Key opinion leaders traverse the challenges associated with vaccine hesitancy.
Ryan Haumschild, PharmD, MS, MBA: We’ve talked a lot about vaccine hesitancy during this discussion. There’s not 1 provider or pharmacist out there who hasn’t dealt with vaccine fatigue, especially among older adults, who have a lot of new recommendations coming their way. We want to make sure they’re preventive and that we have the right vaccines and schedule. But sometimes patients might be a little resistant. It’s not because they’re trying to be difficult. At some point, they’re going to say, “I’ve had enough vaccines. Can I have a break?” Or they may have a little distrust with a vaccine, especially with a new 1. Dr Bridgman, you have a lot of experience in this area because you’re interacting with older patients or patients in general. How do you engage and educate them, emphasizing the benefits associated with immunizing against RSV [respiratory syncytial virus] given where we are in the vaccine landscape?
Mary Bridgeman, PharmD, BCPS, BCGP, FASCP: I’m of the opinion that vaccine confidence exists on a continuum. Oftentimes, our early adopters are patients who, when a new product is available, are at the front of the line: “Sign me up, because I recognize the potential value of vaccines on my health.” On the other end, some patients will never accept a vaccine product or recommendation. As pharmacists, we often have the greatest impact on individuals who are somewhere in the middle, who need some information and are in that contemplative stage, who want information to make an informed health decision. That’s where these educational campaigns are likely to have a tremendous impact. Individuals may not be aware of some of the risks associated with severe RSV infection or have awareness of a new vaccine product. There’s a lot to be said for education in this space for patients. Also, addressing vaccine confidence is never a 1-size-fits-all approach. As health care providers, we need to be able to create safe spaces so our patients can ask the questions and make informed health decisions.
Christina Madison, PharmD, FCCP, AAHIVP: You were kind enough during my introduction to mention that I had done a TED Talk. One of the things I talked about when I was on stage was around the power of messaging and who’s doing the messaging. When we talk about vaccine confidence and when patients feel confident making decisions, that’s when they talk to their family members and their friends. If the individuals around them are getting it, then the acceptance is there. Then it’s your health care professional. It reminds me of a story about my grandmother. When I graduated from pharmacy school, she was very proud. She knew I was going to be the best pharmacist ever. But when it came down to her vaccinations, she trusted her local pharmacist, who happened to be my classmate. I’m like, “You trust Daniel, but you don’t trust me?” [She said] “It’s not the same, honey. I’m going to go to Daniel.” Don’t underestimate the loyalty you get when you have that relationship and that rapport, particularly with our more seasoned individuals. Because of that regularity, you become part of the family. I wanted to point that out because I love coming from a place of confidence and not branding, particularly for our historically marginalized populations, who are hesitant. Ask them why and if it’s OK to have that conversation. Ask them permission. Is it OK for me to provide you with some information? I know you might have some thoughts about this because you’ve heard some things on the news, on Facebook, or wherever. Let me at least provide you with the facts. Whatever you do with those facts is up to you, but I’ll be here when you decide to come back.
Mary Bridgeman, PharmD, BCPS, BCGP, FASCP: I love that you talked about the relationship that’s formed. There’s something to be said for putting that sharp, pointy object in somebody’s arm. I love to convey that to our student pharmacists as well.
Ryan Haumschild, PharmD, MS, MBA: I spent some time during the pandemic trying to demystify questions about the COVID-19 vaccine. I spent time in communities where patients were the most hesitant, just to connect with them. But we saw that there was a lot of misinformation out there, and that continues to be vetted. Dr Madison, you do a lot of connection work with patients and advocacy. Do you anticipate misinformation spreading about RSV the way it has with COVID-19? Is there any way that we can minimize it on the front end?
Christina Madison, PharmD, FCCP, AAHIVP: In general, we’re dealing with challenges around vaccinations. We see a very strong anti-vaxxer movement in this country that has gotten to the point that we’re seeing a huge reduction in pediatric patients getting their regular vaccinations. We may be in jeopardy of losing herd immunity, which is really scary. We’ve almost eliminated some of these childhood diseases, but now we’re seeing things like meningitis outbreaks and polio. That’s crazy. We need to look at this from the standpoint that all vaccinations are in jeopardy because of misinformation. Just give the facts, the information about why is this recommended and what this is going to help prevent. What is your why? Is it the difference between being able to go out and play with their grandchild or go on vacation? What are their why? What do they want? Why do they want to be healthy? Why do they want to be well? That’s what we need to focus on and connect it to, hopefully with care and compassion. Because these aren’t numbers. These are individuals deserving of care and compassion, and we need them to understand the benefits. We also need to be there to answer questions about why they think this might not be the best option for them. I don’t think there will be the amount of misinformation that we saw with COVID-19.
My colleague earlier talked about the timeline. These vaccines have been in development for almost 2 decades. Because you saw that delay in time to conception vs time to approval, I don’t think you’re going to see the same amount of friction that you saw with COVID-19… It’s a more traditional line as far as having that antigen effect and not seeing the mRNA, even though we see mRNA as part of this picture at some point. But that was part of it. There was a novel mechanism of action and a timeline that was so accelerated. I don’t see either of those being a challenge. But we need to get out in front of it, get the messaging out now: “Did you know that we had all these patients who ended up with RSV and complications? Did you know that a new vaccine could prevent that? Wouldn’t that be great?”
Adam C. Welch, PharmD, MBA, FAPhA: I’m optimistic for the reasons you said, but this 1 is going to be different from COVID-19. The COVID-19 vaccine came out authorized. This is going to be approved. We’re not authorizing it to meet an urgent need. These vaccines achieved breakthrough therapy designation, which means they’re fast-tracked to a certain point within the FDA, but they’re still going to come out with FDA approval rather than authorization. Those recommendations aren’t going to change nearly as much as they did with COVID-19. Some of the fatigue from patients saying, “What’s the recommendation today?” It’s changed. In April, COVID-19 recommendations changed again. We’re less likely to see the recommendation change.
The data are out for 1 year of RSV. What we don’t know—the studies are ongoing—is whether that 1 injection will provide protection over more than 1 RSV season. There are cohorts of the original studies published are looking at that, but those data will be out within the next couple of years. Or is this going to be an annual vaccine given each flu season? That may be the case, but we’re not going to see the changing of recommendation, which contributes to fatigue. Sometimes both providers say, “We have to find the newest information.” Patients hear on the nightly news that things have changed. “Am I up to date? Do I need a fourth, fifth, or sixth dose of this vaccine?”
Christina Madison, PharmD, FCCP, AAHIVP: There’s no need to stress. You can go to your friendly pharmacist.
Adam C. Welch, PharmD, MBA, FAPhA: Yes, you can go to your friendly pharmacist. I’m optimistic for those reasons that RSV will be different from COVID-19.
Transcript edited for clarity.