Ex Officio Member of the ACP Board of Regents
— MEDICAL SCHOOL —
McGovern Medical School at the University of Texas
Health Science Center at Houston
— GRADUATING CLASS —
Most medical students have endured the majority of their training during a global pandemic now that we are entering “the junior year of COVID-19.” Skills like chest x-ray interpretation, intubation, and ventilator management take on new emphasis for students training during the era of COVID-19 medicine. In addition, there is a deeper understanding of infectious disease, public health, and epidemiology among medical students as we have observed the pandemic play out over the past 2 years. It has been fascinating to observe the interplay between science and society as COVID-19 vaccines were developed and distributed yet hesitancy among individuals to roll up their sleeves to get the shots has led to an extension of the pandemic. With vaccination efforts being such a strong approach to ending the pandemic and returning to some level of normalcy, I've found myself asking what medical students can do to help address vaccine hesitancy.
Before they were part of our COVID-19 vernacular, I recall learning about concepts like “herd immunity” and “global pandemic” from my preclinical didactic coursework in immunology and epidemiology. We even had a team-based learning exercise focused on critical interpretation of research literature using the infamously retracted Lancet article that sparked the antivaccination movement. I didn't realize back then just how important these seemingly “historical” topics were for future physicians to become familiar with in the case that a pandemic should develop and debates about vaccination efforts arise. Equipped with the knowledge of these topics, medical students are in a strong position to communicate with patients and the public to inform them about the importance and safety of vaccines and help boost vaccination rates.
How do we begin the conversation on vaccine hesitancy? In the clinic, vaccine discussions are neither uncommon nor limited to COVID-19. It is our duty to ask patients about their vaccination status for many illnesses, including the flu, pneumonia, and shingles. Patients may share that they have not yet received the vaccine—and this opens the conversation to discuss their concerns related to the vaccines or their side effects. By listening to the patient and providing them with the knowledge we are equipped with, we bridge the gap between their concerns and taking action to get their shots.
Outside of the clinic, I believe medical students can take the same approach to addressing vaccine hesitancy. If a friend or family member volunteers information that they are unvaccinated or have concerns about vaccines or boosters, use it as an opportunity to learn about their viewpoint. Why do they feel this way about vaccines? Have they had a bad experience with vaccines in the past? What is their greatest concern? Part of this process is also making the distinction between those who are against vaccination (“anti-vaxxers”) versus those who are “vaccine hesitant.” Anti-vax folks are generally opposed to vaccines, whereas vaccine hesitancy is a more nuanced sentiment. Vaccine hesitancy may vary between vaccine types and is influenced by confidence in the science behind vaccine efficacy or safety, convenience of the vaccination process, and complacency (1).
When the Delta variant began to surge in the summer of 2021, I first experienced frustration with those who were COVID-19 vaccine hesitant. This was the first COVID-19 surge after vaccines had become widely available, yet people were choosing to remain unvaccinated! Even a year prior, I was amazed at the decades of science behind mRNA vaccine technology and studies into the coronavirus family that facilitated the rapid development of multiple COVID-19 vaccines. I saw vaccination as our best tool for fighting COVID-19 and getting back to “normal.” As a result, I volunteered for the Moderna vaccine trial and was fortunately accepted in the summer of 2020. A year went by; studies had shown the efficacy and safety of COVID-19 vaccines, the vaccines received emergency authorization from the FDA, and vaccine distribution had now been made available to everyone in the United States. However, people were refusing to get shots in their arms and a more severe variant had developed despite all of this progress.
Realizing my participation in the vaccine trial wasn't going to be enough to help bring an end to the pandemic and fueled by my frustration, I turned to social media as a platform to start conversations related to vaccine hesitancy. I used the “Questions” feature on my Instagram Stories to create a simple “Ask Me Anything” forum so that I could use my background in medicine to help inform others and answer their questions about COVID-19 and vaccines. I responded to all of the questions on my Instagram Stories—doing my best to balance the scientific evidence and medical recommendations while also keeping the content digestible and engaging for nonmedical followers. Friends were then able to take a screenshot of my posts and share them to help disseminate knowledge to their own networks.
At a more grassroots level, I also used the “Polls” feature on my Instagram Stories to get a sense of who was vaccinated. The results of the poll are not anonymous, and I made the decision to reach out to those who responded that they were not vaccinated and ask them about their decision. The responses were extremely varied and spanned the vast definition of vaccine hesitancy. Some individuals didn't have access to a vaccination site that was located near them or open when they weren't at work. Others were concerned about missing work because of vaccine side effects. Some were concerned about the speed with which COVID-19 vaccines became available and approved. A few individuals were simply complacent and felt they were more likely to suffer vaccine side effects than contract COVID-19 and have severe illness or long-term complications.
Opening these conversations and listening to people's concerns rather than ostracizing them for their decisions ultimately made these individuals more open to the idea of getting vaccinated. After some additional effort educating individuals about the science behind COVID-19 vaccines, sharing recommendations for managing vaccine side effects, and researching vaccination sites, I was excited to learn that at least five of those individuals started their COVID-19 vaccine series after our conversations.
Addressing vaccine hesitancy as a medical student can take many forms. Whether you are reaching out to patients in the clinic, family or friends in person, or your network on social media, it ultimately comes down to listening to the individual and meeting their concerns with the medical information we are equipped with. By employing our knowledge from medical school, experience with COVID-19 on the wards, and skills in motivational interviewing, medical students have the power to make a difference and address vaccination hesitancy with those around us.
- Butler R, MacDonald NE; SAGE Working Group on Vaccine Hesitancy. Diagnosing the determinants of vaccine hesitancy in specific subgroups: The Guide to Tailoring Immunization Programmes (TIP). Vaccine. 2015;33:4176-9. [PMID: 25896376] doi:10.1016/j.vaccine.2015.04.038