Obstacles Impacting Compliance with Immunization Schedule


Pharmacists highlight patient hesitations surrounding vaccinations and offer a multitude of approaches for alleviating these concerns.

Ed Cohen, PharmD, FAPhA: Mary, can you articulate further on the discussions that we’ve had, the levels of hesitancy that we’re seeing today?

Mary Bridgeman, PharmD, BCPS, BCGP: Absolutely. Vaccine hesitancy is a delay in acceptance or refusal of vaccines despite the availability of vaccination services. You have the ability to become immunized if you choose and maybe you’re deciding not to. Vaccine hesitancy is a complex and context-specific issue that can vary across time, place, and even vaccine. We have individuals who are accepting of some vaccines and not others for a multitude of reasons. As I alluded to, there are many factors and structural barriers. There are patient, provider, and operational factors that go into this issue of hesitancy. That can influence patients’ feeling confident or hesitant to receive a vaccine or, in some cases, multiple vaccines.

Ed, as you mentioned, vaccine hesitancy isn’t new, and it certainly isn’t a manifestation that’s exclusively arising from the COVID-19 pandemic. However, COVID-19 brought to light these multifaceted aspects and drivers of uptake and acceptance of vaccination or immunization. The World Health Organization declared vaccine hesitancy as one of the major threats to global public health in 2019, prior to the pandemic. Of course, we’ve seen outbreaks of measles and other communicable diseases across the country for the past several years, due at least in part to an increase in individuals seeking nonmedical waivers and other exemptions from state-mandated or school-mandated vaccine requirements. You talked a little about required vs recommended. That’s where vaccine requirements can help with regard to boosting a population’s immunity.

We can all probably reflect on manifestations that we’ve encountered in our own practices with regard to vaccine hesitancy. “Do I really need that flu shot every year? It’s never a good match. How come I should get it?” I can think of so many. “I got the flu from my influenza vaccine. Why should I bother with it again?” When [individuals] get COVID-19 after being immunized, does that illustrate that these vaccines don’t work? In our practices, we’ve all faced varying levels of hesitancy among the patients we serve. We need to recognize it and think about the approaches we can take to influence those beliefs.

The best strategies for addressing hesitancy are with some of our motivational interviewing techniques, exploring why an individual is reluctant or hesitant to receive a particular vaccine, and then, as professionals, reflecting and responding to those concerns. Earlier, we talked a little about trust. It’s a matter of trust and dispelling some of the false beliefs that seem to bubble up on your social media feed. When you search a false belief, it seems like you’re inundated with more of those beliefs that support your assertions or perspectives.

We can also follow our sharing of information with a positive recommendation as a way of closing some of these encounters, because that’s an important influencer in addressing vaccine hesitancy. It’s also important to call out and recognize that vaccine hesitancy is a continuum. It’s a spectrum of early adopters who are first in line and happy to get that vaccine, all the way through the never-vaxxers. The literature suggests that it’s nearly impossible to shift the perspectives of never-vaxxers. It’s certainly our ability to influence the health care decisions of those who are perhaps ambivalent, who maybe want to refuse the vaccine but aren’t sure of that decision, or those who are agreeing to receive the vaccine but don’t feel confident in their decision to do so. As pharmacists, that’s where we’re well positioned to support and reiterate for those individuals their choice.

Ed Cohen, PharmD, FAPhA: The flu season is right around the corner. It’s almost August 1, and the flu vaccine will start flowing into some of the pharmacies. A lot of what we’re seeing with COVID-19 doesn’t transition over into the flu [vaccine] because the customers and patients are still coming to the pharmacy and saying, “I’m here for my flu shot.” One percent of [individuals] call up and ask whether we have a certain brand or type. “I heard there’s a senior vaccine. Should I get the senior vaccine?” They don’t know the names. They aren’t paying attention to the technology, or they traditionally haven’t, but will they as we go forward? Will we see a more educated flu [vaccine] patient coming to the pharmacy? Or will it just be the same, “I’m here for my flu shot?”

Traci Poole, PharmD, BCACP, BCGP: I think it’s going to be the same. You’re going to have a small percentage of patients who have decided to take responsibility for their care and paid attention to the vaccine development and how this all works, but because flu vaccines are so common and have been around for so long, I don’t think the majority of the population will scrutinize the flu vaccines. We’ll go backward. If there’s a new flu vaccine, new technology employed, or a combination flu–COVID-19 [vaccine] in the future, then that may potentially be the case. But I think it’ll be a smaller percentage of the population than we anticipate. “All right, is it cell-based? Is it protein-based? How are the vaccines made?” I don’t think we’re going to see a lot of that.

Transcript edited for clarity.

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