Vaccine hesitancy is defined as a delay in the acceptance or refusal of vaccines despite the availability of vaccination services. While the motivations behind vaccine hesitancy are vast, they can be sorted into three categories: confidence, complacency, and convenience. Confidence is trusting in the effectiveness and safety of vaccines, the system delivering them – including the competence of healthcare professionals – and the motives of those who institute policies and guidance on necessary vaccines. Complacency is the thought that vaccine-preventable disease risks are low and vaccines are not necessary as a means of prevention. Lastly, convenience is how broadly vaccinations are available, affordable, accessible, understood (in language and health literacy), and appealing. Because vaccines are a public health advancement that decreases the incidence, severity, and spread of communicable diseases, vaccine hesitancy is a public health issue as a decrease in vaccinations could lead to an increase in the spread of preventable diseases. 

Conversations regarding vaccine hesitancy are common in our current society due to the availability of the new COVID-19 vaccine designed to protect against the COVID-19 virus. The COVID-19 vaccine is not currently included in the recommended vaccine schedule distributed by the Centers for Disease Control and Prevention (CDC), but it is recommended by for everyone ages 5 years and older, including pregnant individuals. In fact, both the American College of Obstetricians and Gynecologists (ACOG) and the Society for Maternal-Fetal Medicine (SMFM), two organizations that lead the charge in representing obstetricians, recommend all pregnant individuals receive the COVID-19 vaccine. Although the COVID-19 vaccine is recommended by ACOG, SMFM, and the CDC in pregnant individuals, vaccine hesitancy among this population still exists. 

Although vaccine hesitancy exists, there are techniques to assist healthcare providers in combatting it. This first requires providers to learn about a patient’s apprehension to receive the vaccine and determine whether it is an issue of confidence, complacency, or convenience. For issues related to confidence, being honest about vaccine side effects and reassuring parents of their safety can have an impact. This technique is designed to build trust in the provider and is shown to have a positive effect on vaccine compliance. In order for this technique to be successful, health care providers must be intentional in remaining current on vaccine information and providing reliable sources of information to patients and families who may be struggling with confidence. Providers are encouraged to use continuing education opportunities to keep abreast. For issues related to complacency, honest conversations about acute and chronic complications related to vaccine-preventable diseases and personal anecdotal evidence are appropriate measures for combatting complacency. Anecdotal evidence outlining what you would do or have personally done and your experiences with the safety and efficacy of vaccines have been shown to be effective according to a survey of primary care physicians in the United States. Lastly, for issues related to convenience, offering vaccinations at all clinic visits, before hospital discharge, and during prescription pick-up as well as informing patients of community resources, such as immunization clinics and free or reduced-cost immunization programs, are just a few ways that providers can help overcome the issue of convenience. If additional issues related to convenience arise, such as lack of transportation, consider contacting a social worker to aid in alleviating the barrier.

Vaccine hesitancy is not an easy issue to address and everyone in the healthcare field plays an important role in decreasing vaccine hesitancy. Providing patients with reassurance may take more than one provider on more than one occasion. While this can be difficult, do not be disheartened. Rather, use it as an opportunity to reflect and continue the journey of lifelong learning as a provider. Were there questions you were unsure of how to answer? Did an issue arise that you could not address? Pose those questions to colleagues and look for answers in literature. The most important thing to remember is that the goal is to protect patients while assuring them that they have a voice in their care. While giving them that voice, it is our duty to give them the best possible information so they can make the best possible decisions. 

References

1. MacDonald NE, the SAGE Working Group on Vaccine Hesitancy. Vaccine hesitancy: Definition, scope, and determinants. Vaccine 2015;33(34):4161-4. 
2. Strategic Advisory Group of Experts on Immunization, World Health Organization. Report of the SAGE Working Group on Vaccine Hesitancy. Available at: https://www.who.int/immunization/sage/meetings/2014/october/1_Report_WORKING_GROUP_vaccine_hesitancy_final.pdf. Accessed October 23, 2021
3. Strategic Advisory Group of Experts on Immunization, World Health Organization. Report of the SAGE Working Group on Vaccine Hesitancy. Available at: https://www.who.int/immunization/sage/meetings/2014/october/1_Report_WORKING_GROUP_vaccine_hesitancy_final.pdf. Accessed October 23, 2021
4. American College of Obstetricians and Gynecologists. ACOG and SMFM Recommend COVID-19 Vaccination for Pregnant Individuals. Available at: https://www.acog.org/news/news-releases/2021/07/acog-smfm-recommend-covid-19-vaccination-for-pregnant-individuals. Accessed October 23, 2021
5. Shen SC, Dubey V. Addressing vaccine hesitancy: Clinical guidance for primary care physicians working with parents. Le Medécin de famille canadien 2019;65:175-81.