Distinguishing between “vaccine hesitancy,” a term that has gained traction in recent years, and anti-vaxxers is vital if we are to bring the pandemic under control.
Anti-vaxxers can rarely be persuaded to give up their fixed beliefs that all vaccines are harmful. Numerous sources have recommended that health professionals focus on those who are vaccine-hesitant instead, be it from active misinformation on social media or a lack of confidence in the safety of vaccines. Notably, a recent poll shows that 24 per cent of Canadians are undecided about whether they will get a COVID-19 vaccine. Additionally, only 65 per cent of Canadians are willing to receive a safe COVID-19 vaccine upon availability, a decrease from 71 per cent of Canadians polled in April. The reasons behind this worrying rise included concerns about the safety and effectiveness of the novel vaccine.
The World Health Organization recently published a report suggesting three main ways to overcome vaccine hesitancy: cultivating social influencers in favour of vaccination (countering disinformation); curating vaccine-enabling environments (ensuring vaccines are accessible to marginalized communities); and motivating individuals to get vaccinated.
Increased exposure to anti-vaccine blogs increases vaccine hesitancy. Social media is a leading source of vaccine misinformation globally and as people enclose themselves in echo chambers, they become difficult for public health experts to reach. For quite some time, social media companies have been reluctant to regulate harmful content on their platforms, either citing freedom of speech provisions or simply deflecting responsibility for what individuals share. Governments around the world, however, are forcing them to act in the interests of public safety. Consequently, Google, Facebook and Twitter are actively removing pages that post vaccine misinformation just as governments ramp up efforts to maximize messaging reinforcing the safety and efficacy of vaccines.
Within promotional social media campaigns, leveraging the influence of trusted community leaders, physicians and nurses is crucial as it can generate the needed public trust in the vaccine.
We must also ensure the removal of systems-level barriers that prevent many racialized and low-income communities from equitably accessing vaccines – often the same barriers behind the disproportionate prevalence of COVID-19 in these communities and the limits in obtaining testing. We have seen examples of creative and effective efforts in Toronto to ramp up testing, converting public transit buses into mobile testing centres and opening pop-up clinics in community centres. Similar measures should be considered to create a vaccine-enabling environment and bring vaccines to the populations that need them most.
Even with these fixes, individual motivation is the final, rate-limiting step to beating back COVID-19. Many vaccine-hesitant individuals undervalue the risks of contracting the virus and overvalue the safety concerns of a novel vaccine. Indeed, a recent study on the HPV vaccine found that parents are often reluctant to vaccinate their children because of safety concerns or simply not understanding the importance of the vaccine. Addressing both of these risks head on, in a non-judgmental manner, is key to motivating them to change their views. Real-life interactions are where we as health professionals can transform attitudes toward vaccination. Studies continue to show that healthcare professionals remain the most trusted source of health-related information. Direct communication with patients increases the likelihood of vaccine uptake.
So, the next time you encounter patients or family members concerned about the vaccine, make sure to take a deep breath, direct your full, empathic attention to them, sit at their level and make eye contact. Then gently, politely recite the facts: the vaccines are our exit strategy and how we get out of this mess; for them to be effective, at least 70 per cent of Canadians need to be vaccinated; the vaccines were approved by Health Canada on the basis of serious evidence; each trial enrolled tens of thousands of people with no serious problems; a couple of the vaccines are based on a newer technology which seems to work really, really well to build immunity against coronavirus with no known serious side effects.
And, most importantly, without vaccinations, the waves may keep rolling.
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I find that most pro vaccination people are less informed than many anti vaccine people.
Foe example; most who are pro, look at you as if you were an idiot when you relate to them that these vaccines are NOT approved by the CDC but only approved for emergency use!
“Experts have taken to social media to quell misinformation and address common concerns about Pfizer’s messenger RNA (mRNA) COVID-19 vaccine, performing an important public service in support of robust vaccine uptake. However, some scientific information is being oversimplified to the point that it is misleading. The public’s decision to take a vaccine whose long-term risks are unclear should be a well-informed one. Clear communication is crucial to the process of informed consent and for building public trust in the fight against vaccine hesitancy.”
I find the actual Healthy Debate in the comment section and rarely in articles posted in this platform.
What am I missing here?
I get the polio vaccine to prevent me getting polio. I get the small pox vaccine to prevent me getting small pox. The same for measles, mumps and rubella. I am told that the SARS-CoV-2 vaccine will trigger an immune response and a second top-up shot will potentiate the first shot. This is the measure of ? efficacy – these 90, 95% numbers thrown about. However the very subtle messaging about this vaccine, if I get covid-19, is that its effects on me are purported to be diminutive. The dirty little secret is the vaccine does not prevent one from getting covid-19, does not prevent one from spreading covid-19 if they get it and become infectious. So all this subterfuge of masks and isolation will still be demanded. One thing we do know, according to the CDC, for those under 60y of age without comorbidities, is that there is a 99.96% success of getting over covid-19 if one contracts covid-19. Things we do not know (but should) is what is the population prevalence of SARS-CoV-2? Such a tremendous vaccine campaign for the entire population seems misguided. A tremendous vaccine campaign for the elderly, frail and those with comorbidities would be more prudent. “Quaranta” or 40 was the duration of days of isolation in the harbour the Italian officials demanded of the ships coming into Venice during the bubonic plague…they did not demand every citizen of Venice be locked in their home for 40 days, and 40 more, and 40 more…conflating vaccines that ‘do their job’ with vaccines that might (SARS-CoV-2) as a panacea is not where the argument should be. (for what it’s worth, I took a flu shot for the last 8y – despite this, in 2018 I got laid up for 6 days in bed prior to that Christmas – anecdote yes, but hey…yes I got my flu shot this year also – I see it as a primer for my immune system)
This is a link to a very well written article in a respectable medical journal “Nature”. Here the authors discuss the new era of mRNA vaccination. This is something that has been studied on animals and yes there are promising future directions. We should be supporting innovation and advancement in all arenas, especially healthcare. With that said, these authors raise some very serious safety questions. And this was written in 2018 – so just 2 years prior to Big Pharma developing and pushing a novel technology on a mass population at “Warp Speed” as the US calls it.
Here is a quite directly from the article regarding the safety questions (the numbers in the next refer to references which can be found at the link). I would like to know how these Big Pharma groups have addressed the issues of 1. autoimmunity risk, 2. pathological clot ie. thrombus formation? I am happy to take any well researched medicine or vaccine which may improve my health or prevent a severe illness, the key words being “well researched” and having substantial follow-up data. Let’s remember that mRNA vaccines have NEVER been rolled out to the public before. So why is the first time allegedly at “warp speed” before adequate animal and human tests are done? There are countries which have created normal conventional vaccines (e.g. Austria and Russia) that do not use novel mRNA technology, why are we being tested on with this new model?
“Potential safety concerns that are likely to be evaluated in future preclinical and clinical studies include local and systemic inflammation, the biodistribution and persistence of expressed immunogen, stimulation of auto-reactive antibodies and potential toxic effects of any non-native nucleotides and delivery system components. A possible concern could be that some mRNA-based vaccine platforms54,166 induce potent type I interferon responses, which have been associated not only with inflammation but also potentially with autoimmunity167,168. Thus, identification of individuals at an increased risk of autoimmune reactions before mRNA vaccination may allow reasonable precautions to be taken. Another potential safety issue could derive from the presence of extracellular RNA during mRNA vaccination. Extracellular naked RNA has been shown to increase the permeability of tightly packed endothelial cells and may thus contribute to oedema169. Another study showed that extracellular RNA promoted blood coagulation and pathological thrombus formation170. Safety will therefore need continued evaluation as different mRNA modalities and delivery systems are utilized for the first time in humans and are tested in larger patient populations”.
The problem is not just the anti vaxers, the problem is that the medical system has taken a uni dimensional way of treating patients relying on pharmaceutical companies, whose sole endeavour is to sell shares and satisfy shareholders. They cannot patent any naturally occurring substances, which means we have(at the taxpayers expense) given these companies complete control over our healthcare solutions. That is short sighted at best and dangerous often. The fact that these companies have no hesitation to advertise the myriad of side effects that their products cause at the patients expense and then the drugs that are prescribed to deal with side effects should tweak the physicians and the medical schools to start teaching doctors about the rest of the science out there that can actually support our own immune systems to heal, rather than stopping or changing natural processes n our bodies( as most pharmaceutical drugs do). If you really look at the science on many of these drugs, there is never a complete understanding of the medical conditions, and hence the treatments, many times become a short term and sometimes dangerous bandage. It is time for a new medical model, where what used to be mainstream medicine now becomes an option for better treatments. I am not saying we should throw out all pharmaceutical drugs, but we need to be more integrative in our medicine, which is the model for the European and many Asian medical systems. If you want people to buy into anything pharmaceutical companies make now, then you must start with breaking down the autonomy they have to operate and we must insist on funding much more research into naturally occurring substances that already have pier reviewed science to support use, and doctors must be better trained.
Unless you are going to the hospital with a severe trauma or an issue that requires a skill like surgery to correct the issue, the remainder of Western medicine is completely “reactive” in my eyes. I think we have become completely lost in medicine. The majority of time we are trying to mask symptoms. How many people for instance have gone to their doctors with “back pain” only to be given enormous amounts of unnecessary pain meds like oxy? instead of the doctor maybe referring out to someone more skilled like a physical therapist or chiropractor. Isn’t this how the opioid crisis has been fueled? Have we not been talking about this for the last 5-10 years? So why do I, a healthcare worker in a hospital, still receive patients with history of severe back pain, and when I ask them if they have received follow-up or rehabilitation for it, they tell me their doctor prescribed opioids? in 2020? Another example is asthma or COPD, how many times have I had patients who have gone to emergency with shortness of breath to be given “antibiotics” instead of someone doing a proper work up for their breathing? I have patients who have shortness of breath due to heart problems (e.g. narrowing heart valves) who make 2-3 trips in 1 year to emergency with shortness of breath, are presumed to have pneumonia (on some kind of random basis I guess) and then are sent home with “antibiotics” or “puffers” until a clever doctor finally decides it may be time for a heart scan or stress test. So we are still dishing out antibiotics in 2020 left, right, and center. Have we not been talking about antimicrobial stewardship for the last 5-10 years?
The problem with medicine is that students are taught to follow “formulas” from day 1. I would say even from the early days of undergraduate education. You have to follow certain rules, formulas, and hoops to get into med school. Then in school you have to follow certain formulas to assess and diagnose a patient – this may work in some instances, if someone arrives with a broken femur step 1 might be xray, step 2 might be surgery. But in many other medical situations this reliance on formulas just degrades critical and rational thinking. A dermatologist is quick to give you a cream to cover your rash, but how many are going to ask why you have eczema? there are countless treatable root causes. If you don’t do your own research or happen upon a clever doctor who actually wants to help you, you’ll just get bandaid treatments. This is why a typical 65 year old patient under my care already arrives on 6-12 medications, for things that may be otherwise treatable at the root level. And these medications sometimes have severe consequences. For instance, how many people take antacids? do they know that in 10-20 years this may lead to chronic kidney disease, then potentially dialysis? did anyone investigate if they have a food sensitivity or sensitivity to another medication which is causing their heartburn?
Sadly many patients just don’t know how to advocate for themselves or trust everything they are told, and the way the medical institution is set up (fee for service) there is no incentive for doctors to want the best results for their patients.
Please keep up the great work.
Thanks so much, John!