Addressing COVID-19 Vaccination Hesitation as a Pharmacist

Pharmacists have not always been at the forefront of immunization administration, but our history of involvement may go back further than one realizes. Two centuries ago, the world was battling a different faceless foe of viral origin: smallpox.

During this time of turmoil lies the beginning of pharmacists taking on the additional responsibility of vaccination. Since that time, we have come a long way in the frequency and scope of our immunization involvement. Community pharmacists have been routinely administering various vaccines since 1994 when formalized training became available.

What this amounts to is that we were ready to take on our role in immunizing when the COVID-19 vaccines became available; however, our biggest benefit with the vaccine may not be the administration, but rather the counseling we can offer patients.

Pharmacists are accessible health care professionals and often our knowledge is heavily trusted by the communities we serve. Hence, it only made sense that when the vaccine rolled out, the patient questions rolled in.

With phones ringing off the hook and concerned patients masked and anxiously asking questions from behind sheets of Plexiglas, we became a patient’s most reliable resource regarding the COVID-19 vaccination process. Nonetheless, not all the questions were ones regarding when and how to receive the vaccine—many stemmed instead from a place of hesitation. How we counsel patients through their hesitation can make the difference in whether they proceed with receiving the COVID-19 vaccination.

To best address the hesitation, it is first imperative to understand where it is coming from. As we all have certainly felt since the start of the pandemic, change and uncertainty are difficult to process. Patients have not experienced a pandemic before and are faced with finding a way through the uncharted waters.

Add on varying levels of health literacy and a vaccination can spiral into a great unknown and weighty decision to make. As pharmacists, it may be easy for us to forget that concepts we take for granted as common knowledge may seem utterly foreign and confusing to patients (think back to those first therapeutics courses you had and the feelings you encountered then).

One huge source of hesitation is a lack of understanding. Patients are worried the vaccine will harm them, the adverse effects will be unbearable, the formulation is dangerous. Although patients may have received vaccinations in the past without a second thought, the endless list of unknowns during the pandemic has made them ponder further into what a vaccination actually is.

Another route to hesitation for a patient has been carved out from excessive discussion, coverage, and access to information. Patients do not have one news source; they have nearly unlimited access to information.

In general, more information is thought to be a positive. Unfortunately, the information patients have access to is not necessarily consistently coming from a reputable scientific journal. Instead, patients are bombarded with information from all sorts of sources, including ones that have political biases, ones that are from loved ones and friends, and ones that are fueled by conspiracy.

Along those same lines, patients may be presenting with hesitation from the sheer amount of peer-pressure they are facing, whether that be for or against getting the vaccination. Perhaps a loved one is insisting they get the vaccine before visiting or an employer is enforcing proof of vaccination. On the other end of the spectrum, trusted friends may be declaring it an act against their freedom. No matter the scenario or our opinion on it, patients have multitudes of reasons to present with hesitation.

So, what can we do to address the hesitation? We can do what we are highly trained to provide, counseling? Much of the techniques we employ when counseling patients on medications can be used to counsel them on the COVID-19 vaccination and help to address their hesitation.

The first step then is getting to know our patient. To do this, one can begin with asking open-ended questions to see what is most concerning for the patient and assessing where their current stance is.

This serves to help us model our counseling direction and not overwhelm the patient with unnecessary information. Similar to how we would not extensively counsel a patient on a medication they are no longer taking, we do not need to counsel a patient presenting with hesitation stemming from uncertainty based on vaccine scheduling logistics on how a vaccine is produced, this would only confuse the patient further.

Next, it is important to listen and respond empathetically to a patient’s concern, there is significant judgement regarding the choice to get the vaccination already out in the world, the pharmacist should serve as a judgment-free resource. Moreover, all concerns should be addressed as valid concerns.

Just like with counseling on medications, it is always better for a patient feel to feel reassured that their concern was addressed rather than telling them it was irrelevant. All questions a patient presents with are coming from a legitimate place and we should treat them as such.

From there, it is imperative that we are honest with the patient; including with topics such as possible adverse effects (AEs), what the AEs mean and how to treat them, what the process of getting the vaccination looks like, including follow-up for additional doses, and the time it takes to prepare and administer a vaccine.

If we are not telling the patient the whole story out of fear it will make them more hesitant, we risk the patient being increasingly wary due to lack of open communication or disheartened by their immunization experience and less likely to follow-up for booster doses or encourage others in their life to get the vaccination.

Nevertheless, although we may do our best counseling by using all our tools and methods, some patients may still be hesitant…and that is okay. It may be hard to accept a patient might still not be ready to receive the vaccination after our best efforts, but that does not mean they will not take the information we provided them and come back tomorrow ready.

Sometimes time is what people need. Ideally, all patients will be ready to fill out the paperwork right after counseling, but some will need to think a little longer to feel secure in their decision. Pushing a patient to get the vaccination could actually push them farther away from the action, allowing the patient to maintain autonomy in their decision is helping them feel more in control during a time when feeling in control is a distant memory for many people.

Overall, pharmacists are at the forefront of not only providing COVID-19 vaccinations, but also the information a patient needs before receiving the vaccine. Community pharmacies are often the most accessible health care facility for a patient. We should be taking advantage of this to help as many people feel a little less uncertain in doing what is best for their health.

Not only will we be practicing at the top of our license by administering the immunization, but we will also be practicing our expertise in interacting and counseling patients to promote positive health outcomes.

About the Authors

Katie Cook is a PharmD candidate at Duquesne University School of Pharmacy in Pittsburgh, Pennsylvania, who anticipates graduating in spring 2022.

Jonathan Ogurchak, PharmD, CSP, is the CEO and cofounder of STACK, a pharmacy information management platform, and serves as preceptor for a virtual Advanced Pharmacy Practice Experiential Rotation for specialty pharmacy, during which this article was composed.