The UCHealth A.F. Williams Family Medicine Clinic – Central Park is a busy place. Hundreds of patients seek care there and it’s not surprising that some patients have not yet received a vaccination to protect against COVID-19.
The good news is that UCHealth makes it easy for patients to get one. In most cases, providers can easily check a patient’s vaccination status in the electronic health record and, if necessary, help set up a time for a shot at a UCHealth vaccination site. At A.F. Williams, the process is even easier. Thanks to a UCHealth pilot program, the clinic has supplies of the one-shot Johnson & Johnson vaccine and willing patients can get a shot on the spot.
The bad news is that providers at A.F Williams consistently see patients still hesitant to be vaccinated against COVID-19.
Overcoming COVID-19 vaccine hesitancy
“I’m surprised that every day in clinic I run into a few patients who aren’t vaccinated yet,” said Dr. Corey Lyon, a family medicine specialist at A.F. Williams and associate professor in the Department of Family Medicine at the University of Colorado School of Medicine.
Lyon said he checks the electronic health record to verify the vaccination status of every patient he sees. If a patient has received the vaccine but the system doesn’t yet register the information, Lyon offers to help them get it recorded – an important assist, as an individual might have to show proof of vaccination for a job or some other activity. For patients who are unvaccinated, the electronic check offers Lyon an opportunity.
“It opens the door to find out why,” he said.
Ongoing stress for the health care system
It’s the most important question of the ongoing COVID-19 pandemic. Some 72% of those eligible are fully vaccinated in Colorado. But another 22% of those who are eligible have not gotten even a single dose, leaving them unprotected at a time that the delta variant of the virus continues to drive an alarming increase in the number of cases and hospitalizations in Colorado. The consequences for society and for the health care system are profound.
At UCHealth hospitals, for example, as of early November, the unvaccinated accounted for more than three-quarters of all patients hospitalized because of COVID-19 and more than 90% of patients with COVID-19 in ICUs and on ventilators. That, in turn, creates stress on health care workers and on resources available for patients who need treatment for other conditions.
Given those facts and the human toll of the disease, why do so many people remain “vaccine-hesitant” or outright resistant to get a shot with a proven track record of protection?
No easy task to unravel reasons for COVID-19 vaccine hesitancy
That’s not easy to answer. Lyon said he presents the case for getting the vaccine and probes the reasons that some patients refuse. Some have fears about side effects from the vaccine – generally the consequence of the vaccine stimulating a short-lived immune response – which Lyon tries to allay.
“During these times, we review why side effects happen and the short nature of them, usually just 24 to 48 hours, and the long-term benefit of being vaccinated and protected from COVID,” he said.
Others have questions about how the messenger RNA (mRNA) vaccines from Pfizer and Moderna work, and what the vaccine does to the body.
“My explanations to patients include how the vaccine goes into our muscle cells, and helps our cells make a protein that looks like a COVID protein,” Lyon said. “At that time, when our body sees that protein, it makes antibodies to it. Then, if you are exposed to COVID, your antibodies are already made to recognize the COVID protein and stimulate an immune response. Once the mRNA helps our cells make that protein, it quickly disappears.”
But Lyon said that he and his colleagues often get frustratingly vague responses from the vaccine-hesitant.
“What we hear is a lot of patients don’t really have a great reason for why they don’t want the vaccination,” Lyon said.
In some cases, the scientific evidence that supports vaccine effectiveness fails to counter a cacophony of claims and charges on the Internet, social media and community chatter about unproven risks the shot presents, he added.
“They may be overwhelmed and confused by ‘information’ out there from probably unreliable sources,” Lyon said. “When you peel the layers of that onion, you often find a lot of convoluted information that is clouding their ability to say ‘yes.’”
Not surprisingly, the deep skepticism of some toward authority plays a role in the vaccine resistance of some patients, Lyon said. “They may be more concerned about assuring they maintain their civil liberties versus doing something they are told or expected to do.”
Countering the opposition
But Lyon added that the skepticism of or outright resistance to vaccination doesn’t deter him or his colleagues from gently prodding their patients to reconsider their stance.
“If they give me concerns about the vaccine that I know come from unreliable sources, I let them know that I hear what they’re saying and understand,” he said. “But then I try to give them some confidence in my knowledge and let them know that I have been dedicating my last 18 months to treating COVID. I’ve kept up with the scientific literature and would be happy to clarify any questions they might have.”
A.F. Williams is also a training site for University of Colorado School of Medicine Family Medicine residents. Part of their training is learning how to communicate effectively with patients. Lyon said residents practice using motivational interviewing to uncover the “core reasons” for patients’ unhealthy behaviors, such as smoking, and identify what it would take to motivate them to change their minds. The residents use the same technique with patients reluctant to get the COVID-19 vaccine.
In any case, Lyon added, he avoids using scare tactics, such as telling hesitant or resistant patients of the dire consequences, such as extended stints on a ventilator or death, that could await them if they fail to get vaccinated against COVID-19. The approach simply doesn’t work, he said, particularly for those who are firmly opposed to getting the vaccine. An aggressive approach also runs the risk of “jeopardizing the relationship” providers need to care for their patients’ overall health, he noted.
“Until people have had a personal experience with COVID-19, scaring them with what could happen tends not to be very effective,” Lyon said.
The value of trusted sources when discussing COVID-19 vaccine hesitancy
However, providers can use their established relationships with patients to gently crack their shells of vaccine doubt, he stressed. The key is trust built up over time.
“With patients with whom I already have a relationship, I talk about what the vaccine can do for all of us, and how the vaccine doesn’t only protect them from COVID but also their family, kids, neighbors and community,” he said.
“I like to keep my messages short and strong and focus on the benefits of vaccination and what it prevents,” added Dr. Matthew Simpson, who also practices family medicine at A.F. Williams. Simpson said, for example, that he explains the heightened risk of severe disease that COVID-19 poses for his patients with chronic conditions, such as diabetes.
“I tell them that all the COVID vaccines that we have are safe and effective and that because of their chronic disease, I highly recommended that they get the vaccine.”
Keeping the door open
It is a welcome relief for providers at A.F. Williams when they successfully overcome their patients’ doubts and convince them to get vaccinated, Lyon said. The wins compensate for many conversations that fail to sway resistant patients.
“It gets exhausting because it makes so much sense to us as a way to treat this pandemic and decrease the number of infections and the positivity rate and the number of hospitalizations,” Lyon said. “Success fills your tank with a little bit of hope and you keep moving on and trying hard to maintain your focus on the larger goal.”
Regardless of their frustrations, the clinic’s providers will never close the door on discussions about COVID-19 and the vaccine, Lyon concluded.
“We let them know that we’re always here,” he said. “The ball is in their court, and when they change their minds, we’re here for them.”