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Panel: Building Trust Key to Combating Vaccine Hesitancy

Under 40% of adults said that they trust that public health agencies are giving accurate information about vaccine safety, survey data indicated.

A survey conducted by the Harvard Opinion Research Program and SSRS found that only 37% of adults surveyed said that they had “a great deal” of trust in public health agencies to provide accurate information about the safety of vaccines for children, though 47% said they “somewhat” trusted these agencies.

Moreover, the survey found that only a little over half of surveyed adults characterized vaccines as “very safe” for children, with 36% calling them “somewhat safe.”

These results were presented as part of The Forum at the Harvard T.H. Chan School of Public Health in Boston, with a topic entitled “The Measles Outbreak: Why Vaccines Matter.”

The panel briefly addressed the current measles outbreak — which now stands at 1,241 cases in the U.S. in 2019, most of which are among unvaccinated children. While experts said that about 94% of kids are still getting required vaccines, there are pockets throughout the country where vaccine coverage is low.

Gillian SteelFisher, PhD, of the Harvard T.H. Chan School of Public Health, and deputy director of the Harvard Opinion Research Program, said that the survey found that 84% of adults say that parents should be required to vaccinate their children before school entry. But when a separate question asked if a parent had ever delayed or refused vaccination for their children due to safety concerns, 15% said they had.

Barry Bloom, PhD, also of Harvard T.H. Chan, said that the hardest question to answer is when people ask how scientists can be so sure that vaccines are safe.

“It requires some humility and requires some data,” he said, acknowledging that while adverse effects from vaccines are extremely rare, “there is no possibility to be perfect.”

SteelFisher added that many of the attitudes towards vaccines appeared to be generational. Less than half of adults ages 18-34 said vaccines were “very safe” compared with 61% of adults ages 65 and older. Only 31% of adults 18-34 said they had “a great deal” of trust in public health agencies versus 44% of adults ages 65 and older.

She told MedPage Today that mistrust in public health agencies was an example of “broader societal mistrust of institutions.”

“If we have a crystal ball vision from polling, this is not a great picture,” she said at the panel.

But SteelFisher noted that the problem is broader than vaccines, adding that public trust in government is low and that there is “distrust in the medical system,” and that the importance of trust in a person giving vaccines is key.

“As more doctors become part of hospitals, fewer have private practices, and there’s less of a connection,” she said. “A negative experience in the healthcare setting adds fuel — ‘I had a short visit, they didn’t listen to my questions, I got pushed around, I didn’t know who was who.'”

SteelFisher spoke about the importance of trying to support trustworthy interaction in the medical system, so that it’s not just “an institutional voice” talking about vaccines, but “people who care about [patients].”

Jesse Hackell, MD, is a pediatrician and founding member of Pomona Pediatrics in Rockland County, N.Y., which had over 300 cases of measles since last October. He said the vast majority of parents who refuse vaccines aren’t “hardcore people against vaccines,” but people who are “confused” about their safety and efficacy.

“If you’ve seen one parent who’s hesitant about vaccines, you’ve seen one parent who’s been hesitant about vaccines,” he said, adding that parents’ fears can range from a proven false fear of autism to vaccine-associated reactions to a “vague, free-floating anxiety.”

Hackell added that building trust with hesitant parents is a give-and-take engagement process, not a “single episode” where pediatricians can bring parents around.

“Find out specific concerns and talk to parents. Be motivational … I see your concern, it is okay if we address it,” he said. “Yeah, it’s time consuming and we’re not compensated for the time we spend, but … if you’re not willing to invest time in the process, you should probably be doing something else.”

Hackell said that this type of communication starts in the office, but should ideally extend to the community. Howard Koh, MD, of Harvard T.H. Chan and former assistant secretary of Health and Human Services, said that public health officials and leaders in the public sector need to engage with the community to engender trust.

“The message [should be] if you vaccinate your child, you’re protecting your child, but you’re also protecting the community,” he said.

Koh encouraged public health officials and clinicians alike to humanize the process, saying things like “by the way, I recommend this for my own family and my own kids.” He added that he’d gotten vaccines on camera several times as part of public service.

“Hearing perspectives from my colleagues makes me think of that wonderful saying … an ounce of prevention is a ton of work,” Koh said.