Defining vaccine hesitancy, understanding how to address it

Defining Vaccine Hesitancy

Despite their benefits, many barriers to vaccination — including access, convenience, and health history — can reduce the number of people willing to be vaccinated. According to a 2023 article in Plos One, common reasons for vaccine hesitancy include sociodemographic, occupational, health, and vaccine-related factors.

Although these factors do not necessarily denote a “hesitancy” to be vaccinated, patients who fall into any of these categories are often lumped together as “vaccine hesitant” patients.

Hatch was careful to mention people who are not getting vaccines rather than those who are hesitant to get vaccines or anti-vaxxers. While nearly everyone has heard or seen someone vehemently against vaccination on social media or in their community, Hatch explained that most unvaccinated patients are not against it.

As mainstream media focuses on anti-vaxxers and the complicated rhetoric surrounding this issue, it fails to acknowledge the number of people who didn’t get around to getting vaccinated. In an article for the New England Journal of Medicine, Hatch and her colleagues point out that access issues have received less attention than generalized vaccine hesitancy concerns.

“For example, 45% of adults do get a flu vaccine annually,” she explained, explaining that the remaining population who does not get vaccinated is not necessarily hesitant to get their vaccines. “That's a lot of people who don't know when they're due, and it sort of slips to the bottom of the list,” explained Hatch. “That's a problem that behavioral scientists are really interested in and think they can solve.”

The New England Journal of Medicine article emphasizes that vaccine hesitancy encompasses a broad range of attitudes toward vaccination, including vaccine-ready, vaccine-neutral, and vaccine-resistant patients.

Although the rhetoric around vaccine hesitancy during and after the COVID-19 pandemic suggests increased hesitancy rates, Hatch told Healthcare Strategies that flu immunization rates have remained relatively stable before and after the pandemic.

She reiterated that the primary problem is that people are unsure what they are due for and don’t necessarily encounter the vaccine at the right time.

Addressing Ongoing Concerns

Discussions around vaccine hesitancy are not enough on their own. Bringing awareness to the issue is important, but addressing it is what impacts public health.

“I admire what the CDC is doing today, which is thinking in terms of how we get public health [efforts] done through trusted doctors because that is the people that people listen to,” Hatch said.

Disseminating information through trusted sources may benefit patients by educating them on the importance of vaccines. However, these efforts cannot be limited to individual providers.

“One study showed that if every doctor did everything they needed to for all of their patients, doctors would be working 27 hours a day, which isn't realistic,” explained Hatch.

Discussing Risks of Forgoing Vaccination

Hatch explained to Healthcare Strategies that it is difficult to describe the risks and extensive dangers of not getting a vaccine to some patients.

Many research articles have emphasized the dangers of not getting vaccinated. For example, a recent article — adding to the arsenal of articles about the benefits of COVID-19 vaccines — showed that patients who had been vaccinated against COVID-19 were less likely to have an episode of heart disease or become very ill if they contracted the virus compared to those who were not vaccinated.

“The risk messaging is really scary to people. The benefit messaging is harder to explain in these simple, concise ways,” explained Hatch.

Ongoing and future efforts to address vaccine hesitancy should consider simplifying risk messaging without undermining the dangers of not getting vaccinated or the benefits of vaccines.

“There's been this tremendous focus on specific vaccine myths or ideas about vaccines that are cropping up in subpopulations,” noted Hatch. Those things are happening. There are groups doing great work to counteract that kind of messaging.”

Other groups of patients are hesitant, but this could be resolved with a few answers to their questions.

“The trusted doctor is the best source of information, but the trusted doctor would be working 27 hours if they did all the work. So, we need solutions that help amplify the voice of that individual doctor.”

Improving Convenience

Improving convivence and expanding access to vaccination may also improve vaccine uptake.

“We found that most people who had not been vaccinated and were coming to their doctor's visit were not hesitant. They just hadn't gotten it yet,” said Hatch. “If the vaccine had been there at the visit, they would have gotten it.”

Alongside her peers, Hatch pointed out in the article that some patients may have limited contact with the healthcare system unless an illness or injury arises, posing an access barrier. Other populations who may not access or may be hesitant to seek vaccination include patients who are uninsured, undocumented, or speak limited English.

By offering vaccines at multiple locations in the healthcare industry, including pharmacies and urgent care visits, more patients may be able to access vaccines when they are in contact with the healthcare system.

Additionally, providers and health systems can leverage tools to nudge patients toward vaccination. For example, consistent outreach campaigns and digital tools are some ways to improve patient outreach and messaging and urge vaccine uptake.

Regardless of the reason associated with hesitancy, the following remains true: as more eligible patients get vaccinated, public health improves, and the global spread of infectious disease is reduced. Developing the appropriate tools to vaccinate all eligible patients is a vast undertaking; however, basing efforts on existing behavioral research may improve outcomes.