Q&A: Battling Vaccine Hesitancy Among Health Care Workers

February 17, 2021
Frank Diamond

Rebecca Leach, RN, BSN, MPH, CIC: “The flu vaccine is mandated where I work. I do see a day where the COVID-19 vaccine will be mandated as well in health care facilities especially if—as we expect—COVID is not going away.”

Complacency. That’s what worries infection prevention expert Rebecca Leach, RN, BSN, MPH, CIC. Sure, right now all the numbers for the coronavirus disease 2019 (COVID-19) pandemic seem to be heading in the right direction, and in a hurry, too. Infection, hospitalization, and death rates across the United States plummet. Sure, demand greatly outnumbers supply when it comes to the COVID-19 vaccines, but more and more Americans keep getting vaccinated. “My fear is that we’re going to … now that numbers are coming down again, people are going to get more complacent and not really do the things we need to do to keep the numbers down,” says Leach, a member of Infection Control Today®’s Editorial Advisory Board. Vaccine complacency remains a formidable problem, even with health care professionals. Infection preventionists need to educate and encourage their colleagues to get vaccinated, says Leach. At the health system where she works, Leach says that her “biggest role is just helping to educate, going to different departments talking with staff, and just giving them information that I know, and listening to their concerns and helping to try to address them so that they can make the best decision for themselves.”

Infection Control Today®: This beat reporter is surprised that health care workers would not want to get the vaccine. Does that surprise you? And how do you deal with that?

Rebecca Leach, RN, BSN, MPH, CIC: I think in some ways it surprises you. But then we have to remember that there’s a large number of people in the general community who are wary of vaccines. And so why would there be any difference with health care workers? Some of the reasons that they are concerned about it are the same reasons that other people are too, including concerns about safety or side effects and other things. When you think about it, logically, it’s not that big of a surprise. But it seems like since you work in health care, you would be more comfortable with it, but it’s not always true.

ICT®: And the assumption I made in the introduction that infection preventionists are involved in vaccination efforts. Is that true across the board or does it depend on the particular hospital?

Leach: It really does depend on your hospital. A lot of times, it depends on how closely you work with employee health or occupational health in your hospital setting. In smaller hospitals, infection prevention and employee health are usually one and the same. In larger hospitals, like where I work, they’re different departments. But you all work closely together, and especially in a situation like this in a pandemic, you team with each other to help improve compliance with vaccination. But also just the whole process around employee health with COVID infections and employees having to be off and that kind of thing.

ICT®: As I mentioned in an introduction, you’re not solely an infection prevention expert, you’re also a working infection preventionist. Are you involved in vaccination efforts where you’re at? If so, how do you convince people—health care professionals—that they should get the vaccine?

Leach: I work in Arizona, and right now the state of Arizona, the state health department and the county health departments, are controlling the vaccination efforts. And so right now the individual hospitals are not doing it. Every state, even different counties in different states, are doing it a little bit differently. Where I am, we’ve not been directly involved in the vaccine efforts. That has been channeled through the health departments. But what we do is when we are out and rounding and as part of our incident command that still meets regularly for COVID response, we put out education, because we get a lot of questions, especially in the beginning when vaccines were first authorized and approved, about the various side effects. Are they effective? What will be the process? What does it look like? And we still do get a lot of questions and so my biggest role is just helping to educate, going to different departments talking with staff, and just giving them information that I know, and listening to their concerns and helping to try to address them so that they can make the best decision for themselves.

ICT®: What’s the main concern that you usually hear?

Leach: A lot of concerns about side effects. A lot of concerns about …. they heard somebody that they knew got it, and they were so sick. And then you still hear a lot of people who are confused about whether or not they can actually get COVID from the vaccine. It’s a lot of the same things you hear about almost any vaccine for people that have concerns about it. But mostly, it’s the concerns about safety that I hear, because it is an emergency use authorization. It hasn’t been around for very long. So, I just try to explain to them that the findings, the studies, the research … that it was done in an ethical way, and that this is what we know. And so far, the safety has been shown to be really good. There have not been major safety issues, especially as time goes on, and more people get vaccinated. I think that helps people because I keep telling them, “It’s being studied, even now, as people have been vaccinated.” It’s not like they stopped looking at it. I think that helps people. I think another thing to look at is that some people have a lot of mistrust with the government. I think that’s been talked about a lot, especially with our minority groups that have had struggles with the government, and you know, the Tuskegee [Study], and all of those historical things that impacted them. And I think that’s something we need to be open to and listen to and understand where people are coming from and where these fears are coming from.

ICT®: Now, every expert I asked this question of said: “Probably not.” Do you see a day coming when hospitals can mandate that their employees must get the COVID-19 vaccine?

Leach: The flu vaccine is mandated where I work. I do see a day where the COVID-19 vaccine will be mandated as well in health care facilities especially if—as we expect—COVID is not going away. I think most of the leading experts you hear think it’s going to be with us pretty much like the flu is and that it’s not going to go away. I think if that’s the case, and probably not anytime soon, but maybe in the next 10 years or so, it will be a mandated vaccine.

ICT®: I remember the last time we talked, you were spot on about the problems that you foresaw with the vaccine rollout. Do you still have concerns with how that’s going?

Leach: Well, there’s been a lot of, I would say, lessons learned. Here in Arizona, that’s what I can speak to best based on the experiences we’ve had. There’s just been a lot of logistics and communication with everybody who’s trying to get a vaccine meets the different tiers and how that process works. It has caused a lot of strife and public concern for some people. You hear people who just cannot even get an appointment. And you don’t know if it’s because they don’t have enough vaccine, or if it’s just like there’s a problem with the system to get registered. There’s no perfect way to do this. Everybody’s kind of learning as we’re going. It has been a bit of a struggle, I would say. I mean, there are probably some places that have done it well, but it’s been a little bit challenging here.

ICT®: You say that where you’re at the local health care authorities are in charge of vaccination efforts. But does that mean you don’t try to convince people that it’s a good thing to do? How do you handle it in that case?

Leach: Part of our role here is that once the vaccine became available, and we knew what the process was going to be, our hospital partnered with the local health department to set up one of the pods, the points of distribution. And so that was one of our big pushes is that we would communicate with our staff that that was what we were doing and that was how we are showing support for the vaccination. And then also helping to facilitate staff being able to get appointments at that specific location with the health department. They set aside specific hours just for the staff from our health system to go and get their vaccine. That was part of the way that we tried to partner with the health department to ease the way for our staff. A lot of it was putting out information ahead of time, just letting people know that it was even available, how to sign up, what questions they had to try to answer. Try to control the rumor mill about things, and just a lot of education, a lot of talking to people, easing their concerns. And then once a lot of us started to get the first dose of the vaccine, we would talk to people about it. People would ask how it went? How are you feeling? Did you have any problems? So that gives you that firsthand experience as well.

ICT®: Have you actually had the experience where you talked someone into getting the vaccine who was really hesitant to do so?

Leach: I have had that experience. I’ve talked to a few people about it. And honestly, it was more on a personal level. Colleagues and family members who were eligible who were concerned. Part of it was the mistrust of the government, the fears of the safety of the vaccine. A lot of the same concerns that health care workers have. It’s just listening to what people’s concerns are. I think it’s like anything else when something like this, especially in a pandemic—and we’ve all had a lot of fear driving our behaviors—this is no different. Part of it is just listening to what their concerns are. The same things we did with PPE [personal protective equipment], a lot of our infection control standards when we first were encountering COVID. Trying to understand why people wanted to wear hazmat suits when we knew that wasn’t necessary. To try to kind of talk them down and talk to them about it. The same thing goes with this. Where you try to listen to their concerns, try to give them information, and then it really is ultimately up to them to decide. But I’ve had a couple of good experiences, which is good, about people deciding to get the vaccine.

ICT®: What was your secret? You just kept at it?

Leach: Part of it was keeping at it. I think part of it was maybe saying, “You’re an example.” I think that’s another thing that you can do for people is saying: “You’re setting the example. You’re doing this not just for you, but for other people that you care about.” I think trying to bring it to that level so that they know that what they’re doing is actually helping other people. And that’s the point of vaccines, that you’re helping other people. It’s not just for you. It’s for everybody around you. Same thing with wearing masks and all the other things we’re doing.

ICT®: Have you ever heard of a doctor not wanting to get the vaccine?

Leach: I have not yet. But I’m sure there are doctors who are concerned about it just as much as anybody else.

ICT®: What would you advise your fellow infection preventionists to do in terms of educating about the vaccine, or where they should fit? I guess they have to play it by ear, depending on where they happen to be working?

Leach: I think it’s, know your audience and try to really understand their concerns. And then maybe that helps you address them. Also just learning what you can about the vaccine. Reading about the data behind it. A lot of people are worried about the variants and whether or not the vaccine will cover it. They’re kind of thinking, “Is this even worth it? If we have new variants, and that’s going to be the more predominant strain?” You just have keep up with the latest research, and understand your audience and what their concerns are so that you can try to go into the conversation prepared to answer the questions. But also, a lot of it is just listening to what they have to say.

ICT®: And finally, how concerned are you about the variants? How concerned are you about the Super Bowl? Are you worried about more surges?

Leach: I am. I think we’re still going to have surges this year. I guess maybe that’s pessimism, or I don’t know what it is, but I’m worried about spring break. Arizona is a big spring break state. So that’s a concern for me. For a big surge. The Super Bowl? I’m concerned but I feel like it’s going to be a little bit of a spike, but not like it was in January after the holidays. And the variants? I try not to get too concerned because I feel like we know what to do. It doesn’t change our practices around infection control. The same things we were doing last year at this time are the things we need to do this year this time for the variants. I don’t feel like there’s enough of a difference that we need to change our practices or processes. It’s just keeping up with it and keep doing it. My fear is that we’re going to … now that numbers are coming down again, people are going to get more complacent and not really do the things we need to do to keep the numbers down.

This interview has been edited for clarity and length.