Building trust: Tailored messaging needed to limit vaccine hesitancy
The first batches of the Pfizer and Moderna COVID-19 vaccines are here and are being distributed to priority groups like those in nursing homes, healthcare workers and remote Indigenous communities. But as additional shipments arrive, a comprehensive communication and vaccine distribution program will be a necessity.
Over the coming months, Canada will have to quickly immunize its 37.7 million citizens, all within an environment of incomplete information, vaccine hesitancy and varying access to health and social supports. To do that, we must act upon the truths about equity, diversity, decision-making and health system logistics that the pandemic has laid bare. To succeed, Canada’s immunization strategy will have to lean on influential community leaders, family doctors and public health.
Communities consisting of predominantly immigrant, ethnic or other marginalized citizens have been hardest hit by the pandemic. This is no surprise. These groups do not have the same access to health and social supports like income, job and housing stability as well as stable childcare and eldercare.
Canada is one of the most diverse countries in the world, with immigrants comprising 20 to 50 per cent of many cities. I grew up in Thorncliffe Park, a densely populated neighbourhood in east Toronto where 89 per cent of the population lives in high-rise apartment buildings. The majority are well-educated, visible minorities who immigrated to Canada. Household incomes average $50,000 per year. Crowded buses, crowded homes, crowded parks are the norm as are cultural practices based on the primacy of relationships with extended family, religious and social leaders. I grew up surrounded by other voices, other cultures, other religions, other ways of living and learning.
Having since studied and worked in different communities, from the remote northern Cree community of Moose Factory and the sparkling, ocean-side Halifax to the multicultural hustle of Scarborough and the spacious, spare beauty of Calgary, I have come to appreciate the uniqueness of each. Canada is more than hockey and maple syrup.
Canada’s diversity should be incorporated into any vaccination strategy.
Vaccine hesitancy is a significant issue with only 57.5 per cent of Canadians saying they are very likely to be vaccinated for COVID-19. Factors include age, education level and immigration. In fact, one-third of healthcare workers in Canada are immigrants, with the number rising to 79 per cent in cities like Toronto. Even among healthcare workers, 45 per cent expressed vaccine hesitancy. Concerns centered on efficacy, safety and the speed of vaccine development.
Clear, reliable information about the vaccine should be relayed via multiple channels, using multilingual, culturally appropriate and easily accessible strategies to support decision-making.
Family doctors are an obvious source of advice as 84 per cent of Canadians trust their physicians. However, people tend to seek health information from personal networks, extended families and religious leaders as well as in internet searches and social media before contacting their physician. This is especially true among immigrants. Despite this, centralized communication systems usually do not use influencers closest to people, including community organizations and religious leaders, to design and disseminate key information.
Previous experiences with government and healthcare shape how people react to government recommendations around health. In 2019, most Canadian immigrants arrived from India, China, the Philippines, Nigeria, Pakistan, Syria, Eritrea, South Korea and Iran, countries that struggle with transparency and trust. Healthcare in many of these regions is available only to the privileged few. Even in Canada, Indigenous, Black and other people of colour have suffered institutional racism. All this impacts what and who is trusted.
A strategy that includes the expertise and reach of religious leaders, community influencers and family doctors will be more persuasive and relevant.
A similar decentralized strategy is necessary to navigate the logistics of vaccine distribution. Local networks between family physicians and public health should be given the authority and funding to co-design locally relevant vaccine distribution programs.
After all, family doctors are more geographically accessible than hospitals for many citizens. Even during lockdowns in hard-hit provinces like Ontario, 96 per cent of family physician offices continued to provide care. Limited vaccine supplies mean we need the infrastructure to identify and track priority populations, necessitating access to a person’s medical and social history. Family doctors routinely record this information because community-based family medicine by nature is comprehensive, continuous, first-contact and person-centered.
Decades of experience have refined the approach family doctors use for vaccinations, even those requiring multi-dose regimens for infants, children and adults. Family physician offices are experts in identifying those in need, administering vaccines, managing side effects, tracking immunizations and calling patients back for booster doses. Both the Pfizer and Moderna vaccines require two doses to reach maximal efficacy. Evidence shows that, outside school settings, tracking vaccine administration, telephone call-backs and relationships with family doctors improve the uptake of multi-dose vaccination programs.
The COVID-19 vaccines hold the promise of moving beyond a pandemic reality. To reach that reality will require not only learning from the lessons of the past, but acting on them in innovative, community-based ways.