It’s time to talk about vaccine hesitancy

By Dr. Samantha Hill

I, and many doctors, have taken to social media and other channels, excited to receive the COVID-19 vaccine. But the other day in the operating room, a very smart and amazing scrub tech told me he doesn’t want to get the vaccine “just yet.” He wants to wait a year, to see if there are any unintended consequences. I was shocked. In fact, I initially thought he was joking. He wasn’t.

It’s a recurring conversation, and while this is surprising to me and many other doctors, it seems that there is a significant portion of the population that feels the same way.

Vaccine hesitancy is not new. In 2019, the World Health Organization called vaccine hesitancy one of the top ten global health threats. It said that vaccines prevent two to three million deaths yearly, a number that could increase by 1.5 million if worldwide coverage improved. That was before the COVID-19 pandemic swept across the world, devastating countries, economies and families.

With minimal currently accepted therapeutic options available to treat COVID and avert tragic outcomes, an ounce of prevention may be worth far more than a pound of cure. Of course, at present, prevention is all about adhering to public health measures of physical distancing, masking, and practising proper hand hygiene. But as vaccine supply becomes more widely available, getting as many people as possible vaccinated as rapidly as possible will become an essential part of Ontario’s recovery at all levels.

I’ve written before about the need to approach these conversations with empathy and openness. Polarizing human beings into pro-vax and anti-vax  camps only entrenches people in their positions and gets in the way of conversation, education, mutual understanding and respect.  Ultimately, as a society, we uphold body autonomy, free choice and the right to make — for ourselves — medical decisions that affect us. It gets tricky around vaccines of course, because our choices also affect others, their risks and their lives. For many, getting vaccinated is an expected part of our social contract as Canadians; the same contract that stops us at red lights even when we are in a rush and gives us access to schools and health care.

The urgency to vaccinate is rooted in the fact that we need to immunize approximately 65-70 per cent of the population as rapidly as possible to prevent unnecessary loss of life. It’s a massive venture and having individual conversations about risk and benefit is time consuming. It behooves us to examine some of the factors that play into this conversation.

Some of the mistrust surrounding vaccines stems from personal experiences, some of it relates to cultural experiences. Members of Black communities remember the Tuskegee experiment, an unethical 40-year study that left syphilis untreated in black men, who believed they were getting free health care.  Members of the Black community continue to experience persistent structural inequities daily in their health-care experiences. Members of our Indigenous communities remember residential schools and regularly experience disrespect toward their cultural medicines and attempts to impose non-Indigenous norms upon them. These are systemic issues reflecting fundamental issues around fairness and equity in health-care delivery. Difficult conversations and visible systemic actions to resolve the inequities must occur. Furthermore, “nothing about us without us” carries exceptional importance here — including community members with lived experiences in the planning and discussions is an essential element.

I’m not the first to raise these ideas and I won’t be the last. The Royal College of Physicians and Surgeons of Canada issued this statement on cultural safety guidance for clinicians during the pandemic. The First Nations Health Authority and Research Ethics BC have developed information on culturally safe and trauma-informed practices for researchers during COVID-19. The Canadian Foundation for Healthcare Improvement has also talked about the new reality of culturally safe practices during COVID.

Ensuring that vaccines are easily available is another key component to ensuring compliance. For many, being required to go to the hospitals charged with administering the COVID vaccines is incredibly inconvenient, required significant transit time and resulting in the loss of a day’s income.  Getting vaccinated must be easy and must not impose financial or other burdens.

We must also acknowledge the widespread misinformation surrounding the COVID vaccine. Social media has made it very hard to contain conversations to scientifically grounded fora. According to data collected by Advanced Symbolics Inc., misinformation about the COVID vaccine is spreading among all age groups in Ontario on social media. Doubts and misinformation about how thoroughly the vaccines were tested or the extend of side effects are being shared widely on social media, especially among people under 25 and those between 25 and 34.

The most interesting headlines and the most click-inducing links are ones that evoke emotional responses.  Unfortunately, this is a breeding ground for conspiracy theories and other misinformation. Even in the less extreme headlines, people argue they don’t need the vaccine because they aren’t at risk. They don’t seem to understand the impact of the long-term effects for those who survive COVID and they don’t seem to realize that getting vaccinated will save others’ lives — perhaps even those of loved ones.

Those who worry the vaccine was rolled out too quickly and isn’t safe need to understand that it was rigorously tested — possibly more so than many other vaccines prior to use — and that the ongoing collection of data demonstrates exceptional safety.

And those who worry that their underlying conditions may make it unsafe to get the vaccine need to know that there are very few contraindications and that they should talk to their doctor about their individual circumstances. Their trusted physicians are key in counselling and educating, as well as in administering vaccines.

As we move forward, supply will cease to be the limiting factor; getting vaccines into arms will depend on administration planning and population buy-in. For the sake of us all, I hope we will have already had these conversations with our patients, colleagues and leaders. Vaccination delays will cost lives. We’ve lost too many people already.

 Dr. Samantha Hill is a cardiac surgeon and President of the Ontario Medical Association