevant communities. Practically, this recommendation means that Black physicians, including those affiliated with historically Black medical institutions, should have a key voice. Similarly, physicians from well-respected medical institutions in Republican-leaning states should be incorporated into efforts in those states.”

Above all, the article’s authors argue, by far the biggest motivating factor for most Americans to become vaccinated will be the prospect of a “return to normal.” “Although we must explain that precautions such as mask wearing will still be needed in many circumstances until vaccine adoption is widespread, leaders who wish to motivate vaccine adoption can balance such warnings with positive messages about how vaccination can facilitate a return to activities such as seeing friends and family or working in an office. These messages are especially important in relation to vaccines that require two doses, to avert drop-off before the second dose,” they note.