The Secret to Increasing Vaccination Rates is to T.E.A.C.H.
Fighting COVID-19 requires a personal, empathetic, and non-judgmental approach
T.E.A.C.H. (Trust, Empathy, Authority, Clarity, Honesty)
I suppose I should start with some good news. As of July 18, the Centers for Disease Control and Prevention (CDC) reported that 59% of the adult United States population have been fully vaccinated, and 68% have received at least one dose. On average, the infection rate over the past seven days is 89.6% lower than the peak observed on January 10, 2021.
Now, the bad news. Despite the Biden administration’s herculean attempt to give 70% of all adults at least one shot by July 4, we missed the mark by several percentage points. What’s more, cases are on the rise. New cases are up nearly 70% in just a week, and hospitalizations are up nearly 36%, thanks to the delta variant. An Associated Press analysis of government data showed that 99% of “breakthrough” infections occurred in the unvaccinated, meaning that nearly all COVID-19 related hospitalizations and deaths could be prevented by vaccination. CDC Director Rochelle P. Walensky called the uptick in cases, “a pandemic of the unvaccinated.”
Many would have us believe this disparity is solely political. Washington Post reported that blue states (those that voted for Biden) have higher vaccination rates than red states (those that voted for Trump), and Axios reported that red counties are more hesitant about the COVID-19 vaccine than blue counties. But at a granular level, vaccine hesitancy crosses racial, political, and socioeconomic lines. On the Crooked Media podcast Pod Save America, Surgeon General Dr. Vivek Murthy said, “Everyone is not the same here. Some people may have been exposed to misinformation online. Others may have had bad experiences with the healthcare system that lead them to distrust vaccines.”
Even people with scientific or medical training may be reluctant to get vaccinated. The American Nurses Association (ANA) reported that 30% of nurses were unvaccinated, primarily citing lack of information and fears of short- or long-term side effects. A friend of mine, a toxicologist who works for a large pharmaceutical company, admitted that he almost didn’t get the vaccine. His job and primary mindset is all about drug safety, so he nitpicked every vaccine clinical safety trial. Thankfully, he did eventually get vaccinated, after weighing all the risks and benefits related to his family’s safety.
Public health officials have gone into overdrive trying to stem misinformation and increase vaccination rates. The CDC published a guide to building healthcare personnel’s confidence in the COVID-19 vaccine by encouraging senior leaders to be vaccine champions, hosting Q and A discussions, sharing key messages with staff through multiple channels, educating healthcare teams on vaccine safety, educating non-medical teams on the importance of vaccination, and visibly celebrating all who get vaccinated. The Biden administration went one step further with plans to go “community by community, neighborhood by neighborhood, and oftentimes, door to door” to provide resources and help people schedule vaccine appointments. The president called getting vaccinated, “a patriotic thing to do.”
Unfortunately, public health initiatives will not make up the lost ground. Kneejerk political responses often oppose anything coming out of the government. For example, 65% of Republicans oppose the White House vaccination plan, even as 81% of Democratic voters support it. Dr. Murthy stated, ”about two thirds of the unvaccinated are pretty much against vaccination. About a third of the unvaccinated are in the wait and see category.”
It’s no secret that personal testimonials are just as, if not more, important than government communication. A participant in a March 2021 focus group of vaccine-hesitant Trump voters declared, “What I don’t trust is the government telling me what I need to do when they haven’t led us down the right road.” People want clear information coming from trusted sources: doctors, friends, and family.
I took this to heart recently when I heard that one of my son’s close friends was not yet vaccinated. Despite our subtle nudging and her assurances that she was going to get on it soon, she clearly seemed hesitant. I decided to take a different tack and sent her the following text:
Hi, J. It’s Mr. Winicur. I apologize for texting you, but I wanted to offer to talk to you about COVID and vaccinations. I work in the pharma industry, and my background is in the life sciences, so I can answer any questions you have as best possible (or find the answers for you). There is no judgement here, just the best straightforward information I can provide.
I told her she could either call, text, or email me, whichever made her feel most comfortable. To my great surprise, she took me up on the offer.
Understand, I would not have made this offer to just anyone. This young woman has known me for five years through my wife’s and my volunteer work with our kids’ high school marching band, and she clearly trusts me. She sent me a long email outlining her personal concerns, the vaccine hesitancy she was getting from her family, her challenges with finding valid information, and a laundry list of well-thought-out questions that took me the better part of a day to fully research.
About a week later, I made a similar offer to a woman I know in a more professional capacity, and she also took me up on the offer. She sent me a new list of questions that took another day of research. In both of these cases, the women had valid concerns borne from a glut of true facts, nuanced data, over-sensationalized reports, and straight misinformation.
As a medical information professional, I know that addressing questions requires more than data dumps, judgmental narratives, and pontification. It requires a communication framework that I call T.E.A.C.H. (Trust, Empathy, Authority, Clarity, Honesty).
TRUST
It’s completely hackneyed to say that trust is the foundation of any relationship, but lord, is it true. I have 395 “friends” on Facebook; only a small fraction would actually trust me enough to share intimate details of their family life, admit their lack of knowledge, or ask for help. Dr. Murthy said it well, “Trust really is the currency that matters here. It doesn’t matter how much I know about the vaccines and the data, or how much experience I have as a doctor. If somebody out there doesn’t trust me, then it’s really not going to move the needle in terms of how they’re thinking or help them make a decision.”
Part of that trust is making it clear that my role is only to provide the best information I can without any judgement, demagoguery, or hidden agenda.
EMPATHY
Dr. Murthy described the importance of listening before assuming. He said, “What is effective, I believe, is pausing to listen to folks, understand where their concerns are coming from.” Personally, I found much more success when I stopped trying to convince, lecture, or anticipate, and started by simply asking the question, “What worries you?” But my answers, while based on data and scientific interpretation, still acknowledge underlying fears and concerns. When people are frustrated by a surfeit of conflicting, misleading, or confusing data, I talk about my own challenges in wading through the science. When people complain about misinformation coming from their own family, I admit to the hazards of balancing familial love, household politics, and reality.
AUTHORITY
Dr. Murthy reported that about 80% of people want to talk to their doctor about making a decision about vaccinations. As a medical science liaison with a PhD in the life sciences and decades of professional experience with medical communications, I have the privilege of a thorough grounding in science and academia. This is not a value judgment; it is simply my area of expertise. The letters after my name are my “alphabet soup,” the short history of my education and credentialing. You better believe I use them when necessary. It’s all about credibility in the eyes of my audience. I’m not just building confidence than I can listen, I’m building confidence that I actually know something about the topic.
Just as importantly, I make clear who I am NOT. I am not a physician, infectious disease expert, epidemiologist, or laboratory researcher. I’m just a person who can help people wade through the literature and sort the metaphorical gold from the pyrite.
CLARITY
Communicating scientific data to the general public is as much an art as it is a science. Journals are dedicated to the practice of scientific communication, and a multitude of courses have been designed to turn scientists into better communicators.
I don’t get bogged down in the academic minutiae of data visualization. I simply meet the person where they are. Instead of deferring to the age old KISS principle (Keep It Simple Stupid), I try to relieve my audience from the burden of thought. Even the most intelligent reader doesn’t want to hunt for my answer in the middle of five pages of prose.
For example, after my son’s friend sent me her long list of concerns, I broke them down into single questions that could be easily answered. I provided a short answer, a longer answer, and Internet links to my sources. It was a graded approach.
Here is one example:
QUESTION: I have been told multiple times that “people have been dying from the vaccine,” but the same people have yet to show me the mortality rates. Should I worry about the mortality rates?
SHORT ANSWER: Mortality rates associated with NOT getting the vaccine are much, much higher than the mortality rates associated with getting the vaccine.
LONG ANSWER: According to the CDC’s VAERS reporting system, death after COVID-19 vaccination is rare. How rare? In 331 million doses of vaccine, there were 5,946 reported deaths, which translates to an all-cause mortality rate of 0.0018%. “All-cause” means just that; the death may or may not be related to the vaccination. https://www.cdc.gov/coronavirus/2019-ncov/vaccines/safety/adverse-events.html
What is the mortality rate of NOT getting vaccinated? Think of it this way. There are currently 607,092 deaths due to COVID in the US, which translates as a total population mortality rate of 0.18%, 100x greater than the vaccine mortality rate. However, if you actually get COVID, the case-mortality rate is 1.8%, or 1,000x greater than the vaccine mortality rate. In other words, the danger posed by NOT being vaccinated is much higher than the danger posed by being vaccinated. https://coronavirus.jhu.edu/data/mortality
HONESTY
Finally, all of this requires a level of personal honesty. Dr. Murthy stressed the importance of sharing our own experiences: How did you decide to get the vaccine? What was it like when you actually got it?
In addition, I am upfront with my preconceptions, prejudices, and agendas. For example, before addressing my friends’ questions point by point, I started with the following paragraph:
I warn you now, despite my attempts to provide unbiased, factual information, my own biases will probably come out. My father-in-law died from COVID-19. My own father was nearly hospitalized with COVID-19. My wife may or may not have had COVID-19 back in March 2020 before testing was readily available and had to quarantine in her bedroom for a couple of weeks. This disease is deadly, and the infection, hospitalization, and mortality rates are scary. My goal, clear and simple, is to show you that the risk of NOT getting the vaccine far outweighs any risk of getting it.
Yesterday, my son informed me that his friend plans to get vaccinated this week. I’m ecstatic, not just because I think it’s the right thing for her to do medically and epidemiologically, but also because it shows that T.E.A.C.H. works. We may yet beat back this pandemic, one trusted relationship at a time.
