Primary Care Clinicians as COVID-19 Vaccine Ambassadors
Vaccine hesitancy was a significant problem in the US and throughout the world-even before the recent spread of COVID-19 misinformation. In fact, the World Health Organization (WHO) listed “vaccine hesitancy” as 1 of 10 threats to global health in 2019 because of a significant increase in measles cases, coupled with the threats to international campaigns to immunize against cervical cancer and also to finally end the spread of polio in Afghanistan and Pakistan. It is not surprising that many patients are wary about receiving the COVID-19 vaccine. The many common concerns include: (1) safety and efficacy concerns related to the “warp speed” of vaccine development for this novel virus, (2) the possibility of short and long term side effects, (3) unclear long term efficacy, (4) minority populations not being an integral part of the clinical trials, (5) historical medical experimentation on minority populations, and (6) the politicization of the COVID-19 virus. As part of preventive maintenance, pediatricians (and other primary care clinicians treating children) consider vaccinations to be a major component of their practice. The measles, mumps, rubella (MMR), and polio vaccine for instance, not only protect the individual patient and his/her family, but the public’s health at large. In one large study, most parents considered their children’s pediatricians to be the best source of vaccination information. Primary care clinicians who mainly care for adults on the other hand, may spend much of their medical practice focused on chronic disease management and the treatment of pain. They recommend annual Influenza vaccines and various boosters, as well as the Zoster, Pneumococcal and Haemophillus influenza type B vaccines. Although extremely important to an individual patient, the public health risk of a single patient unwilling to be vaccinated with one of these vaccines will not risk the public’s health. Primary care clinicians treating adults have little training in communication regarding vaccination aimed to develop herd immunity. After all, there was no vaccine for the Spanish Flu in 1918 and today’s clinicians were not practicing medicine in 1955 when the Salk polio mass vaccination program began in the US. The roll out of the H1N1 vaccine in 2009 was considerably smaller than today’s COVID-19 vaccination efforts but suffered from similar supply shortages and miscommunication. Clinicians in the US have been stretched to the limits in every way imaginable, and now they are met with another moral imperative: to ask their patients about their plan for obtaining the COVID-19 vaccine. This might include: (1) empathic listening and kindness to their patients (beneficence), (2) communicating the risk of not obtaining a COVID-19 vaccine (non-maleficence), (3) allowing their patients to make an informed decision without judgment (autonomy), and (4) ensuring that the COVID-19 vaccine is distributed equitably (justice). This is a tall order for clinicians, but the public will surely benefit as clinicians provide the necessary space for this conversation. 

Historically, primary care clinicians have had difficulty communicating to their patients about controversial and potentially emotional topics. While some have participated in residency and post-licensure offerings in “Breaking Bad News,” these programs are usually targeted to oncologic and other sub-specialty clinicians. Suicidality, intimate partner violence, substance use, sexual health, and gender identity are some examples of topics that clinicians receive little training on relative to the importance of these conversations. , The risk of poor clinician-patient communication may result in less than optimal outcomes for the individual and/or family unit. Now, clinicians are asked to talk to their patients about issues that affect the patient, the public health and even the health of the planet. These include gun safety, climate change, and health and now the importance of the COVID-19 vaccine. 

Because patients have their own personal narrative (including fears, disbelief, mistrust, anxiety, etc.) regarding the COVID-19 vaccination, it is important for clinicians to learn how to communicate with a variety of patients. In fact, there are strategies for primary care clinicians to consider in the delivery of communication regarding vaccination. Many patients are hyperaroused and anxious due to the impact of the pandemic, and a discussion of the vaccine is best delivered in a reassuring tone aimed at helping a patient to see that the vaccine is a mechanism toward calm and not something additional to worry about. Conversely, for those who are detached or pessimistic, it is important to speak to the potential dangers of worldwide under vaccination and the consequences if citizens do not do their part in reaching herd immunity through vaccination. For patients who are passive as a result of pandemic forces, it is important to actually introduce anxiety into the situation to trigger them toward taking action. 

There are many possible solutions regarding how primary care clinicians might quickly learn how to effectively communicate with their patients regarding their COVID-19 vaccination and thereby alleviate any fears and distrust that they may have. Project ECHO, a virtual telementoring network, is an example of a synchronous educational training model that could be used to teach clinicians regarding COVID-19 vaccine communication. For instance, clinicians can attend a one-hour Vaccine Communication ECHO training session to receive guidance from expert clinician communicators to understand how to navigate difficult conversations with their patients. Project ECHO is currently piloting a similar communication ECHO on Climate Change and Human Health to educate clinicians regarding how to communicate with their patients on the interrelatedness of the warming climate and health. Large organizations might also consider placing a short series of videos on their asynchronous “Learning Central” sites so that clinicians can watch scenarios of patient communication encounters regarding vaccination hesitancy. Smaller ambulatory clinics might decide to hold in-person or virtual round-table discussions to communicate the importance of COVID-19 vaccination with their patients to ensure the health of the clinic as well as the surrounding community. Finally, written educational material can be prepared by large medical organizations, such as the American Academy of Family Physicians, the American College of Physicians and the Centers for Disease Control and Prevention regarding COVID-19 vaccination communication strategies for patients. It is important to understand the potential impact that vaccine communication through daily clinical practices may have. While a multi-pronged approach to encourage vaccination is important, and would likely include social media, the role of important societal influencers, and the prosocial communication of returning to pre-pandemic experiences, the literature points to the critical importance of the clinical encounter. Throughout this pandemic, clinicians, and patients have been navigating this novel virus together, however, bringing a successful end to this pandemic will take enormous collaboration across the global community. Primary care clinicians can be trusted ambassadors for encouraging their patients to obtain the COVID-19 vaccine, but they would benefit greatly from receiving a brief training in vaccination communication skills. Clinicians can successfully act locally in their communities while understanding their value in the global campaign to combat this pandemic. Perhaps soon, we can remove vaccine hesitancy from the WHO’s list of top ten global threats and develop herd immunity with the COVID-19 vaccines. Today is the perfect opportunity for primary care clinicians and patients to work together towards the goal of eradication of the COVID-19 virus and a return to some sense of normalcy. 

