Barriers to Influenza Immunizations


Chad Worz, PharmD, BCGP, FASCP, discusses how vaccine hesitancy and misinformation about flu vaccines create barriers to annual flu immunizations.

Rodney E. Rohde, PhD, MS, SM (ASCP) CM, SVCM, MBCM, FACSc: Dr [Chad] Worz, how has vaccine hesitancy and misinformation about flu vaccines specifically created barriers to annual flu immunizations in your experience?

Chad Worz, PharmD, BCGP, FASCP: When I think about it again, our members, the pharmacists I work with, are dealing with an older adult population, primarily over [age] 65, in assisted living settings, in nursing home settings, and in the community. I think that we have to do a good job making sure they understand the differences between flu and COVID-19 and RSV [respiratory syncytial virus] [vaccines]. There are groups of people who will get every vaccine you recommend. There are groups of people who will never get a vaccine you recommend. But I think what we’ve found in our setting is that when we turn it into, what would you do for your mom or dad? What would I do for my mom or dad? What would I do for my kids? Those kinds of statements help reduce some of that hesitancy. In long-term care, we got 90% of the residents of long-term care facilities vaccinated with the primary series. We’re up to, I think, just short of 60% from a booster perspective. A lot of people criticize that, but the reality is it’s 4 or 5 times higher than the national average, which means those conversations with people who are younger about their parents or grandparents are working to get their parents and grandparents vaccinated may not work for them, but at least they’re listening and they’re open and they’re recognizing, in the vulnerable group, we have to be more vigilant than we were in the past. Prior to COVID-19 when I was in practice at a nursing home, if we got 55% or 60% of the residents vaccinated for flu, we were happy. I look back at it now and say we were too complacent. We were just like, “Oh, we did a pretty good job.” Now I think you’re seeing people say, no, we’ve got to do better because we saw the outcome of not doing better in COVID-19. A lot of people lost their lives. A lot of people had serious bouts of COVID-19. I think it should be something that spurs us into better compliance with vaccines going forward, particularly in that older adult population.

Rodney E. Rohde, PhD, MS, SM (ASCP) CM, SVCM, MBCM, FACSc: It really gets back to what we’ve all been talking about. I personally like to use risk reduction. Whether it’s a vaccine, whether it’s hand [washing] hygiene, whether it’s isolation or physical distancing, all these things that have become common terminology now. It’s an interesting world. I mean, 3 years ago, people weren’t talking about herd immunity in the general public, and now they tend to think a little bit more about it. I think that conversation is so important....

Chad Worz, PharmD, BCGP, FASCP: I want to touch on risk reduction because I love that. Because I think when you look, especially in that nursing home world, where we created such a social isolation that people were visiting each other through plastic. They were looking through glass from the sliding glass door of the nursing home room. We probably went too far. We pushed too hard. We didn’t talk about it in terms of risk reduction. We talked about it in terms of absolutes. I think if we’re going to gain back the trust of people, we have to be realistic about risk reduction. Your mom or dad is at high risk of this. They need to get this vaccine. This might be the thing that alleviates the ability of you not to be able to see them. Those conversations need to happen in a way that’s engaging and not mandated.

Rodney E. Rohde, PhD, MS, SM (ASCP) CM, SVCM, MBCM, FACSc: [I]totally agree. And if you are going to get to meet them, maybe there are some other measures you can spread out a little bit in the room, some air changing going on.

Chad Worz, PharmD, BCGP, FASCP: And as I said, we have to be more realistic, too. [Consider a case where,] my mom’s dying; I don’t think it’s fair for her to die alone through a glass window.

Rodney E. Rohde, PhD, MS, SM (ASCP) CM, SVCM, MBCM, FACSc: [I]couldn’t agree more.

Chad Worz, PharmD, BCGP, FASCP: And to your point, here’s what you should do if you’re going to take that risk, or if you’re going to be a little bit more risky with your activity.

Randy McDonough, PharmD, MS, BCGP, BCPS, FAPhA: One thing I want to add to that, too, is I think the role of health care providers, and I’ll talk about pharmacy in particular, is that is being the advocate for the patient and that advocacy role, and you should take that seriously. I tell people that I really didn’t understand what that meant until I became the power of attorney for health decisions, for family members. All of a sudden, it was on me to make that decision about what needed to be done to keep them alive and keep them healthy. I said once you understand that, now you know this is what you should be doing with every single patient. You should be taking that kind of attitude because you are their advocate and you need to make sure we talk about pharmacy and medication-related problems. Not getting a vaccine is a medication-related problem, and we [have] got to make sure they get it.

Chad Worz, PharmD, BCGP, FASCP: Again, I like using the mom or dad [example]. I mean, fortunately, my parents are still alive. So I use that with patients, with people. This is what I did for my dad. This is the decision I made for my dad. He’s like your dad or your mom in this way. Those things are powerful.

Rodney E. Rohde, PhD, MS, SM (ASCP) CM, SVCM, MBCM, FACSc: They are. I know, so powerful. My mom, who is 76, is fortunate to still be living. My dad’s 82, living. In spring 2020, when the pandemic hit, my mom was diagnosed with a gastrointestinal stromal tumor. If you want to learn about how people feel, make it your loved one. So, I had to drop my mom off for surgery on that tumor alone, in tears. Open the door, “See you later, Mom.” Two weeks later, we picked her up. Thank goodness everything went well. But that really impacted me, and it’s probably why I’m here, in all honesty, talking to you gentlemen. Because at some level, that’s the stuff you have to talk to people about. Whatever your experience is because they’re people.

Transcript edited for clarity.

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