Vaccine Hesitancy Narratives

Photo by Hush Naidoo Jade Photography on Unsplash INTRODUCTION In this collection of narratives, the authors describe their own experiences with and reflections healthcare worker vaccine hesitancy. The narratives explore each author’s engagement different communities experiencing hesitancy, touching reasons for proposed solutions, legal aspects. Author’s names appear above narratives. l. Johanna T. Crane Vaccine defined as “a delay acceptance or refusal vaccination despite availability services,”[1] is a worldwide but locally shaped phenomenon that pre-dates COVID-19 pandemic.[2] Contrary to some portrayals, hesitancy not same more absolute antivaccination stance, what call “anti-vax.” Many people who are hesitant ideologically opposed vaccines. Hesitancy also sometimes framed anti-science, yet reluctance vaccinate often about managing risk, trustworthiness, doubt in context uncertainty; it represents an effort “talk back science” unaddressed needs concerns.[3] US, newness vaccines, unprecedented speed at which they were developed, remaining under emergency use authorization first complicated public confidence. Political polarization racial social inequality shape distrust well. While has increased months since vaccines became available, many eligible individuals have been vaccinated, including significant number workers.[4] among workers may seem surprising, especially given frontline experience – I confess surprised me first. But when began interviewing health care study COVID roll-out community centers, learned take complex view. Although was focused patient access,[5] we spoke described colleagues (and, few cases, themselves). From these conversations, “healthcare heroes” regular members communities. Their concerns reflect prevailing advanced communities, such worries side effects safety. Like other workers, fear missing work losing income, all employers offer paid time off recovery. (Importantly, highest lower-paid positions little job security, clerks, housekeepers, assistants, home aides.)[6] For color, protection offered sits tension both current historical medical abuse neglect. Some interviewees, fully vaccinated themselves, rejected framework “hesitancy” entirely, arguing Black Brown be should understood through lens “self-protection”. Due nature work, faced great pressure This understandable, against protects only themselves aligns ethical duty prevent harm patients reducing risk transmission settings. When FDA approved December 2020, extremely grateful designated “1a” group prioritized receive shots.[7] bioethicists, prioritization represented recognition extreme risks front-line had endured onset pandemic, critical shortages PPE. important remember going felt like serving guinea pigs new granted full approval. individuals, expectation would additional rather than reward. Healthcare feel ashamed subject shaming others;[8] make difficult discuss workplace. Throughout lauded “heroes”, promoted workforce “heroic” action. messaging implies waiting shameful cowardly echoed opinion pieces op-eds describing unvaccinated “selfish” “free riders.”[9] By fostering proper dialogue, can respond respectfully while still working towards goal vaccination. We bioethics willing listen our colleagues’ respect. Top-down approaches aimed “correcting” cannot address fundamental issues trust stake. Instead, there must dialogue over time. Conversations trusted provider crucial role.[10] Blaming rhetoric, whether explicit implicit, gets us nowhere fact, likely moves backward exacerbating any existing resentment hold toward employers.[11] Lastly, onus institutions, individuals. There lot talk getting people, particularly, "trust" institutions racializes puts burden harmed acting trustworthy ways.[12] Dialogue, respect, trustworthiness guide even era workplace mandates. Mandates strategies look uncertain future. As Heidi Larson, founder Confidence Project, recently said, “We forget making people's future history now. Are treated engaged?”[13] ll. Kara Simpson Since release late robust discussions within community, media, political arenas workers. aware become vaccine, rushing “take shot.” people’s opinions aligned race, ethnicity, socioeconomic status, affiliation. People color one groups labeled politicization explained low turnout.[14] It uncommon hear, “this just came out; let’s wait see if effects.” Interestingly, did understand why remained hesitant. Trust vital component viable relationship, clinical realm. To successful outcomes, essential clinicians build trusting relationships peers. distrustful institution due years systemic racism abuses experienced, witnessed, about. excluded from outside work. assert hesitation because lived receiving professional environment. These dual traumas tandem strengthen building will Currently, worried experienced intergenerational enslavement marginalization, mandates coercive serve reminder how “lesser” bodies considered unworthy voice, human rights, independent decision making. mandate paternalistic understatement. An unintended result reinforcement coercion coexist. give power conspiracy theories those already do seek adequate inequalities. Furthermore, dissuade becoming others leave field. essence, symptom much larger problem: establishment. mission support interventions foster “trustworthiness” cause trauma. Several organizations mask weekly testing measure protect population large respect autonomy unvaccinated.[15] lll. Jennifer Breznay very teaching hospital Brooklyn, hard hit March 2020. worked inpatient units witnessed suffering. And after nine despair COVID’s toll, tremendous frustration heard reject vaccine. co-chair Bioethics Committee, drafted statement recommending employees. draft revised employees, appreciated perspectives before. end, releasing statement, directed efforts creating dialogue. volunteer not-for-profit operates seven early childhood education centers Northern Brooklyn. Executive Director invited collaborate encourage staff vaccination, decided Zoom conference 20 staff. nervous audience perceive me, white doctor whom know. awkward coming them agenda. question appropriate messenger compared person color. Yet, shouldn't away this. So, chose simply disclose my discomfort beginning Zoom. “Thanks having me. You know, physician, you might say. Four hundred inequity system create mistrust, I’m here try answer your questions.” Ultimately reported stimulating conversation think piece intimate open conversation, where elicit values. lV. Ashley L. Stewart rural areas state, inextricably tied Rural hospitals hire from, serve, function located. Successful implementation requires role influence community. After identifying common area, them. Even find unique personal, related community.[16] Community-based coincide underlying issue, lack information principled experience-based resistance.[17] coordinators encountered wealth misinformation left initially undecided. Compounding information, expressed sense consequences voicing concerns, tight-knit concern being judged merely sharing questions decisions.[18] They saying doing something promote value change relationship live work.[19] engaging productive valuable discouraged vaccinated. wanted get entire based most research unbiased, consistent, timely sources could trust, multiple once. Communication focus answering types questions, done private anonymously. Where poorly supported incorrect widely objective turning tide distrust. If dismisses assumes waste time, community-based further directly, avoidance unsuccessful.[20] Being respectful non-judgmental posed know true hard, completely honestly without judgment inform people. Telling “for greater good” sound told “bad” fail up claims. respected resource priority preserve. treat everyone regardless status.[21] mandates, divisive policies, disrespectful treatment status discriminatory coercive, weakening appeal Such practices less anchored position come proponents untrustworthy authoritarian. maintain autonomy. Using unethical means achieve end lead “greater perception authority “by necessary.” V. David N. Hoffman central moral quandary arises whenever discussed refuse fired. clarify applying definition employment employers, violation results loss employment. Government-controlled now weighing topic generally pursuing impose periodic, usually weekly, requirements decline sector, require employees things condition employment, -19. prominent case date, gave rise lawsuit Texas involving Houston Methodist Hospital. case, 170 asserted employer allowed force judge held that, no employee obligated continue declines follow rules established employer, obligation vaccinated.[22] Texas, said forced set limits conditions Employees right jobs. That misunderstood concept: “employment will.” Employment sounds rule want quit (we permit indentured servitude). At fire reason reason, unless pretext involves protected statuses (race, religion, sex, national origin, jurisdictions gender orientation, identity). Generally, hospitals, decide someone complete sexual harassment training participate hospital’s infection control program, employee’s right, mean similarly providing evolution discussion influenced narrower debate playing out court opinion, courts law, enforceability New York’s enacted mandate. Regardless survives, religious exemptions, profound dilemma. litigation, exemption, always burdened responsibility determine individual genuine sincere objection able provide accommodation safe effective protecting interests co-workers patients. anticipated federal mandate, reportedly test/mask alternative, task challenging. leads final point analysis, deprive so does so.[23] - [1] MacDonald NE. hesitancy: Definition, scope determinants. Vaccine. 2015;33(34):4161-4164. doi:10.1016/j.vaccine.2015.04.036 [2] Larson HJ, de Figueiredo A, Xiahong Z, et al. State 2016: Global Insights Through 67-Country Survey. EBioMedicine. 2016;12:295-301. doi:10.1016/j.ebiom.2016.08.042 [3] H. Stuck: How Rumors Start Why Don’t Go Away. Oxford University Press; 2020; Benjamin R. Informed Refusal: Toward Justice-based Bioethics. Sci Technol Hum Values. 2016;41(6):967-990. doi:10.1177/0162243916656059 [4] Deepa Shivaram, Fight Against COVID, Health Workers Aren't Immune Misinformation September 18, 2021. NPR Special Series: Coronavirus. https://www.npr.org/2021/09/18/1037975289/unvaccinated-covid-19-vaccine-refuse-nurses-heath-care-workers [5] JT, Pacia D, Fabi R, Neuhaus C, Berlinger Advancing Covid equity Federally Qualified Centers: A rapid qualitative review. Accepted awaiting publication JGIM. [6] Kirzinger. “KFF/The Washington Post Frontline Care Survey Intentions.” KFF, 22 Apr. 2021, https://www.kff.org/report-section/kff-washington-post-frontline-health-care-workers-survey-vaccine-intentions/. [7] Crane, Samuel Reis-Dennis Megan Applewhite. “Prioritizing ‘1a’: Ethically Allocating Scarce Vaccines Workers.” Hastings Center, 21 Dec. https://www.thehastingscenter.org/prioritizing-the-1a-ethically-allocating-covid-vaccines-to-health-care-workers/. [8] “'I'm Not Anti-Vaxxer, but...' US Workers' Raises Alarm.” Guardian, Guardian News Media, 10 Jan. https://www.theguardian.com/world/2021/jan/10/coronavirus-covid-19-vaccine-hesitancy-us-health-workers. [9] Gerson M. healthy free-rider. Post. April 15, [10] [11] Stuck : [12] Race Cures: Rethinking Racial Logics ‘Trust’ Biomedicine. Sociology Compass. 2014;8(6):755-769. doi:10.1111/soc4.12167; Warren RC, Forrow L, Augustin Hodge S, Truog RD. Trustworthiness before — Covid-19 Trials Community. N Engl J Med. Published online October 16, doi:10.1056/NEJMp2030033 [13] Offri D. Anthropologist. Yorker. June 12, Accessed August 11, https://www.newyorker.com/science/annals-of-medicine/heidi-larson-vaccine-anthropologist [14] Razai M Osama T, McKechnie D G J, Majeed A. Among Ethnic Minority Groups. BMJ 2021; 372 :n513 doi:10.1136/bmj.n513 [15] Dasgupta, Sharoda, “Differences Rapid Increases County-Level Incidence Implementation Statewide Closures Mask United States, 1–September 30, 2020.” Annals Epidemiology, vol. 57, Sept. pp. 46–53., https://doi.org/10.1016/j.annepidem.2021.02.006. [16] Do, Tuong Vi C “COVID-19 Acceptance Appalachian (Eastern Kentucky/West Virginia): Cross-Sectional Study.” Cureus 13,8 e16842. 2 Aug. doi:10.7759/cureus.16842; Danabal, K.G.M., Magesh, S.S., Saravanan, S. Attitude 19 urban Tamil Nadu, India survey. BMC Serv Res 21, 994 (2021). https://doi.org/10.1186/s12913-021-07037-4 [17] Scott C. Ratzan MD, MPA, MA, Lawrence O. Gostin JD, Najmedin Meshkati PhD, CPE, Kenneth Rabin PhD & Ruth Parker MD (2020) COVID-19: Urgent Call Coordinated, Trusted Sources Tell Everyone What Need Know Journal Communication, 25:10, 747-749, DOI: 10.1080/10810730.2020.1894015 [18] Huang, Pien. “Some Wary Getting Vaccines.” NPR, 1 https://www.npr.org/sections/health-shots/2020/12/01/940158684/some-health-care-workers-are-wary-of-getting-covid-19-vaccines. Portnoy, Jenna. “Several Hundred Virginia Health-Care Have Been Suspended Fired Coronavirus Mandates.” Post, WP Company, 4 Oct. https://www.washingtonpost.com/local/covid-vaccine-mandate-hospitals-virginia/2021/10/01/b7976d16-21ff-11ec-8200-5e3fd4c49f5e_story.html. [19] Lueck Alaina Spiers Which Beliefs Predict Intention Get Vaccinated COVID-19? Mixed-Methods Reasoned Action Approach Applied 790-798, 10.1080/10810730.2020.1865488 [20] Lockyer, Bridget, “Understanding Context: Findings Qualitative Study Involving Citizens Bradford, UK.” Expectations, 24, no. 4, May 1158–1167., https://doi.org/10.1101/2020.12.22.20248259. Literacy—Helping Decide Accept Vaccination, 750-752, 10.1080/10810730.2021.1875083. [21] Zimmerman, Anne. Columbia Academic Commons, Civilized Vaccination Discussion: Abandoning False Assumption Scientific Goals Shared All, https://academiccommons.columbia.edu/doi/10.7916/d8-rzh0-1f73. [22] Bridges, al v. Hospital al, https://docs.justia.com/cases/federal/districtcourts/texas/txsdce/4:2021cv01774/1830373/18 [23] Hoffman, “Vaccine Raise Ethical Dilemmas,” Hasting Center Forum. https://www.thehastingscenter.org/vaccine-mandates-for-health-care-workers-raise-several-ethical-dilemmas/