Vaccine Confident mark
An initiative to help pharmacists strengthen vaccine confidence in their patients and communities
How to talk to people about COVID-19 vaccines Addressing concerns that the COVID-19 vaccines were “rushed” Addressing concerns about COVID-19 vaccine side effects Addressing concerns related to pregnancy, breastfeeding, and fertility Addressing the belief that COVID-19 vaccination is “not needed” Addressing concerns about COVID-19 breakthrough infections Addressing concerns related to religious beliefs Understanding the “COVID skeptics” Addressing concerns about staying up to date with COVID-19 vaccines How to restart the vaccine conversation Understanding the “system distrusters” Addressing concerns about SARS-CoV-2 variants Identifying credible information about COVID-19 Vaccines Addressing COVID-19 vaccine myths Understanding the “cost anxious” Addressing concerns about vaccinating children and teens Addressing COVID-19 vaccine misinformation and disinformation Addressing COVID-19 vaccine misunderstandings Addressing concerns about administering COVID-19 vaccines with other vaccines Addressing concerns of people who are immunocompromised Effectiveness of COVID-19 vaccines during pregnancy and after delivery Using numbers to communicate COVID-19 risk to patients Managing pandemic-related exhaustion

Managing Pandemic-Related Exhaustion

The COVID-19 pandemic has been responsible for an estimated 30 million excess deaths worldwide.1 Despite being ranked as the best-prepared country in the world before the pandemic began, the United States experienced the greatest number of deaths throughout the majority of the pandemic.2 One key reason is the number of unvaccinated people.

Even today—when more than 98% of Americans have some degree of protective immunity against SARS-CoV-2—unvaccinated people remain at increased risk.3 During the 2023–2024 fall and winter virus season, more than 95% of hospitalized adults had no record of receiving the latest COVID-19 vaccine.3 Data from the Centers for Disease Control and Prevention (CDC) continue to show that COVID-19 vaccination reduces the risk of symptomatic disease and hospitalization by about 50% compared with people who are not up to date on vaccination.3

All indications are that COVID-19 will remain a public health threat for the foreseeable future. Ongoing efforts are needed to prevent severe illness from COVID-19, especially in older adults, people with pre-existing medical conditions, and infants. CDC emphasizes the importance of using proven respiratory virus prevention strategies to reduce the risk of severe disease.

But after 4 years, people are…exhausted. Some of the exhaustion comes from mental fatigue, defined as “a psychobiological state caused by prolonged periods of demanding cognitive activity and characterized by subjective feelings of ‘tiredness’ and ‘lack of energy’.”4 Some of the exhaustion comes from emotional fatigue: feelings of being emotionally overextended and depleted of one’s emotional resources.5 A recently recognized phenomenon is pandemic fatigue: demotivation to follow recommended protective behaviors, emerging gradually over time and affected by a number of emotions, experiences, and perceptions.6

The evolving challenge for pharmacists is to promote COVID-19 vaccine confidence and uptake while addressing and managing exhaustion—both their own exhaustion and that of their patients.

Managing Pandemic Fatigue

In a January 2024 essay in The New York Times, primary care physician Danielle Ofri gave voice to what many health care providers were seeing: patients would agree to receive the flu vaccine but refuse the updated COVID-19 vaccine, even if they had received previous doses.7 As Ofri explained:

“When I ask my patients if they have any concerns or questions about the Covid vaccine, hardly any do. Practically no one asks me about safety data or how effective it is at preventing viral transmission, hospitalization and death…. There’s just a vague hedge or an abashed, ‘I don’t know, I just don’t.’ As I try to suss out what’s on my patients’ minds, I can feel their slight sense of surprise that there is no specific issue causing their discomfort about getting the updated Covid vaccine. It’s as though they have a communal case of the heebie-jeebies.”

This scenario is much different from the one usually addressed by the literature on overcoming vaccine hesitancy. To foster vaccine confidence, health care professionals are encouraged to share clear, complete, and accurate messages about COVID-19 vaccines and take visible actions to build trust in the vaccine, the vaccinator, and the system. But as Ofri noted, her patients “can’t really articulate a specific reason [for rejecting the updated COVID-19 vaccine], even to themselves.” The conversations become less about facts and more about emotions.

What’s needed most in these conversations is an attitude of deep and genuine curiosity, expressed as mostly open-ended questions. Pharmacists might open the conversation with a general question such as:

  • What’s on your mind about the COVID-19 vaccine?
  • What makes you feel differently about the COVID-19 vaccine versus the flu shot?

Follow-up questions would explore any concerns that patients are able to articulate. For example, if patients state that they’ve “already had too many COVID vaccines,” the pharmacist might explore the sense of “too many”:

  • What do you think you mean by “too many”?
  • What feels like the “right” number of vaccines? What do you think made you pick that number?

Strive to keep the focus on the reluctance for as long as possible, rather than addressing vaccine-specific concerns. The goal is to help patients recognize and process the ambiguity—what Ofri termed the “free-floating discomfort”—before attempting to share information or counter misinformation.

Managing Mental and Emotional Fatigue

The pandemic-related mental and emotional fatigue that pharmacists themselves may be experiencing is understandable. Since March 2020, there has been an onslaught of information about COVID-19 control and prevention—information that oftentimes has been confusing or contradictory. Pharmacists have had to contend with a steady stream of misinformation and disinformation about COVID-19 vaccines, in a highly politicized environment. Pharmacists on the front lines of the pandemic have had regular encounters with patients who are frightened, angry, or abusive—all while trying to manage their own overwhelm and anxiety.

Summoning the mental and emotional energy to continue to champion COVID-19 vaccines can feel like a giant hurdle. Mental fatigue and emotional fatigue can lead to and amplify each other.8 When people are mentally exhausted, they have less control over their emotional responses; they may become irritable, angry, or anxious more quickly or frequently than usual. Emotional exhaustion can impair mental executive functions such as working memory, attentional control, decision-making, and problem-solving.

Fortunately, there are steps pharmacists can take to push back against mental and emotional fatigue. The strategies and practices described below are examples of interventions that can reduce the drain on mental and emotional resources and help to replenish resources.

Check In With Yourself Regularly. A check-in is a simple practice for tuning in to how you are feeling in the present moment and acknowledging what is there. Several times each day, take a moment to stop and ask yourself:

  • How am I doing?
  • What am I feeling?

Simply noticing and acknowledging feelings of mental or emotional fatigue can help you feel more in control. You might follow up by asking, “What is one small thing I could do right now to reduce my [mental and/or emotional] fatigue?”

Center Yourself Before Starting Conversations. Vaccine conversations can be challenging, even when they aren’t adversarial. Ideally, pharmacists remain calm and centered, focusing on and responding to whatever the patient is saying in the present moment and monitoring their own reactivity and defensiveness.

One technique for “getting out of your head” and grounding yourself in the present moment before a conversation is the “3–3–3” practice.9 You engage each of three senses—seeing, hearing, touching—to purposefully take in details of your immediate environment. Specifically, you notice and name:

  • Three things you can see nearby.
  • Three sounds you can hear.
  • Three things you can feel (or that you’re touching).

You might conclude the practice by taking three deep breaths.

Connect With What Matters. What is important to you about providing vaccination services? Which of your core values come into play? Connecting with your “why” can shore up your mental and emotional energy before and during vaccine conversations.

Ofri provided a glimpse of her “why” in The New York Times7:

“…if we don’t [engage in conversations about COVID-19 vaccines], we will be tolerating a level of preventable death that we’d find unacceptable in any other realm of health care. It is possible to acknowledge pandemic fatigue without throwing in the towel. Our community’s long-term health and lives depend on it.”

One approach to connecting with your “why” is to create a mission statement for vaccine conversations, using the format “I [action] [target audience] to [important outcome].” A mission statement based on Ofri’s experiences might read:

I will make the effort to conduct curiosity-based vaccine conversations with every willing patient to help ensure that not even one person dies unnecessarily.

Consider keeping your “why” front of mind by finding a physical representation of what you value most.10 Is there an object, photo, or some other tangible item that readily evokes your reasons for continuing to advocate for COVID-19 vaccines? Place that item in a prominent place, where you can make a point of looking at it before meeting with patients.

Learn to Regulate Emotions. Emotion regulation can be defined broadly as individuals’ ability to control or modulate their emotional state. As humans, our tendency is to try to regulate emotions (especially strong negative emotions) in unproductive ways—denying or suppressing them, or reacting impulsively (e.g., a patient who flies into a rage because a medication is not in stock).11 This approach can keep us trapped in the mental fatigue/emotional fatigue loop.

A more productive approach is to notice our emotions, accept their existence, and calm ourselves before we overreact. Emotions are a normal and natural part of how we respond to situations. Simply naming what you’re feeling when emotions arise can help you get control of what is happening.12 For example, is what you’re feeling anger, sadness, fear, or something else? Then dig a little deeper. If you feel anger, what are you angry about or toward? If you feel fear, what are you afraid of?

Take Micro Breaks. Pharmacies can be exceptionally busy workplaces, with true breaks hard to come by. But pharmacists can conserve and replenish mental and emotional energy by taking micro breaks: short pauses ranging from a few seconds to 5–10 minutes.13

What you do during that pause is up to you—but be sure it’s something that makes you disconnect from work briefly.14,15 It can be as simple as closing your eyes and taking a few deep breaths, or stretching your head, neck, and shoulders. You might look at a photo or video that brings you joy or repeat a comforting phrase or mantra. Ideally, you would select an activity that helps you address any immediate physical, mental, or emotional needs.

Prioritize Sleep. As sleep scientist Aric Prather has observed, sleep often ends up being the last thing on our to-do list when it should be the first.16 Insufficient good-quality sleep along with consequent tiredness on waking deplete both cognitive energy and emotional energy and reduce our psychological coping capacity.17 There is some evidence linking mental fatigue to a buildup of glutamate in the prefrontal cortex; the accumulated glutamate likely is eliminated during sleep.18

The American Academy of Sleep Medicine (AASM) and the Sleep Research Society agree that most adults should sleep at least 7 hours per night on a regular basis to promote optimal health.19 The AASM website offers a number of fact sheets with helpful information about common sleep problems.

References

  1. Our World in Data. Estimated cumulative excess deaths during COVID-19, World. Accessed March 31, 2024. https://ourworldindata.org/grapher/excess-deaths-cumulative-economist-single-entity
  2. Nuzzo JB, Ledesma JR. Why did the best prepared country in the world fare so poorly during COVID? J Econ Perspect. 2023;37(4):3–22. doi:10.1257/jep.37.4.3
  3. Centers for Disease Control and Prevention. Background for CDC’s Updated Respiratory Virus Guidance. Updated March 1, 2024. Accessed March 31, 2024. https://www.cdc.gov/respiratory-viruses/guidance/background.html
  4. Marcora SM, Staiano W, Manning V. Mental fatigue impairs physical performance in humans. J Appl Physiol. 2009;106(3):857–864. doi:10.1152/japplphysiol.91324.2008
  5. Maslach C, Goldberg J. Prevention of burnout: New perspectives. Appl Prev Psychol. 1998;7(1):63–74. doi:10.1016/S0962-1849(98)80022-X
  6. World Health Organization Regional Office for Europe. Pandemic fatigue – reinvigorating the public to prevent COVID-19: Policy framework for supporting pandemic prevention and management. 2020. https://iris.who.int/handle/10665/335820
  7. Ofri D. My patients used to be enthusiastic about the Covid vaccine. What changed? New York Times. January 27, 2024. Accessed March 31, 2024. https://www.nytimes.com/2024/01/27/opinion/covid-vaccine-skepticism-doctor.html
  8. Thurrott S. Strategies to help you cope with mental and emotional exhaustion. Banner Health. April 21, 2022. Accessed March 31, 2024. https://www.bannerhealth.com/healthcareblog/teach-me/how-to-cope-with-mental-and-emotional-exhaustion
  9. How to use the 333 rule to ease anxiety and calm your mind. Calm. October 31, 2023. Accessed March 31, 2024. https://www.calm.com/blog/3-3-3-rule-anxiety
  10. Valcour M. How to refuel when you’re feeling emotionally drained. Harvard Business Review. April 30, 2020. Accessed March 31, 2024. https://hbr.org/2020/04/how-to-refuel-when-youre-feeling-emotionally-drained
  11. Henriques G. How to cultivate a curious attitude in times of distress. Psychology Today. November 18, 2022. Accessed March 31, 2024. https://www.psychologytoday.com/us/blog/theory-knowledge/202211/how-cultivate-curious-attitude-in-times-distress
  12. Klynn B. Emotional regulation: Skills, exercises, and strategies. BetterUp. June 22, 2021. Accessed March 31, 2024. https://www.betterup.com/blog/emotional-regulation-skills
  13. Albulescu P, Macsinga I, Rusu A, et al. “Give me a break!” A systematic review and meta-analysis on the efficacy of micro-breaks for increasing well-being and performance. PLoS One. 2022;17(8):e0272460. doi:10.1371/journal.pone.0272460
  14. Kogan N. 6 science-backed ways to improve your well-being at work. Harvard Business Review. July 7, 2023. Accessed March 31, 2024. https://hbr.org/2023/07/6-science-backed-ways-to-improve-your-well-being-at-work
  15. Micro breaks: The importance of taking a break from work. Calm. Accessed March 31, 2024. https://www.calm.com/blog/micro-breaks
  16. Prather AA. The Sleep Prescription: Seven Days to Unlocking Your Best Rest. Penguin Books; 2022.
  17. Khammissa RAG, Nemutandani S, Feller G, et al. Burnout phenomenon: Neurophysiological factors, clinical features, and aspects of management. J Int Med Res. 2022;50(9):3000605221106428. doi:10.1177/03000605221106428
  18. Wiehler A, Branzoli F, Adanyeguh I, et al. A neuro-metabolic account of why daylong cognitive work alters the control of economic decisions. Curr Biol. 2022;32(16):3564–3575.e5. doi:10.1016/j.cub.2022.07.010
  19. Watson NF, Badr MS, Belenky G, et al. Recommended amount of sleep for a healthy adult: A joint consensus statement of the American Academy of Sleep Medicine and Sleep Research Society. Sleep. 2015;38(6):843–844. doi:10.5665/sleep.4716

Return to Playbook Topics View in Spanish