Community Pharmacist Fosters Next Generation of Vaccine Confident West Virginians

When children ages 5 to 11 years old became eligible to receive COVID-19 vaccines, Matthew Rafa, PharmD, wanted to do more than just vaccinate the kids in his community.

“We have a real vaccine hesitancy issue in our state,” said Rafa, who practices at Kroger Pharmacy in Wheeling, West Virginia. “Wouldn’t it be great if we could turn some of those kids from vaccine hesitant into vaccine confident, rather than let them become adults who had one bad experience with a vaccine and then were unwilling to give it another try?”

Before he began to see patients in this age group, Rafa read all he could on best practices for vaccinating children, ranging from distraction techniques to ways to reduce pain. Then he devised his own plan.

Rather than just hurry children into the chair and hold them steady, Rafa came right out and asked the young patients if they were scared and acknowledged that he understood their fear. He then explained that his main goal was to make sure the shot didn’t hurt and that he had several tools to help ensure that they wouldn’t feel pain while they were being vaccinated.

To reduce pain, Rafa used lidocaine gel as well as Buzzy, a small bumblebee-shaped device placed directly on the arm that uses ice and intense vibration to distract the patient and disrupt pain transmission.

As he applied the lidocaine gel, he’d tell children who admired superheroes that he was applying an Iron Man shield. For the Disney princess fans, Rafa would call the cooling gel “Frozen magic.”

“I’d ask them, ‘Do you feel it getting cold? Do you feel it getting tingly?’” Rafa explained.

Rafa covered the walls of the counseling room with superhero and Disney princess posters. Just before he administered the vaccine, he’d say to his young patients, “Can you name all the characters in 10 seconds? The record is 7. Can you beat that?”

“I can’t tell you how many times the kids didn’t even know I’d given them the shot,” Rafa said. “They were still talking and rattling off names, and I already had the needle in the sharps container and was putting the Band-Aid on their arm.”

Rafa felt it was important to give children a sense of control over the situation. He did this in small ways such as allowing them to choose the color of their vaccine card as well as the decorative theme of their Band-Aid.

Rafa took his impressive know-how to schools and weekly family dinners at a local soup kitchen. That way, he said, he’d eliminated all the barriers. “They can’t tell you it’s not a good time when you are both right there.”

The pharmacist noticed that by the time children came back for their second dose of COVID-19 vaccine, they were already more vaccine confident. “They’d come in, climb up in the chair, and say, ‘OK, I’m ready.’”

Rafa instilled confidence in older children, too. He’d educate them on how to make sure future vaccines hurt less, no matter which provider they went to for their health care.

“Whenever you get another shot, make sure you keep that arm loose and relaxed, and then it won’t be as sore after,” Rafa would tell his young patients. “I wanted to educate them so that even if they’re not coming to me regularly, wherever they are going, they’re going to feel more confident in getting any shot.”

Feedback from thrilled parents suggested to Rafa that his mission was accomplished. “One night, after I had given a vaccine to an especially frightened child, his mother texted me to let me know that the boy had asked if they could come back to me for all their shots.”

—Sonya Collins
August 2022

Resources to Know What Drives Vaccine Confidence and Tailor Your Outreach to specific populations to build COVID-19 vaccine confidence are available at APhA’s Vaccine Confident microsite.