From the Provincial Health Services Authority
Did you know: a health care provider recommendation is the main reason people get vaccinated?
In a survey of parents, EKOS Research found 91 per cent cited a health-care provider’s recommendation for the reason they accepted a vaccine. This statistic reveals how important PHSA staff and physicians can be in encouraging patients to get a COVID-19 vaccine.
“Health-care providers are the number one reason – across multiple studies – that someone will take a vaccine,” says Dr. Julie Bettinger, a professor of pediatrics for UBC and BC Children's Hospital Vaccine Evaluation Center. “I can’t emphasize enough the role that health-care providers can play in recommending COVID-19 vaccines, explaining them and encouraging patients to take them.”
A study by Canada’s Privy Council office found in April 2020 that more than 70 per cent of Canadians would get a COVID-19 vaccine, if a safe vaccine was available and recommended. But, that confidence has slowly eroded to 66 per cent as of March 2021, according to an Angus Reid survey.
“People have lots of questions about new vaccines,” says Bettinger. “The number one question people have is always about safety.”
The Moderna, Pfizer-BioNTech, AstraZeneca and Janssen COVID-19 vaccines have been approved for use in Canada. They have been thoroughly tested and are proven to be safe and effective. The first dose can provide up to 92 per cent protection from symptomatic COVID-19 disease for at least three months, and close to 100 per cent protection against severe disease and death, according to effectiveness data out of the United Kingdom. A second dose provides up to 93 per cent protection.
“I think we can answer a lot about safety with the clinical trial data, based on the short term, frequent outcomes,” she says. “Clinical trials showed the vaccines were safe.”
“Long term, we don’t have the data yet, but I can tell you, based on everything we know about all the other vaccines, we don’t see any major concerns that would halt the use of COVID-19 vaccines.”
Bettinger says it’s important for health-care providers to be honest about the long term data.
“We only know what we know – and what we’ve been able to measure. We didn’t know anything about COVID-19 a year ago and we’ve come a long way with our knowledge on that. We’re still learning and it’s going to be the same with vaccines.”
There’s also typically questions about the new technology and the speed of the development of a vaccine.
“We need to be able to explain this technology and reassure people we have not cut corners in order to have a COVID-19 vaccine available.”
According to the BC Centre for Disease Control (BCCDC), mRNA vaccines, including the Moderna and Pfizer-BioNTech COVID-19 vaccines, are not live vaccines and cannot cause infection in the host. Manufacturing of mRNA vaccines has been under development for a decade. Viral vector vaccines, including AstraZeneca and Janssen COVID-19 vaccines, introduce instructions from the virus that causes COVID-19, using a non-COVID-19 virus that has been modified to be inactive and not cause viral infection.
In the April 12 BC Update, Provincial Health Officer Dr. Bonnie Henry said, we are seeing that all of the vaccines that we have are working well against the viruses that we are seeing circulating in B.C. right now. That includes all of the variants of concern.
Watch Dr. Julie Bettinger's presentation to health-care providers about vaccine hesitancy: https://mediasite.phsa.ca/Mediasite/Play/0fc7a204110e4762b70f52840433bfee1d
Understanding vaccine hesitancy
We don’t yet know all the reasons why people wouldn’t want to get a vaccine, but one of those reasons could be because people are “vaccine hesitant.”
Vaccine hesitancy can be defined as the refusal or delay in getting a vaccine, despite one being available.
It can be influenced by various factors including complacency, convenience or confidence in the vaccines. For example, someone may not see themselves at risk of catching COVID-19, it may be too hard for people to go and get a vaccine, or they may not trust the government and health-care system.
“Those of you who think you know what a ‘hesitant’ person looks like, throw it out of your mind because it doesn’t exist,” says Bettinger. “It really depends on the individual in front of you, the community they live in and what’s happening in the media, on social media and in the larger global community.”
Finding sources of truth
Some vaccine hesitancy may be triggered by an increase in misinformation about vaccines on social media.
“We know there are efforts in place to undermine vaccine confidence,” says Bettinger. “I would stick to peer-reviewed journals and articles. Well-known medical journals are where the good science is going to end up. Even trusted news agencies have good information like the Vancouver Sun, Globe and Mail, Global News, CTV or the BBC. I would avoid finding medical information on platforms like TikTok, Instagram, Facebook and YouTube.”
There is distrust in communities hardest hit by COVID-19 infections as well as among those who face multiple barriers to receiving health care and are treated inequitably due to systemic and structural racism – including communities of colour, immigrant communities, and First Nations, Inuit and Métis communities.
“This hesitancy is not stemming from a lack of knowledge or education,” she says. “It’s stemming from the way communities have been treated by medical systems and by individuals in power.”
To best inform patients, Bettinger recommends health-care providers educate themselves about the different vaccines, the safety of the COVID-19 vaccines, how vaccines are monitored and how the safety system works.
“After we start using these vaccines, we keep monitoring them to make sure they stay safe,” says Bettinger. “The reason we are finding out about these potential adverse events, like blood clots, shows the safety surveillance is working, but they are so rare, these vaccines are still considered safe to use in Canada.”
We only tend to see very rare events once vaccines are actually being used in the general population, Bettinger says, because they are too infrequent to pick up in clinical trials. The sample size is not large enough. You need a very large population who receives the vaccine to find them. According to Immunize BC, most negative effects occur within 6 weeks of receiving a vaccine.
Have the conversation
The best course of action for patients’ concerns, she says, is to listen, not make any assumptions and do your best to answer their questions.
“There’s no one message that’s going to work for everyone,” says Bettinger. “It’s a matter of engaging in a conversation and understanding what they’re hesitant about, why and explaining the science.”
For more information on COVID-19 vaccine safety, please visit the National Advisory Committee on Immunization or the BCCDC website on Immunization Clinical Resources for health professionals.
If you haven’t been vaccinated and want to sign up, please visit the BCCDC Getting a vaccine website.
It is not mandatory for staff to receive a vaccine, but it’s much safer to get a COVID-19 vaccine than to get the disease it prevents. Vaccines protect not only you, the individual, but everyone around you: your patients, family, friends and colleagues.
To participate in vaccine safety monitoring for our COVID-19 vaccines, health-care providers and patients can sign up on CANVAS-COVID.ca. Sign up is available before or after vaccination.