Analysis

COVID-19 vaccine hesitancy: what to say to allay patients’ concerns

Not everyone trusts the coronavirus vaccine – but advice from nurses can change minds

Public scepticism, safety fears and anti-vaxxer sentiment pose patient education challenges for nurses as the vaccine programme gathers pace

  • Practical advice for nurses on how to broach the subject with reluctant patients – and reassure them
  • Find out what the common concerns are that make patients wary of receiving vaccines
  • Practice nursing and public health experts share their knowledge to help you support patients

For many, the regulatory approval and the implementation of the first COVID-19 vaccine in the UK brings hope of controlling the pandemic.

But there are signs that uncertainty

Public scepticism, safety fears and anti-vaxxer sentiment pose patient education challenges for nurses as the vaccine programme gathers pace

  • Practical advice for nurses on how to broach the subject with reluctant patients – and reassure them
  • Find out what the common concerns are that make patients wary of receiving vaccines
  • Practice nursing and public health experts share their knowledge to help you support patients
Illustration showing small figures of people, divided into colours that represent the percentage saying yes, no or maybe to the COVID-19 vaccine – most in green, fewer in yellow, and fewer still in red
Studies suggest a significant minority of people are unconvinced about the safety or efficacy of COVID-19 vaccines Picture: iStock

For many, the regulatory approval and the implementation of the first COVID-19 vaccine in the UK brings hope of controlling the pandemic.

But there are signs that uncertainty about the vaccine persists for some people.

Risk of suspicion about vaccination becoming mainstream

A University of Oxford study into ‘vaccine hesitancy’ in relation to the COVID-19 vaccine found that while 72% of respondents were willing to be vaccinated, 16% felt very unsure, and 12% said they were likely to avoid or delay getting the jab.

72%

of 5,114 UK adults told the Oxford Coronavirus Explanations, Attitudes and Narratives Survey they were willing to be vaccinated against COVID-19

One in 20 people of the more 5,114 people polled described themselves as anti-vaccination for COVID-19.

One in five people thought vaccine data are fabricated, according to the study published in December.

‘The signs are concerning: we may be close to a tipping point, when suspicion of vaccination becomes mainstream,’ says Daniel Freeman, professor of clinical psychology at the University of Oxford.

‘Already we’ve seen conspiracy theories about the virus achieve significant traction. Is COVID-19 vaccine hesitancy about to follow in their wake?’

A separate poll of 2,076 UK adults, commissioned by the Royal Society for Public Health has revealed that three in four respondents (76%) would have a COVID-19 vaccine if advised to do so by their GP or health professional.

‘Vaccine hesitancy is the delay in acceptance or refusal of vaccines despite the availability of vaccination services’

World Health Organization

However, of particular concern were findings that 57% of respondents (199) from black, Asian and minority ethnic backgrounds were likely to have a COVID-19 vaccine, compared with 79% of white respondents. Confidence was lowest among respondents of Asian ethnicity, of whom 55% were likely to say yes to being vaccinated.

A Nurse talking to a BAME patient, both wearing face masks
Research suggests people from BAME backgrounds have less confidence in the coronavirus vaccine than white counterparts Picture: iStock

Reluctance to trust a vaccine, and nurses’ role in promoting confidence

The World Health Organization (WHO) defines vaccine hesitancy as a ‘delay in acceptance or refusal of vaccines despite the availability of vaccination services’.

The reasons why people choose not to vaccinate are complex.

A WHO vaccines advisory group identified complacency, inconvenience in accessing vaccines, and lack of confidence as key reasons for hesitancy.

Healthcare staff, especially those in the community, remain the most trusted advisers and influencers of vaccination decisions, and they must be supported to provide trusted, credible information on vaccines, the group says.

16%

of respondents felt very unsure about getting vaccinated

(Source: Oxford Coronavirus Explanations, Attitudes, and Narratives Survey)

In the UK, the nursing role is in the vanguard of delivering large-scale vaccination programmes, and COVID-19 vaccination is no exception.

The RCN ‘actively encourages’ all members to have the COVID-19 vaccine to help protect themselves, their patients, their families and the wider community. However it does not support mandating vaccination to staff as this would not be effective.

So how can nurses address vaccine hesitancy among patients?

Managing public concerns and answering individuals’ questions

RCN professional lead for public health Helen Donovan finds the term vaccine hesitancy unhelpful, as having questions about a vaccine, or any other health intervention, before receiving it is entirely normal.

Nurses need to be ready for discussions about the new vaccines, but those involved in vaccination will be expecting this, she says.

‘Nurses deliver almost all vaccination programmes and we are used to managing these concerns and answering these questions,’ she says.

‘Don’t ask people if they have thought about having the vaccine, just normalise by saying “have you had it yet?”’

Marie Therese Massey, independent practice nurse adviser and educator

‘Vaccine acceptance covers a huge spectrum, there will be a large proportion who accept vaccines and will take it without many questions. Then there is a percentage of people who accept some vaccines but reject others, or just have more questions than others. This doesn’t mean they are anti-vaccination.’

Nurses’ preparation and staying up to date as information changes

Nurses, especially general practice nurses, need to have a good understanding of the background of the vaccine, and how it works, so that they can allay any fears, she says.

Being well prepared by reading RCN, Public Health England (PHE) and NHS guidance, and knowing where to direct people for good, reliable information is key.

Helen Donovan, RCN public health lead
Helen Donovan, RCN public health lead

The RCN advises nurses involved in vaccination to sign up for PHE updates so that they always have the latest information. The Green Book also has the latest information on UK vaccines and vaccination procedures.

All staff involved in administering the vaccine will have specific training before they start.

Fears related to the vaccines’ accelerated development

Answers to questions need to be specific to the person asking them, with the level of detail they require, Ms Donovan says.

The RCN advocates empathy for the person’s concerns, and the need to listen to them carefully. Provide a succinct answer that sticks to the facts without overloading the person, it advises (see box below).

‘When it comes to the speed of regulation and development, we as nurses need to be very clear that the approved vaccines have gone through all the usual phases of development’

Helen Donovan, RCN professional lead for public health

One common question raised about the COVID-19 vaccines is whether they have been tested sufficiently, given their accelerated development.

‘We have to acknowledge that there are more questions with these vaccines as we haven’t had them before, and this is understandable,’ Ms Donavan says.

‘When it comes to the speed of regulation and development, we as nurses need to be very clear that the approved vaccines have gone through all the usual and necessary phases of vaccine development.

‘Anyone who has been involved in research will know that normally lots of time is spent waiting for approval from relevant bodies or seeking funding, which has not happened in this case. The stages in the vaccine trials have been able to roll into each other to help save significant time.’

Vaccine conversations: tips for talking to patients

A nurse talking to a patient, wearing a face mask and gloves
Picture: Alamy

It is important that nurses are well informed to provide answers for people’s questions. However, the approach you take during the conversation is key.

The aim of the conversation is to gain trust and support people to hopefully accept vaccination.

  • Ask questions to gain greater insight into the individual’s main concerns and listen to them
  • Be empathetic: ‘I understand why you might be concerned’. It really is not surprising that parents and the wider public have questions and concerns
  • Avoid giving a fact-filled lecture, simply giving more and more information is not the solution and can be counterproductive
  • Stick to the concerns raised and provide a limited number of main points in response, expressed simply
  • Focus on the risk of the diseases—the public, and some professionals, have little experience of diseases because of the success of the vaccination programme
  • There is evidence that restating a myth serves to reinforce it— instead identify a myth as being false and focus on the facts: the benefits of vaccination while acknowledging the side effects of vaccines
  • Highlight the consensus among scientists and health professionals about the evidence in support of vaccination
  • Acknowledge that we all want the best for ourselves and our children
  • Do not dismiss individuals' concerns
  • If people decide not to vaccinate, be clear they can change their mind at any stage and leave the door open for further discussion
  • If asked whether you have been vaccinated or your own children have, confirming that you have is an important exemplar

(Adapted by the RCN from Fifteen-minute consultation: Vaccine-hesitant parents)

Commonly-expressed concerns about vaccines

Independent practice nurse adviser and educator Marie Therese Massey says concerns typically include people saying they, or someone they know, has had a bad experience with a previous vaccine.

Marie Therese Massey
Marie Therese Massey

‘People will often say they don’t want the flu jab because they had it before and got flu, or they will say they have never had flu, so that don’t need the vaccine, or they believe – often wrongly – that they are allergic to one of the ingredients,’ she says.

Concerns can be particularly heightened about children. Parents’ fears about the measles, mumps and rubella jab and autism persist, despite the research paper that suggested the link being long-since discredited, and parents often say they feel that babies receive too many vaccines simultaneously.

‘The general public health messages hold good when it comes to vaccines,’ Ms Massey says. ‘So nudge theory and making every contact count remain relevant, mentioning and discussing it with people at every opportunity, asking ‘have you had your COVID-19 vaccine?’ when doing an annual diabetes review or similar, once it is widely available. Don’t ask people if they have thought about having the vaccine, just normalise by saying “have you had it yet?”’

The power of personal persuasion

Understanding communities and using local religious leaders can help spread positive and robust information about vaccines.

12%

of respondents said they were likely to avoid or delay getting the COVID-19 vaccine

(Source: Oxford Coronavirus Explanations, Attitudes, and Narratives Survey)

Making the most of new technologies, such as webinars on the vaccine hosted by a local general practice nurse or GP could be a good way to dispel myths, and sending texts and letters can ensure the opportunity to get vaccinated remains in the minds of those who are eligible, Ms Massey says.

‘Some practices get GPs and practice nurses to call when people haven’t attended cervical screening or vaccination, and these personal approaches can make a real difference.’

Emphasising altruistic reasons for vaccination, including herd immunity, protecting older relatives and protecting the NHS can all be positive messages when speaking to individuals reluctant to go ahead, she says.

It appears that the younger age groups, who are generally less affected by COVID-19, may be less likely to embrace vaccination.

Illustration showing two people back to back, with a syringe between them, and one person saying yes, the other saying no
Picture: iStock

Patient education can take time

‘The feedback we have so far is that older people are more likely to want the vaccine to resume their lives, and are really keen for it to become available,’ Ms Massey says.

But getting the chance to explain and talk through issues all takes time that can be sorely lacking. ‘We can’t do this in five minutes, it takes time to answer people’s questions.’

For some people, feeling ready to receive the vaccine may be a process that requires a number of contacts with healthcare professionals. People should be signposted to accurate information if they don’t feel ready for the vaccine initially, and supported to come back.

‘We are at the start of the process, and in any vaccine programme we don’t give people one chance to receive it but leave the door open for the future,’ the RCN’s Ms Donovan says.

‘However as this is a new programme, this approach will take time as initial vaccine supplies will be limited, but people should be able to receive it at some point.’

RCN guidance on vaccine administration

Further information


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