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How to Talk to a Vaccine Skeptic

July 14, 2021
A nurse explaining the vaccine to a patient

At first Steve Morrow, the 48-year-old founder of a sporting goods company in Gilbert, AZ, was waiting to see how others responded to the COVID-19 vaccine before getting a shot himself. He was worried about side effects like blood clots. But as time passed, “It then became a bit of a pride thing,” he muses. “If I haven’t had COVID yet, why would I get it now? And I probably don’t need a vaccine.”

It wasn’t until a friend had a massive stroke in June, likely related to his COVID-19 infection, that Morrow finally rolled up his sleeve. “That is what put me over the edge,” he says. “I figured if there is a connection between COVID and his stroke, then I should take precautions.”

After months of working out the logistics of getting shots in arms and trying to meet the overwhelming demand when vaccines were scarce, health officials now face an entirely new challenge: convincing vaccine holdouts like Morrow to take the plunge. 

“As we hit this point in the rollout, when 50% to 70% of adults have had at least one dose, it’s just going to get harder,” says Alison M. Buttenheim, PhD, MBA, scientific director for the Center for Health Incentives and Behavioral Economics at the University of Pennsylvania. “What’s going to work are repeated, sustained one-on-one conversations with people.” 

That suggests that physicians can play a significant role in closing the vaccination gap. In fact, says Mark R. Miller, vice president of communications for the de Beaumont Foundation, “We consistently see in the research that doctors are the most trusted source of this kind of information.”  Miller points to de Beaumont Foundation’s guide for building trust in COVID-19 vaccines as a useful resource.

Fortunately, opportunities are ripe. “There are still a lot of people who are open to being vaccinated and haven’t been vaccinated yet,” adds Tom Frieden, MD, former director of the CDC and currently CEO of Resolve to Save Lives, an initiative to prevent pandemics and cardiovascular disease. “Every health care visit is an opportunity to provide or promote a vaccine.”

What’s the best way to talk to someone who is on the fence?

Start by listening

Resist piling on the facts. “Patients don’t want to be lectured or marketed to,” says Miller. “They don’t want to feel like it’s a campaign.”

Find out what they are concerned about instead. “What are the reasons that they’re voicing?” says Frieden. “Then try to empathize with those reasons and validate what they’re feeling.”

“Don’t lead with, ‘Here, I’m going to tell you all the reasons why you should get vaccinated,’ but begin with, ‘What’s going on? Tell me about where you are with this?’” suggests Buttenheim.

Customize the conversation

“At this point people are getting information overload,” says M.A. “Tonette” Krousel-Wood, MD, MSPH, president of the American College of Preventive Medicine, which has launched a Vaccine Confidence campaign. “So you want to give them the information that’s most important for them to know as individuals.”

If someone is worried about side effects like blood clots or myocarditis, for example, address those concerns. Likewise, if they are in the “wait-and-see” phase, Buttenheim says, ask them what they are waiting for. “If they’re waiting to see if it’s safe, remind them that we now have hundreds of millions of doses in arms,” she says.

Focus on where you can make a difference

Not everyone is receptive to discussing COVID vaccines. So, focus your efforts where it counts.

“What we have found is that there is a small proportion of people, 1% to 10%, who are really dug in and arguing with them just makes them dig in deeper,” says Frieden. “So we look at the ‘moveable middle’ (between those already vaccinated and those who won’t vaccinate) and focus on that group for what we need to do.”

Don’t lead with fear

While it’s important to acknowledge and validate the fear that people are experiencing, try not to promote it, says Wen-Ying Sylvia Chou, PhD, MPH, program director in the Health Communication and Informatics Research Branch of the National Cancer Institute, who has researched social media misinformation.

“Research shows that fear makes you vulnerable to misinformation,” Chou says. “Anti-vaccine messages have been successful because a lot of them are fear-based appeals.”

A more optimistic approach may get you further. “We suggest promoting positive emotions, with messages of hope, togetherness, love and connection, and the prospect of resuming social activities,” Chou says.

Personalize persuasion

Certain kinds of messaging seem to be particularly effective at getting shots into arms, experts say. One is personalizing your own vaccination experience. 

“You can say, ‘I was hesitant too, and I changed my mind, and here’s what made me change my mind,’” suggests Buttenheim. “This can be powerful coming from a health care provider. You bring the person along in your own decision process.”  

For months, Darcy Vierow, 44, founder of a travel planning website, had qualms about getting vaccinated. She finally asked her doctor about it.

“She shared with me that she and all her family had gotten the vaccine and had no issues with bad side effects, and she was confident that I would also tolerate the vaccine well,” says Vierow, who lives in Greenville, SC. “I made an appointment immediately.”

Emphasize the safety over effectiveness

“There are a lot of people who believe that vaccines work in preventing COVID, but that they’re not safe,” says Miller. “One of the things that seems to work well is comparing the unknown risks of the vaccine with the known long-term effects of COVID.” After all, even young people who are otherwise healthy may experience long-term COVID effects.

In fact, a new study from Resolve to Save Lives suggests that educating people about long COVID may be effective at getting people to roll up their sleeves. After learning about long COVID symptoms like fatigue, brain fog, and gastrointestinal problems, 32% of unvaccinated people said they were more likely to consider getting the shot. (That number rose to 39% when people were shown video testimonials from long haulers.) 

“If a doctor were to say, ‘You know, my patient who I saw this morning is still suffering with brain fog, headaches, and shortness of breath four months after COVID,’ that might convince the reluctant patient to get vaccinated,” says Frieden.

It worked for Stacy Harris, a music industry publicist in Nashville, who was concerned that drug makers had cut corners to develop COVID vaccines so quickly. Ultimately, she decided that getting vaccinated was preferable to the chilling prospect of becoming a long hauler.

Rinse and Repeat

Keep in mind that it may take several no’s to get to yes. Trying again or multiple times can eventually lead to success.

“You may not get to a place where the person is ready to make a decision at the end of one conversation,” says Buttenheim. “Be open to circling back in another visit. I’ve seen many people change their minds over time.”

Vaccine Talking Points

These facts seem to resonate powerfully with people who are unsure about the vaccines, Frieden says:

  • The risks of infection are vastly higher than the risks from vaccination.
  • Even healthy young people can get severely ill, die, or have long-term harm from COVID-19 infection.
  • COVID-19 vaccines don’t stay in your body. They teach your immune system to fight the virus and then they disappear. In contrast, if you get COVID, you’re going to have billions and billions of copies of the virus all over your body for at least 7-10 days.
  • Nearly every doctor who has been offered a COVID vaccine got it as soon as they could.
  • The more of us who get vaccinated, the faster we can get back our jobs and rebuild our economy.
  • In the coming months, vaccinations can save the lives of at least 100,000 Americans who would otherwise be killed by COVID-19.