Could Empathy Help Overcome Vaccine Hesitancy?

A woman hesitating to receive a vaccination.

(Adobe Stock 487697035 by dusanpetkovic1)

A new international study published in Health Psychology points to clinicians taking an empathetic approach to take on vaccine hesitancy with patients. The findings show that clinicians using this approach and who listened to patients’ concerns and questions resulted in those patients being more open to listening to counseling with a healthcare professional about vaccines.¹

Specifically, investigators from the University of Bristol in England oversaw a study with 2500 participants in both the United Kingdom and the United States, and the interview technique was set up in a 4-step process.¹

Initially, in the first step, patients were invited to share their thoughts and concerns about vaccination so that healthcare professionals could understand their motivations and reservations. In the second step, understanding and trust were built by affirming the patient's feelings and concerns. Thirdly, a tailored explanation was provided to challenge misconceptions, offering a truthful alternative to any misinformed beliefs. Lastly, relevant facts about vaccination were provided, such as how they can benefit the individual by guarding against disease as well as collectively protecting others by reducing the spread and building vaccine-induced herd immunity.¹

The results showed changes in attitudes about vaccines and an openness to further discussion. The majority of participants (around 64%) who experienced the empathetic refutational interview also indicated they were more open to continuing the conversation with a healthcare professional, and around 12% became more willing to be vaccinated compared to those participants who received a factual approach.¹

“The study highlights how the way misinformation is tackled, especially with vaccine averse groups, [and] can play a vital role in changing perceptions which can be hard to shift,” lead author Dawn Holford, PhD, senior research associate in psychology, University of Bristol, said in a statement. “Although we expected people to generally respond more positively to an empathetic approach, it was surprising how much greater the preference for this style of communication was among those who expressed concerns about vaccination.¹

In both Europe and here in the US, there have been measles outbreaks, and the rates of standard childhood immunizations have been dropping in the last few years. In January 2023, the CDC reported that over the last 2 school years, the national coverage for childhood state-required vaccines among kindergarten students declined from 95% to approximately 93%. During the 2020-21 school year, vaccinations dropped to 94%, and during the 2021-22 school year, it dropped again to approximately 93%.²

While this does not sound like a large number, it still represents thousands of young children not getting their vaccinations. This is also a disturbing trend, as some families may feel they do not need them or are fearful of vaccines.

“Compared with the 2020–21 school year, vaccination coverage decreased 0.4–0.9 percentage points for all vaccines. Although 2.6% of kindergartners had an exemption for at least 1 vaccine, an additional 3.9% who did not have an exemption were not up to date with MMR,” the investigators wrote in an MMWR last year.²

This is the lowest rate of vaccination in over a decade, the CDC states. And the MMWR report said that as many as 250,000 kindergartners are not protected against measles.²

Additionally, a recent study by the World Health Organization found the global decline in childhood vaccinations to protect against preventable diseases was the largest sustained drop in approximately 30 years.3

As one experienced measles clinician points out, it does not take immunization rates to drop significantly in a specific area in order for there to be the potential for greater outbreaks in a local community. “When those rates go below 95%—and this is really about in a specific community, what is the rate in the daycare? What is the rate in a high school? In a city? In a state?” Patricia A. Stinchfield, RN, MS, CPNP, president, National Foundation for Infectious Diseases (NFID) said in a recent interview with Contagion. “To just take a big global number and say that's pretty high, we're good, is not okay. When a local community gets below 95%, that gives measles an ability to make an entrance and spread in that community.”⁴

The study's coauthor, Stephan Lewandowsky, PhD, chair in cognitive psychology at the University of Bristol, has been involved in many studies demonstrating the significant influence of misinformation around vaccines.

“It is important to understand the motivations underlying people’s vaccine hesitancy so we can correct misconceptions without confronting people’s deeply held attitudes head-on,” Lewandowsky said in a statement. “By affirming and empathizing with those deeply held attitudes, we create a space where people are sufficiently comfortable to process corrective information, so they can make a better-informed decision.”

During the COVID-19 pandemic, he developed a novel online guide that addresses and corrects the proliferation of misleading myths surrounding COVID-19 vaccines.

References

1. Pioneering research reveals empathetic communication can help overcome vaccine hesitancy. Newswise. February 28, 2024. Accessed March 14, 2024.
https://www.newswise.com/articles/pioneering-research-reveals-empathetic-communication-can-help-overcome-vaccine-hesitancy

2. Parkinson J. Measles Outbreaks: How Complacency Associated With Immunizations and COVID-19 are Driving Increases. ContagionLive.com. January 8, 2024.
https://www.contagionlive.com/view/measles-outbreak-in-philadelphia-prompts-caution-calls-for-mmr-vaccination

3. COVID-19 pandemic fuels largest continued backslide in vaccinations in three decades. WHO press release. July 15, 2022. Accessed March 14, 2024.
https://www.who.int/news/item/15-07-2022-covid-19-pandemic-fuels-largest-continued-backslide-in-vaccinations-in-three-decades

4. Parkinson J. A Comprehensive Look at Measles. ContagionLive.com. March 13, 2024.
https://www.contagionlive.com/view/a-comprehensive-look-at-measles