With fall approaching, the Centers for Disease Control and Prevention is gearing up efforts to promote three respiratory virus vaccines this year—annual flu shots, new RSV vaccines, and updated COVID-19 shots—and the agency’s plans include confronting vaccine skepticism and hesitancy head-on.
In a presentation to clinicians on Tuesday, the CDC laid out its general recommendations for the use of those vaccines and ended with its four-step strategy to persuade patients swayed by anti-vaccine talking points to come back over to the side of science and public health.
The strategy, developed by the CDC in partnership with experts at the American Psychological Association, isn’t new, but it has become increasingly needed as anti-vaccine misinformation and disinformation gained further ground during the pandemic. Even now, conservative politicians and officials continue to spread misinformation and skepticism about COVID-19 vaccines, leading to a sharp partisan divide in vaccination uptake and intentions.
Still, multiple studies have demonstrated that health care providers and their staff are the most trusted sources for health care information, including vaccines, Nurse Educator JoEllen Wolicki noted in today’s presentation. This gives them one of the best chances to sway patients’ thinking—and the CDC’s strategy aims to help them do so effectively.
The baseline requirement for this to work is to have health care providers strongly endorse vaccination, which—sadly—isn’t always the case. Some, in fact, have spread ridiculous falsehoods, such as that vaccines can cause people to become magnetic. But, assuming a clinician hasn’t bought into anti-vaccine nonsense themselves, there’s an opportunity there.
First, according to the CDC, a clinician should start from a presumptive position—strongly recommend vaccination and then presume the patient is already on board. If they’re not, that’s when the four-steps begin.
Step 1: Embrace empathy and collaboration. Clinicians should be sensitive to all cultural, family-based, and circumstantial reasons someone might be hesitant to get vaccinated. Most importantly, this step is for listening. Do not argue or debate; that does not work, Wolicki warned.
Step 2: Ask permission to share information. This is the step where the clinician tries to get the green light to try to do some persuading. If the patient says they’re not open to getting more information or having a discussion, clinicians should try to get the patient to open up about why that’s the case. If the final answer remains a firm ‘no,’ then the clinician should respect that and back off, but try to keep a foot in the door by saying something like, “Maybe we could talk about the vaccine at your next visit?”
Step 3: Motivational interviewing. If the clinician gets the go-ahead to talk more about vaccines, then they should take a motivational interviewing approach, which aims to use a patient’s goals, values, and motivations to negotiate a way to achieve them. A good way to start the conversation is with a scaled question, such as “On a scale of one to 10, how likely are you to get a COVID-19 vaccine?” Then, the clinician can explore both sides of whatever the number is. For this, the CDC warns against yes/no questions and instead recommends asking open-ended questions, such as “Why did you choose this number?” and “What would it take to get to a higher number?“
The goal is to get them to talk out their thinking because this can change how they process their choices and “can develop forward momentum,” the CDC says. The agency notes that most vaccine-hesitant people have practice talking about their concerns, but they don’t have practice talking through the benefits of vaccination, so it’s useful to try to reverse their thinking there. In the course of the discussion, the CDC recommends clinicians affirm positive behaviors, like if the patient says they have gotten a flu shot in the past—”That’s great!“—and reflect on what they’re saying—”It sounds like you have questions.” Last, the CDC recommends summarizing the patient’s perspective back to the patient.
Step 4: Respond to questions. If the patient raised questions in step 3 about vaccine safety, risk, or their individual health, the clinician should answer them and reframe vaccine data for the patient’s individual risk, e.g., “Based on your health, you are at an increased risk of getting very sick, and in the group the vaccine will most benefit.” If a clinician isn’t sure about an answer, they should talk through how to find good sources of information.
It’s unclear how effective this strategy will be overall in the coming respiratory virus season. But the CDC notes that clinicians “play a vital role” in ensuring people get recommended vaccinations, particularly older adults most at risk from influenza, COVID-19, and RSV. In a recent poll, 57 percent of US adults said they intended to get the updated COVID-19 vaccine, a large increase from the actual uptake of the last booster. CDC Director Mandy Cohen is currently on a national “trust tour” amid the COVID-19 vaccine rollout, working to rebuild the reputation of the country’s health agency and fight back against misinformation, including skepticism of vaccines.