Know What Drives Vaccine Confidence
Vaccine confidence, per CDC, is the trust that patients, their families, and providers have in:
- Recommended vaccines
- Providers who administer vaccines
- Processes and policies that lead to vaccine development, licensure or authorization, manufacturing, and recommendations for use
This confidence, or willingness to accept a vaccine, falls on a continuum. At one end of the spectrum, a person demands the vaccine and actively seeks out vaccination. At the other end, a person may refuse the vaccine. In between, many people have questions or take a “wait and see” approach. Pharmacists can engage these individuals, who make up the “movable middle,” to build vaccine confidence in the communities the pharmacists serve.
Many people are turning to pharmacists and other health care providers to help them decide whether they should get one of the COVID-19 vaccines.
Vaccine confidence starts with you. According to a recent pulse survey conducted in May 2021 by APhA, 88% of respondent pharmacists are fully vaccinated against COVID-19. This pulse survey and a pulse survey conducted in March 2021 by APhA, found that 92% of respondent pharmacists said they plan to or have been vaccinated against COVID-19. Oftentimes, when patients are deciding whether they should be vaccinated, they’ll want to know whether you’ve been vaccinated yourself, and what your experience was like.
Know the Facts: COVID-19 Vaccines and Vaccine Confidence
Take APhA’s short quiz to test your knowledge about vaccine confidence basics, the role pharmacists can play in building confidence, types of vaccine platforms (e.g., mRNA; adenovirus vector), myths about use in childbearing years, and vaccine efficacy and effectiveness.
Take the quiz
Learn About the Drivers
According to the Kaiser Family Foundation Vaccine Monitor, a majority of those who remain hesitant are concerned about serious side effects. Build trust with patients by communicating that some postvaccination symptoms are normal, but that serious side effects are extremely rare. It can be helpful to share your vaccination story to prepare others for what to expect.
Whether a person decides to get vaccinated against COVID-19 will depend on many factors. These factors can range from simply not knowing how to access the vaccine to reasons that are deeply personal.
The World Health Organization (WHO) has developed a model to help clinicians understand some of the reasons for undervaccination. The model, known as Measuring Behavioral and Social Drivers of Vaccination (BeSD), considers four specific domains that influence vaccine uptake:
- What people think and feel about vaccines (e.g., perceived benefits, perceived risks)
- Social processes that drive or inhibit vaccination (e.g., provider recommendations, social norms, rumors)
- Individual motivation or hesitancy to seek vaccination (e.g., readiness, willingness, intention, hesitancy)
- Practical issues in seeking and receiving vaccination (e.g., availability, convenience, cost)
Review the WHO’s Data for Action: Achieving High Uptake of COVID-19 Vaccines, which has interview guides that pharmacists can use to assess each of the domains of the BeSD model with their patients.
Click below to learn why some people may have personal reasons for feeling less confident about getting the COVID-19 vaccine.
Cultural perspectives on vaccination can vary as a result of a person’s public health stance, religious viewpoints, and the level of suspicion in mistrust of vaccination in their community.
- In the Black community, there is a longstanding distrust of medical care in the United States. A lack of access to care today, reception of subpar care, and past medical experimentation like the USPHS Syphilis Study at Tuskegee have all contributed to this distrust. Learn how the “COVID-19 vaccine faces Black communities’ centuries-long mistrust of health care” in APhA’s recent news article.
- The COVID-19 pandemic has heightened the longstanding need to address barriers to health equity. In this review of Health Equity Considerations and Racial and Ethnic Minority Groups, CDC defines health equity as “when all members of society enjoy a fair and just opportunity to be as healthy as possible.” Several factors impact health equity: discrimination, health care access and use, occupation, educational, income, and wealth gaps, and housing. For example, people in racial and ethnic minority groups often work in essential settings, and many members of these communities live in crowded living spaces. These factors can increase a person’s likelihood to be infected with COVID-19, making it critical that these communities feel vaccine confident.
Patients may lack confidence in vaccines due to religious concerns, even though many religious groups have issued statements that clarify their beliefs and support getting vaccinated.
- Some people may express concerns about the connection between mRNA vaccines and cells derived from a fetus aborted in 1972 and transformed into the HEK293 cell line. That cell line was used in the research process that enabled the development of mRNA vaccines. Fetal cells are NOT used in the manufacturing of any COVID-19 vaccine. Catholics and others opposed to abortion can be directed to the Vatican Statement on the Morality of Using Some COVID-19 Vaccines, which states it is morally acceptable to receive COVID-19 vaccines because of the remoteness from that abortion and the grave consequences of COVID-19 infection.
- Some people may express concern about the connection between the Ad26.CoV.S vaccine from Johnson & Johnson/Janssen and cells derived from a fetus aborted in 1985 and transformed into the PER.C6 cell line. That cell line is used to produce the adenoviruses used in that vaccine. Catholics and others opposed to abortion can be directed to the Vatican Statement on the Morality of Using Some COVID-19 Vaccines, which states it is morally acceptable to receive COVID-19 vaccines because of the remoteness from that abortion and the grave consequences of COVID-19 infection.
- Some people of Jewish or Muslim faith may express concerns about components of the vaccine with porcine origins because of their opposition to pork products. Pharmaceutical components that may have porcine origin, gelatin, and lactose are not used in the manufacture of any COVID-19 vaccines. Reference the Statement from the Seminar Held by the Islamic Organization for the Use of Pork Gelatin and Porcine and Other Animal Derived Ingredients in Non-oral Medication for support of the use of porcine-derived medical products.
- Visit the Immunization Action Coalition (IAC)’s resource center for Religious Concerns for more information.
Many concerns have emerged among people who are pregnant, lactating, or contemplating pregnancy. Pregnant or lactating individuals were not included in the COVID-19 vaccine clinical trials, which is typical for most clinical trials. However, safety data have not indicated a cause for concern in the thousands of pregnant or lactating people who received one of the COVID-19 vaccines since December 2020.
Patients may question what is inside the vaccine vial. Point out to them that every ingredient in a vaccine is present with the FDA’s approval. These ingredients and the entire production process are subject to thousands of quality-control checks.
Patients may feel the encouragement to receive a COVID-19 vaccine infringes on their individual liberties. Point out that individual rights go hand-in-hand with duties to neighbors around us. For example, we follow traffic rules for the common good. Being vaccinated makes it less likely that one will infect someone else, including one’s own family members.
Value Concerns (‘Why Bother?’)
Patients may doubt that COVID-19 is a serious disease or doubt that the COVID-19 vaccines prevent disease. Point out that COVID-19 leads to ICU admissions and that the total death count for 2020 was much higher than previous years. Each of the COVID-19 vaccines being offered has been studied in rigorous clinical trials of 40,000 volunteers each, with clear evidence that vaccination substantially reduces the likelihood of severe disease if infected.