Madeline King, PharmD, BCIDP

Let’s talk about the elephant in the room. We’ve been bouncing around it a little. Let’s talk about vaccine hesitancy and how you guys address that in education standpoints as well as how that can impact vaccination compliance or resistance. What’s your language? What’s your methodology around noticing that? Do you notice it? Do people say it to you? Do you feel it? How do you work down that road to try to convince people to get a vaccine?

Wendy Wright, DNP, ANP-BC, FNP-BC, FAANP, FAAN, FNAP:

 This is my baby. This is my doctoral work, so I love this stuff. A couple of things that I want people to know is that studies are pretty clear these days that even people who are vaccine proponents now feel the need to question science and vaccines. Every provider should expect what used to be a 30-second recommendation to now take 5 minutes because people feel the need to ask the questions about it. Even though they’re going to take it, they feel the need. There’s more vaccine hesitancy out there.

The other thing is that we talked about strong recommendations. We call it presumptive vs participatory. In a study, they followed providers who asked, “How do you feel about getting your shots today?” It shouldn’t surprise you that less than 10% of people took their shots. But when the provider said, “You’re due for 2 shots today. It’s okay to give them together,” 80% of people took those vaccines.

My last point on vaccine hesitancy is that you have to be prepared that people are going to ask about it. Take a deep breath and answer their questions. There are going to be the 4% of the population who are vaccine refusers. I’ve learned from all of my research that you will never move those folks. They believe in something that none of us can even fathom, but they come up with it. If they want to believe something, they’re going to google it and find research to support their beliefs. You’re never going to move them.

It’s the movable middle that we have to focus on. That’s the 20% to 40% of the population who will go based on a trusted source, as JAM [Jacinda Abdul-Mutakabbir, PharmD] mentioned. If they trust you and you make that recommendation, they’ll listen. Focus on the movable middle. The ones who march in and say, “What vaccines do I need? Give them to me,” are a provider’s dream. “Sure, give me everything I need.” With people in the middle, we have to take a breath, meet them where they’re at, be honest with them, give them what they’re asking, and don’t go into too much detail.

 Yes. I’ve also seen people talk about how sometimes it takes more than 1 interaction with a patient to convince them. Maybe they come in and you tell them, “You need this vaccine today,” and they say, “Absolutely not.” But by the end of the appointment, they say, “Tell me more about it and I’ll think about it for next time.” We see this with patients in the clinic with other vaccines as well. “I’m not ready to get 5 vaccines today, but I’ll get 1 next time.” We think, “OK, we’ll take what we can get. Let’s just start off on the right foot.” Sometimes it takes persistence and patience, which we don’t all have at this point in the pandemic. But there are people who can be swayed if we take the time, ask them multiple times, and not give up on them.

 Yes. We use a Z code in our charts for vaccine refusal by patient or parent. That’s a signal to the nurse practitioner who sees them next that there’s been a vaccine that they didn’t get the last time, and to take a look at the note and try to follow up on that conversation.

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Wendy Wright, DNP, ANP-BC, FNP-BC, FAANP, FAAN, FNAP, and Madeline King, PharmD, BCIDP, provide insight on vaccine hesitancy among patients and the importance of increasing vaccine uptake to protect against SARS-CoV-2.

Addressing Vaccine Hesitancy and Uptake for SARS-CoV-2

Wendy mentioned a childhood vaccination slippage. In the other part of my world that I work in, part of my research is antimicrobial resistance. We’ve also seen huge backslides in antibiotic and antimicrobial resistance because when we were going through all of these processes the past 2 years, at that beginning of the pandemic when patients were dying and we didn’t always have the time to do confirmatory testing to find out if it was true bacterial pneumonia vs SARS pneumonia, we often gave empirical antibiotics to patients to help make sure. We understood that. But the consequences of this massive pandemic and as it has went forward, not being a good solid vaccinated population, is that you still have to do those things. We have to get back. We’ve suffered in cardiovascular disease and diabetes. This pandemic has touched everything you can put your finger on in ways that many people don’t realize. Maybe we’re just now starting to see those ongoing effects.

Something I’ve learned in the past 10 or 15 years since I completed my research for my dissertation is meeting people where they are. I’m not a physician, so I’m not dealing with patients per se, but I’m dealing with the public. I’m sure JAM [Jacinda Abdul-Mutakabbir, PharmD] and others on this panel would agree that not everybody should always look like me or, to Madeline’s point, speak like me in a certain language. We need a massive calling for diversity in our professions across all areas, including testing, physicians, pharmacy, nurses, and physical therapists. You name it. We need people in allied health. If you’re listening and you have children or know people who are going to college, send them our way. We need these people, and we’re tired. We need more of you.

We aren’t even talking about health care. The next pandemic is health care professional burnout. There are massive issues across all of our sectors. We’ll hold off on that. Perhaps that’ll be another sponsored panel someday, because that’s an ongoing crisis.

Rodney Rohde, SV, SM, MB (ASCP), FACSc, discusses the regression in combating antimicrobial resistance in the US because of the COVID-19 pandemic.

Impact of COVID-19 Pandemic on Antimicrobial Resistance

 Because I vaccinate in the community and I only vaccinate with Pfizer, I run into the conversation of, “I’ve done X number of COVID-19 doses with the Moderna vaccine, so I don’t want to get Pfizer.” Then I have to be very intentional with my messaging. I talk about heterologous vaccines. “Vaccines are sexy.” I use that hashtag. I explain to them how they can mix the vaccines and so on. I get asked, “Are these new vaccines made any differently than the original vaccine?” That has been the consistent question that I’ve gotten in the field. Then I inform them, “No, not at all. We use the same lipids that were previously used to package that mRNA technology. It’s the same things we saw previously. The only addition is that strain, which is very easy to add to the original COVID-19 strain.”

I try to have intimate conversation. It’s always my goal to connect with the patients whom I serve and to make sure that I walk them through the process of selecting the vaccine. I also come at them from the point of, “I only have this, so let’s talk about whether this is the vaccine you’d like. If it’s not the vaccine that you want, then I’ll help you find where you can access the Moderna vaccine. However, I only have Pfizer here, and this is what we’re going to have to do.” Typically, folks will get Pfizer if they wanted Moderna. I’m able to have that decent conversation exchange.

With communicating, I have to take into account that I’m a trusted messenger in my community, so I can’t take advantage of that. When they ask me, they know that I’m going to give them statistics. I’m going to give them the numerical rundown. I’m going to tell them how these vaccines are performing because I want them to know that I have their back and they can trust that I’m going to be studied up and that I take my position in the community seriously.

Right on. That’s our duty to our patients at all times.

Jacinda Abdul-Mutakabbir, PharmD, comments on the importance of communicating the similarity of the bivalent booster vaccine safety profiles to patients.

Safety of SARS-CoV-2 Bivalent Booster Shots

 Let’s transition to our next segment, which is going to be a fun one with several of you. Let’s talk about conversations with our patients. This has been the theme of this conversation, which is a good one. Let’s talk about conversations with patients and others who are considering getting vaccines or other types of things surrounding COVID-19. How would you or how should health care practitioners in general communicate with their patients to determine which booster shot is best? Do you comment on composition? Do you get down into the weeds of that booster? Do you talk about safety data? How do you initiate conversations with your patients?

You have to include all those things, but you have to include them in terms that the patient will understand. Because if you’re using terminology above a level that they can understand, they’re going to tune you out, or they’re going to be afraid to ask questions. It’s important to understand the audience that you’re talking with and to speak with them on that level. It’s important to tell them why the vaccine is important, how it protects them, why the booster is important, how it keeps them out of the hospital, and the safety data that we have. It’s important to emphasize that we don’t have beyond 2 years of data, but the data we have are really good. Reinforce all those points.

In the beginning, I was volunteering, giving COVID-19 vaccines at a clinic where most of the patients were Spanish-speaking. A lot of issues I came across were being able to communicate to patients in a language that they understood—not even on a level that they understood, but in a language that they understood. We have a lack of interpreters and translators in some of the health care settings that the 3 of us work in. If you aren’t in a hospital with an interpreter phone or an interpreter iPad, if you’re out in the community, that may be really challenging. We could do a better job of having people who can tell patients in a language that they understand what they’re getting and why they’re getting it. It might increase vaccine uptake if we can speak with people on a better level.

 I’m a little less scientific. I say, “We do Moderna on Monday, and Pfizer on Friday. I’m looking at your vaccine record, and it appears you’re due for your COVID-19 booster. Which day would you rather have your vaccine, Monday or Friday?” Then we’ll say, “Put them on the schedule for their vaccine.” I’m a little less formal with the science. Then if they ask me questions, I’m prepared to answer. I’ll say, “You’re also due for your flu shot. Let’s get that on board today. You can certainly have it when you come back, but we can get it today, and then we’ll book you for the COVID-19 vaccine.”

The World Health Organization issued a statement about a month ago. They said that there are 25 million children who have missed vaccinations as a result of this pandemic. This pandemic has taken us back 30 years in the world of pediatric vaccines. It has been our biggest backslide in the last decade or more. As providers, we need to vaccinate at every opportunity. We need to find ways to make it easy for our patients. For months, we gave vaccines in the parking lot at our office because people were too afraid to come in. We did it in their car in a tent we had set up.

Make that strong recommendation, meet them where they are, present the recommendation, and then if they have questions, answer them. Someone said to me, “You’re recommending this for me. Have you had it?” I said, “Of course I’ve had it. I would never recommend anything different from what I’d recommend for me and my child. And I love my child most days.” I have a teen. “What I’m recommending for you is what I recommend for my family. I would never do anything different from that.” They say, “OK, get me signed up.” Sometimes it’s that personal appeal. I play the mom card. I’m not afraid to play the mom card, but I use different cards depending on the person I’m talking to.

Expert nurse practitioner Wendy Wright and Dr Madeline King share their approach to conversations with patients on optimizing SARS-CoV-2 booster vaccine administration.

Madeline King, PharmD, BCIDP

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