In this video, Ryan Hassan, MD, MPH, a pediatrician at Oregon Pediatrics in Happy Valley and medical director of Boost Oregon — a parent-led nonprofit that “helps people make science-based vaccine decisions” — advises healthcare providers on working with vaccine-hesitant patients.
Hassan also discusses how failures in the nation’s public health system during the COVID-19 pandemic have led to some public mistrust.
The following is a transcript of his remarks:
When I’m in the clinic, and I’m working with patients, and I have a patient who is a little ambivalent about vaccines — or hesitant or not really sure — and isn’t quite ready to vaccinate yet, I try to start by making sure the patient knows that I’m not there to try and pressure them to change their mind, and that I’m not there to try to debunk things that they may have heard or may believe.
Rather, I want to create a space where they are comfortable, where they can share any concerns and worries they have without the fear of being judged or shamed or guilted or pressured. I try to make it clear that my job is not to try and tell them ‘This is what you need to do,’ but rather to guide them in any way that is helpful to provide them with the chance to have the information they need to make the best decision for themselves.
It starts with that acknowledgement. Then, it’s just asking open-ended questions, trying to explore their own ideas and thoughts around it and figure out ‘What are some of the considerations you’ve given to getting a particular vaccine? What are some reasons you might want to get it? What are some fears you might have, and what information could be helpful for me to share?’ Starting there will often lead to some more fruitful conversations.
There has certainly been a large spike in vaccine hesitancy and anti-vaccine propaganda. I’ve seen that in my clinic. In the last few months alone, I’ve had half a dozen or more patients who’ve explicitly told me that they used to vaccinate, but now they’re not going to — ‘after everything that happened with COVID’ is usually the phrase I hear. Just ‘I don’t know; I’m not sure about it anymore.’ I hear that a lot.
It’s quite a shame. Vaccines are more important now than ever. The more hesitancy there is, the more that we need vaccines because the lower our vaccination rates are. With everything that happened in COVID, there were a lot of missed visits, a lot of gaps in healthcare, and our vaccination rates have plummeted generally. They are remaining quite low — especially in Oregon, in many areas, and that puts us at risk.
I think another thing that it’s important to be mindful of is that there are a couple reasons why there’s so much more hesitancy. One is the fact that the anti-vaccine organizations — the people in the “disinformation dozen,” for example — have capitalized on the fear and uncertainty around the pandemic. They’ve doubled their profits at least — and probably made a lot more, but from what we know at least doubled their profits — just since the pandemic. They’ve been able to take all of that fear and uncertainty and channel it into new conspiracy theories and new disinformation tactics. That’s been very harmful.
The other thing to bear in mind though is that it’s not just that disinformation [that] is spreading widely. That is a huge problem, but there’s also a very real problem that the reason disinformation is so successful is because it is based in truth. There are real failings of the medical system, and our government more broadly, that have led people to be distrustful. The CDC has made a lot of mistakes that they haven’t been transparent about. The administration and the government broadly didn’t handle the pandemic well. There’s never been good transparency. There’s always been a lot of civil rights infringements, and that builds distrust as well. That communication breakdown has, I think, contributed a lot.
Simple things like the way we phrase things is often overlooked in public health. We aren’t very mindful of how our words are received. And in the anti-vaccine disinformation sphere, people are very much able to take advantage of what we say.
I had a patient a couple years ago — I guess it would’ve been mid-2021 — and they said they didn’t trust vaccines anymore. They vaccinated their older kid completely, and now they had a new child and they weren’t going to vaccinate them at all. And they said ‘Well, it’s because of everything that happened with COVID.’ I said, you know, ‘Tell me more.’ And they said ‘Well, I just don’t like that they put this vaccine out even though the FDA didn’t approve it.’
I was like, ‘What are you talking about? They did approve it. They approved it and it was nationally televised. It was a week-long thing where they talked about the EUA [emergency use authorization] process and the vote and how it got the emergency use authorization.’ And [the patient just said] ‘No, no, no, it wasn’t approved.’ I said ‘Okay, let’s look into this a little. I think what you mean is it doesn’t have a biological license authorization, a BLA, because of the short timeframe. That’s in process. They don’t have the time to do all that, and they didn’t want people to be dying in the meantime. So we passed an EUA, it [FDA] approved it through an EUA.’
I tried to explain this, and literally a few weeks later, I saw the headline in the media ‘FDA finally approves COVID vaccine’, meaning that they had passed the BLA. We are using language that is reinforcing the disinformation that people are hearing. It was already approved, but we’re using this term ‘it’s approved’ now that it’s a BLA.
BLA doesn’t matter. It’s not relevant to anybody other than a researcher. I don’t even care as a clinician about a BLA versus an EUA. Payers don’t even know what that means, but they hear ‘authorized’ and ‘approved’ and they’re like ‘Okay, well now it’s approved and it wasn’t before.’ That doesn’t mean anything relevant to your decision-making.
The other example is ‘breakthrough’ cases of COVID. This is a term that became popular once millions of people were vaccinated and some of those people got sick with COVID. We would be telling stories about ‘Well, look at these “breakthrough cases.”‘
That is not an appropriate term. It’s not a breakthrough case when someone with a COVID vaccine gets a mild COVID infection, that is the vaccine working as intended. You did not go to the hospital or die from COVID. You had the COVID vaccine, so you had a mild illness. Most people don’t have any, but those who do have a mild illness, that’s the vaccine working.
The fact that people [who are] vaccinated are dying at significantly lower rates — almost no vaccinated people die from COVID — is something we should celebrate, but we don’t frame it in that way. We allow the message to be misconstrued by using bad language.
Those I think are important things to keep in mind, that we need to fight back against these profiteers who are stoking these fears, but we also need to be mindful of the way we are communicating and the failings of our own ability to be transparent, educate the public, and serve the public good.
The public health emergency ended recently, and now we’re struggling to find ways to pay for COVID vaccines for people and COVID treatments like Paxlovid that cost $500 — and are going to be even more expensive, Pfizer has said — that people are not going to be able to afford. We’re putting profit first as always, because it’s a for-profit system, and why would a patient, who needs healthcare, trust a medical institution, a pharmaceutical industry, and a government that is ending the emergency and taking away all of these provisions — that we clearly can provide, because we’ve done it for the last 3 years — and now forcing people to pay for healthcare that they can’t afford, and pay for vaccines that they’re not going to have access to? Even my clinic is struggling to figure out how much vaccine we can get for COVID or for the new RSV immunization.
So I think these are real structural problems that the medical system and the government and our elected officials need to contend with.