In late February, we reached out to members of MCN staff and MCN’s Board of Directors to ask what hesitancies their patients are expressing, and how they as clinicians are responding to those hesitancies. Here are their responses:
Laszlo Madaras, MD, MPH, Chief Medical Officer of Migrant Clinicians Network and hospitalist at WellSpan Summit:
In our area of central Pennsylvania, there are a lot of suspicions still about the vaccine, most often that it was developed too quickly to be safe. Also, that it will forever change your DNA and make it difficult to have children. My counter argument has been that half a million Americans have died of COVID-19 without the vaccine, and none (as far as I know, as of February 2021) have died from being vaccinated. [Regarding the change of DNA or fertility changes] I counter in various degrees of depth depending on my assessment of the patient's science background and willingness to listen.
The speed of vaccine development is a tribute to the progress of biochemistry and genetic science over the past two decades since the Human Genome Project, and should be applauded. Nevertheless, I acknowledge that the post-vaccination results have only been monitored for a few months (and only now do we even have 12 months of data on this new virus itself), so we cannot be too cavalier about knowing the full effects and side effects until many more months of observation have passed. But, that again is part of the scientific process, which had to adapt to a rapidly emerging virus. And I tell patients that I myself have now taken two doses of the Pfizer vaccine so I not only talk the talk, but I also walk the walk.
Vicki Thuesen, APRN, WHNP, FNP, Clinical Director of Agricultural Worker Health & Services at Montana Migrant and Seasonal Farmworkers Council:
The common hesitancies we are hearing are the worry that the government put a chip in the vaccine that will track immigrants and cause them to be deported; that the vaccine can alter genes and cause infertility; that you don't need the vaccine if you have already had COVID; that you only need one dose of Pfizer or Moderna if you already had the virus; that the virus isn't safe because it was developed too quickly.
We have tried to debunk these myths or misinformation in several ways. First, one of our board members and an employee made posters and pamphlets in English and Spanish addressing each of the above concerns. We posted these in our clinics and on our website. We identified people in each of our communities who would be advocates for vaccinating. We found people who would be advocates in churches, food banks, etc. We have found that migrant workers who have been coming to our clinics for many years are somewhat hesitant. H2A workers who are coming into the area seem to be asking right away where they can get the vaccine.
Robert Shelly, MD, FAAP, Internal Medicine and Pediatrics, Sodus Community Health:
In New York, agricultural workers are unfortunately still not eligible to receive the vaccine, so the degree of hesitancy in this population hasn't been concretely tested against reality. However, my impression is that we are not seeing the degree of vaccine hesitancy in this group that has been reported in the media. In my experience, immigrant agricultural workers typically view vaccines (and injectable treatments in general) favorably. Our outreach teams are also doing a lot of education and have decades of established relationships in the community.
Regarding my approach with patients, I emphasize...that Covid-19 has caused many deaths, the vaccine has caused none, and widespread vaccination offers our best chance of moving beyond this crisis. But I think that relationships and personal trust matter more than science when it comes to encouraging people to be vaccinated. My approach generally includes:
- Empathy with folks that it can be scary to think of receiving a new vaccine that many people are afraid of, that receiving the vaccine is an individual choice, and that I won't judge them for their decision.
- That I personally believe in the benefits of the vaccine and received it myself.
Having a relationship over time with people is very helpful, as quite a few have told me that they were waiting to decide about the vaccine until talking to me. Last week, an immigrant patient started his visit telling the staff he wouldn't get the vaccine because he heard that it ‘was responsible for the genocide that happened in New York City,’ but left the visit expressing willingness to get the vaccine.
Gayle Thomas, MD, Medical Director of the North Carolina Farmworker Health Program:
The most common [hesitancy] is, ‘it is too new, [and] we don’t have enough experience with it yet.’ My response: ‘we started working on vaccines against viruses like this one about ten years ago when SARS and MERS were spreading. We have given this one to millions of Americans now, so we do have experience with it.’
Eva Galvez, MD, Family Physician with Virginia Garcia Memorial Health Center, Oregon:
There are a variety of concerns that my patients express, but what I am hearing most is that they are worried about vaccine safety and the potential long- and short-term health risks.
My response is to first validate their concerns and to reassure them that it is normal to have these concerns. I tell them that an important step in deciding whether or not to get the vaccine is to ensure that all of their questions are answered and that they are obtaining their information from a trusted source.
From there, I do my best to provide them with basic information regarding the vaccine development and potential side effects. For many, I find that just hearing that it is safe from someone that they trust, for instance, their doctor can be quite powerful and might be enough to sway them in the direction of getting the vaccine.
Carmen M. Velez Vega, PhD, MSW, Community Health Capacity Building Program at the Puerto Rico Public Health Trust:
I have heard people say they don’t trust the vaccine because of the short time it took to be approved. I have also heard they believe the vaccine introduces harmful substances in the body. Some people refer to memes and social media messages that warn against the vaccination and see it as a form of killing people off. Mostly misinformation spread through social media. Education is key. Creating messages that speak to a diversity of audiences. Using spokespersons that look like them, people they can relate to. Having community doctors, nurses and other professionals present the message. At the Puerto Rico Public Health Trust, we brought together a scientist and a social media celebrity to send a message together.
Read this article in the Spring 2021 issue of Streamline here!
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