The Deeper Dig is a biweekly podcast from the VTDigger newsroom, hosted and produced by Sam Gale Rosen. Listen below, and subscribe on Apple Podcasts, Google Play, Spotify or anywhere you listen to podcasts.
With experts warning that the U.S. may be unlikely to reach herd immunity from Covid-19, health officials are increasingly focused on reaching people who are reluctant to get a vaccine.
That population in Vermont may be small. The state has one of the highest rates of Covid-19 vaccine acceptance in the country, according to federal data from April. But at least 7% of adults said they’re not sure about the vaccine or don’t plan to get it.
For months, doctors have been urging those Vermonters to reconsider. In routine visits with patients, primary care physicians have been on the front lines of combating vaccine hesitancy.
The conversations can be emotionally and politically charged, they say, and some patients may remain unconvinced. But many people with concerns about the vaccine come away with a more open mind.
“It’s actually very similar to the way that I ask about smoking,” said Heather Stein, the chief medical officer for Community Health Centers of Burlington. “I ask people if they’re smoking, and then I also ask, ‘Can I talk you out of it?’ It’s sort of similar: ‘Can I talk you into getting the vaccine?’”
On this week’s podcast, Stein; Alison Landrey, a primary care physician at Northern Counties Health Care; and Jill Blumberg, a family practitioner at White River Family Practice, describe how they’re approaching difficult conversations about the vaccine — and what others can learn from their approach. Below is a partial transcript, edited for length and clarity.
What do you see as your role in the vaccine rollout?
Alison Landrey: Everybody who comes into the office, we ask, “Have you signed up for your Covid vaccine? Have you gotten your Covid vaccine?”
Most people say, “Oh, yeah, I went and got it, and it went really well.” Then it comes up and people say, “No, I’m not sure that I want it.” Or, there’s a handful of people who really have been a firm “no” and don’t want to talk to me about it. I’ve had a couple of people who have totally shut down and said, “don’t say anything more about it. I’m not getting the vaccine,” and there really was no opening for me. That’s the vast minority.
There’s a group in between those two extremes: the people who really aren’t really sure if it’s safe for them, have questions, have heard different things and are looking for some guidance or are open to some guidance — and have some trust and in my professional opinion and expertise.
Heather Stein: The greatest power of the primary care relationship is that patients know us. We know about the surgery they had last year. We know what medications they take. We know how they reacted to a vaccine previously. So it enables us to talk to people about their own personal risk-benefit ratio for something like a vaccine, which can seem very new and sometimes a little bit scary — especially if it’s something that they’ve never had before.
It’s actually very similar to the way that I ask about smoking. I ask people if they’re smoking. And then I also ask, “Can I talk you out of it?” It’s sort of similar: “Can I talk you into getting the vaccine?” And if it’s a really obvious “no,” then we move on because that’s probably not going to be a productive conversation, and it’s not really meeting their goals for the visit. But in a lot of cases, they may be ambivalent or just have questions, but maybe didn’t know that they could ask them to me.
Jill Blumberg: We’ve actually been gearing up for months. We did not know at the beginning whether we would be giving out vaccines. So we did actually spend quite a bit of time thinking about how we might be able to coordinate that. And then it has become apparent that we are not in that position — that instead, we are potentially a really good resource for people who have questions about the vaccines.
What concerns are you hearing most often?
Jill Blumberg: We’ve had lots of conversations with individuals who are waiting. We have been told that they feel uncomfortable that the vaccines came out so quickly. Some people are worried about the long-term effects. And some people just don’t feel they personally would be that affected if they got the coronavirus. And so they just are not that enthusiastic. And then we do have some patients who are worried about things that they found online that we can easily dispel, things like “the vaccines are going to change my DNA.”
Heather Stein: In most cases people have heard about post-vaccine reactions, and they want to know whether or not they’re going to have them. So, “is it going to make me sick? And how long is it going to make me sick?” And that’s something that we can’t predict 100% of the time. But we can definitely give people realistic expectations.
I was just speaking with a patient before I came in who was scheduled to get their second vaccine here in the next week. And they’ve heard that the second vaccine has a lot more side effects or that people have more of a reaction. So we talked through what to expect: It probably won’t be anything right away, but at 12 to 24 hours, you might feel like you’ve got flu-like symptoms. And this is what I would suggest to deal with symptoms. And this is when you can expect for them to be gone and to call us if you have any questions.
Alison Landrey: One of the more common ones I’m hearing is concerns about long-term safety. They say, “Well, it hasn’t been around very long. We don’t know how safe it is. How do I know it won’t affect me down the road?” And, “We just don’t have enough information.” So I can address that and really reassure them about the safety there.
One of the things is that technology for this vaccine has been around a long time. So we do have a lot of information about how the vaccine was developed. And long-term safety is excellent for that type of technology. Other vaccines that we’ve used using similar technology haven’t shown any long-term safety issues, and so there’s no reason to think that there might be. It’s just not a concern that we have.
Heather Stein: The being new is definitely an issue for some. That’s a little bit more of a conversation to work through: “Yes, it is a new vaccine, and it’s been approved under emergency use authorization, but I got it myself. My family members have all gotten it. It’s something that I trust, having reviewed the information, and I would say I strongly recommend it for you because I care about you, and I want you to stay safe. So I would really recommend that you get this even though it’s something that was just created in the last year.”
And often if there’s someone who gets the flu shot on a regular basis — even though yes, getting the flu shot is something that you do every year, the actual vaccine is often a little bit different every year. So that doesn’t feel so unfamiliar.
Jill Blumberg: The one that I’ve heard has been people are worried about the vaccines changing their DNA. And for that strategy, I’ve basically just asked permission and said, “Hey, do you want to take some time and actually talk about how it works? Because I can explain to you how it works and how you do not need to worry about this changing your DNA.”
I had a patient of mine I’ve known for a long time, and we kind of went through how everything works. And she’s like, “I remember this from biology in high school.” I was able to explain how the mRNA comes in, why it doesn’t affect the DNA long term, how the components of the vaccine are basically gone within a couple of days and what remains is the body’s response.
Different people want to know different things about it. So in her case, just explaining how the vaccine worked was quite helpful.
Are these conversations effective?
Heather Stein: In some cases. There’s definitely some people who have more ambivalence, or they’ve heard more or different stories, or maybe there’s even concerns that they have that they don’t raise with me, but they’re going to go back and think about later.
I’m not going to be disappointed if I have a conversation with somebody, and they don’t decide that they want to get the vaccine while they’re in the room with me. People, if they’re making a good decision for themselves, don’t do it in an instant. They think about it for a little bit, and maybe they’ll read a little bit more, and maybe they’ll talk to somebody else. So this is oftentimes just one piece of information that they’re going to use to make their decision. But I hope that we are a trusted source for them and that we’re giving them information that resonates with their goals.
Jill Blumberg: Overall, I think my patients are great. They make great decisions. I have to trust that. It happens in every area of medicine that I’m a consultant. And so I’m just hoping to take somebody who was against the vaccine and just have them think about it a little bit more — and certainly touch base with them the next time I see them — but this is a choice for people now. I have to leave it up to them.
How do you respond differently to people in those two groups: the in-between people and the people who give a hard “no”?
Alison Landrey: First of all, I think exploring what the questions are and what the perspective may be — maybe they have heard some information that I can help understand where that’s coming from, or they’ve had bad experiences with vaccines in the past, or they’ve heard stories. So trying to tease out where the reluctance toward the vaccine is coming from and understand where it’s coming from.
Also, I think it is important somewhat to normalize that. It’s normal to have questions about it and not be totally sure — and not make them feel badly that they’re not interested or whatever. And so I try to respond to this in the same way to both of those groups.
But that small minority that’s the hard “no”… are the people that really are not receptive to back-and-forth conversation about it. I think it’s really only been like three people that I’ve had that particular experience with, and you’re going to have some that just are not interested no matter what you talk to them about.
Heather Stein: If people state that they are absolutely not interested in getting the vaccine no matter what, it would be rude and not very therapeutic if I sort of kept poking at that. So I’ll usually make a general statement that I got the vaccine, I strongly recommend it for health promotion, and I’m happy to answer any questions — but it’s your body and you’re absolutely entitled to make decisions about yourself and your own health choices.
Every once in a while, somebody, even though they made a pretty dramatic “no” statement in the beginning, will then follow up and actually have questions. And then we can have a real discussion about whatever their concern might be and whether or not it’s one that is something that could happen.
Like, the clots after the Johnson & Johnson vaccine — that is a real, incredibly rare risk. So I think that’s something that we can talk about. And then there are other risks that are really not based in science, like the concern about 5G, or tracking, or infertility. All of those things either don’t have basis in how vaccines are developed, or they’ve been disproven and really don’t make sense. So I can give that information, and they’ll walk away and think about that and maybe search for more information on their own.
Alison Landrey: It’s just sometimes upsetting to still hear people say, “Well, you know, the Covid virus itself isn’t real.” Those are those, like, three people who just totally have misinformation coming at them from wherever sources they’re looking at or whatever community they’re in. And they really think this is all either a conspiracy, or it’s overblown and that the coronavirus itself is not harmful. And that’s disappointing.
Heather Stein: I was speaking with a gentleman — I was on call over the weekend, and I just happened to ask him about the vaccine while I had him on the phone. His background was, he had come from Eastern Europe, and while his wife had gotten the vaccine, his parents and he had this deeply ingrained distrust of vaccinations. And that has to do with historic events that happened in Eastern Europe, where, in some cases, some vaccines that were rolled out were not well tested, or there were other things going on. It came from a very reasonable place. So he was one who was very ambivalent — actually said, “I’m 50/50.” So we had a good conversation about that, and he took away a little bit of information.
Alison Landrey: One other concern that comes up among the vaccine hesitant conversations is sort of like, “Oh, I don’t really need it.” You hear that from people sometimes who say, “Well, I’m isolated as it is. I don’t see a lot of people. I’m not concerned about my own risk.” And sort of trying to get that public health message across: The more people we vaccinate, the sooner we can lift some of those restrictions on everybody. We may not have to wear masks in the future if enough people get vaccinated.
I try to think about, “OK, well, what’s something that you used to do before the pandemic that maybe you aren’t doing now that you’d like to do again? … Wouldn’t it be nice to be able to go hear some music in the park without a mask?”
As a doctor, you have a certain degree of authority with patients. What are some strategies that might help the rest of us talk to folks in our lives who have similar concerns?
Heather Stein: That can be a really challenging conversation to have because we care personally about our family members. Part of what makes me effective in counseling patients is that I care personally about them, but I’m also not going to be really upset if they don’t choose to get it today — which with a family member, you might be. Because you’re not just worried about them over the next year or two years or three years. You’re worried about them next weekend. They’re somebody that is a close person to you.
So I would say that one of the most important things is actually just checking how much emotion you’re going into that conversation with because any emotionally charged conversation is going to be that much harder. Whereas if you actually come from a place of caring personally about the person you’re talking to and trying to assess what their goals are, and then whether or not the vaccine fits with their goals — like if you just told me that you want to travel: “Can I give you a little bit information about what travel is going to look like over the next couple of years? You may actually have to have a vaccine, or you might have to get uncomfortable testing every time you want to travel.” That may actually be the thing that motivates some people.
For other people, it may be talking about, you know, “My kids can’t get vaccinated yet, so Aunt Jo, I really don’t want you to come to the house until I can make sure that you’re not going to potentially bring something for the kiddos. We absolutely want to connect with you. We’re going to connect with you over FaceTime, but I’m not ready for you to come to the house.
“Do you have any questions about the vaccine? Because I got it, and this is what helped me make my decision.”
Coming from a place of prejudging the person that you’re talking to and where they might have gotten their information or what they might be worried about, is probably not going to set you up for success.
Jill Blumberg: I think what people tell the people that they love — that does make a huge difference. I feel my biggest connection comes when I just tell people how excited I was to get it myself and that I did it, and I’m really glad. How relieved I was when my 80-year-old dad was fully vaccinated. And I think those stories do break through, hopefully, eventually.
