Their development was rushed. They cause infertility. They will track your every move with an amazingly tiny microchip ….
These and many other common myths and misconceptions about COVID-19 vaccines have contributed to plodding vaccination rates in the U.S., said Shikha Jain, MD, FACP, a medical oncologist at UI Health in Chicago. Seventy percent of U.S. adults had received their first dose by early August, a goal President Joe Biden had wanted to meet by July 4.
“I have patients who I will ask why they don't want to get [a vaccine], and they will literally quote this misinformation and disinformation that they've found online or heard in their communities,” she said.
Messaging that discourages vaccine uptake has proven deadly during a pandemic that has taken the lives of more than 720,000 Americans, said Dr. Jain, who is an assistant professor of medicine and the director of communication strategies in medicine at the University of Illinois College of Medicine in Chicago.
“I think that there's a lot of work still to be done on addressing all this misinformation that's out there, because this infodemic, these misinformation and disinformation campaigns, are absolutely killing people,” she said.
Physicians are some of the most trusted messengers when it comes to health information. But many are becoming frustrated and burned out amid prevailing false narratives that decrease confidence in a safe and very effective vaccine, especially among the communities that are most vulnerable to COVID-19, said Dr. Jain.
ACP agrees. “Contributing to the spread of misinformation that is not factual or based on the best available evidence puts the health of patients, families and communities at risk and thwarts the efforts of all physicians, health care workers, researchers, and others who are working tirelessly to fight COVID-19,” ACP President George M. Abraham, MD, MPH, MACP, said in a September statement. ACP has also partnered with YouTube to combat misinformation.
“We've gotten to the point now where many of us have to steel ourselves before we ask somebody if they're vaccinated, because the people who aren't often will be not very receptive to hearing what we have to say at this point,” Dr. Jain said. “And unvaccinated people can become quite upset when they're asked about their vaccine status these days.”
Such conversations also continue outside the exam room. “To most effectively combat this misinformation, it is essential to meet people where they are getting their information, which is why you have seen so many health care workers active across so many platforms,” said Dr. Jain, who reaches more than 10,500 followers on Twitter using the handle @ShikhaJainMD and is a regular contributor to news outlets, such as CBS News, Fox 32 in Chicago, and U.S. News.
As the pandemic continues, internists are bound to have more of these conversations with patients, whether they're encouraging a first vaccine dose or responding to requests for a third. Physicians who, like Dr. Jain, have been disseminating accurate information and education throughout the pandemic shared their tips for doing so in a sustainable, equitable way.
Staying the course
Among ACP's membership, faith in COVID-19 vaccines does not appear to be compromised. In a January survey of 844 current and former U.S. members of ACP, 94% of internists said they would recommend any available COVID-19 vaccine.
But not all physicians back the vaccines, and some use their expertise to spread negative, non-evidence-based opinions on safety and effectiveness to the public through social media, speaking engagements, and other channels. An August MedPage Today report identified 20 U.S. physicians who've spread false information about COVID-19, including a San Francisco internist who shared a hypothesis in a widely circulated video that 5G networks caused the pandemic, bolstered by the claim that the 1918 Spanish flu pandemic was caused by the introduction of radio waves. (The doctor surrendered his license in February.)
To mitigate physicians' roles in contributing to misinformation, the Federation of State Medical Boards confirmed in late July that those who do are at risk for disciplinary action, including suspension or revocation of their medical license.
The American Boards of Internal Medicine, Family Medicine, and Pediatrics followed suit in September, issuing a joint statement warning their certified physicians that providing misinformation about COVID-19 vaccines is unethical, unprofessional, and dangerous and may put their certification at risk. “We are particularly concerned about physicians who use their authority to denigrate vaccination at a time when vaccines continue to demonstrate excellent effectiveness against severe illness, hospitalization and death,” the primary care boards wrote.
And then there are the vaccine champions. For many internists, such as Carlos del Rio, MD, FACP, spreading accurate information about COVID-19, public health mitigation measures, and eventually vaccines has become yet another part of the job during the pandemic.
“We're not only battling a virus; we're battling a misinformation epidemic that, for those of us trying to do the right thing, just makes our work really difficult,” he said. “Sometimes you feel like a salmon trying to go up the river.”
In response to the myth that there is no reason to get a vaccine because it doesn't completely prevent COVID-19 infection, Dr. del Rio uses a helpful car analogy. “I remind people that the vaccines are like wearing a seatbelt: Seatbelts don't prevent you from getting into a car accident, but it's the best thing you can do to reduce the risk of serious injury and to keep yourself alive,” he said.
Dr. del Rio, who has appeared on CNN multiple times and reaches more than 46,000 followers on Twitter via the handle @CarlosdelRio7, noted that this is the first pandemic of social media, which has the potential to spread both factual and inaccurate information at rapid speed.
At the same time, having a public presence on social and mainstream media may invite vitriol on comment threads, via direct messages, and in email inboxes. “I could show you some really nasty emails,” Dr. del Rio said. “Most of the time, I just ignore it.”
An active presence on social media doesn't always come with detractors, however. For Adam Cifu, MD, FACP, building up a Twitter community of nearly 19,000 physicians and other like-minded followers using his handle @adamcifu means that overall, he hasn't been plagued by attacks online.
In fact, a lighthearted tweet of Dr. Cifu's made the rounds in September when he suggested that “It might be time to fight misinformation fire with misinformation fire.” In hundreds of replies, followers reported that receiving a COVID-19 vaccine led to such positive side effects as losing 10 pounds, achieving fitness milestones, and receiving promotions at work.
“It's funny how tweeting something like that, as a whole, seems to show that a lot of other people are thinking the same thing at the same time, like the way that you express it, and therefore pile on to it,” said Dr. Cifu, who is a primary care internist and professor of medicine at the University of Chicago Medicine.
He has also been a vaccine influencer in clinic, leveraging his long-term, trusting relationships with patients to achieve an impressive vaccination rate. Of his practice's 850-patient panel, Dr. Cifu estimated that only about 10 patients have refused to get the vaccine.
“I was surprised at how little it took to convince patients who have not voluntarily received the vaccine because they wanted to come into the office and talk to me,” he said. “It was not like I had to spend five minutes explaining the vaccine and why it was important; they just wanted to hear that I thought it was a good idea and, knowing your medical history, it would be the proper answer. That 10- to 15-second statement, which was wholly true, obviously, was more than enough to make them say, ‘OK, I'll get it.’”
In the wake of the FDA's first full approval of a COVID-19 vaccine on Aug. 23, vaccination numbers kept trudging along but did not see the increase that might have been expected. In the two weeks since the Pfizer-BioNTech COVID-19 vaccine was approved, the country's average weekly vaccination rate declined by 38%. As of Oct. 18, CDC data showed that 79% of U.S. adults had received at least one dose and 68.5% were fully vaccinated. Six percent of fully vaccinated adults had received a booster dose.
Going forward, FDA approval probably won't make much of a difference for those who have decided not to get vaccinated, Dr. Cifu said. “Unfortunately, I think … [for] the people who are going into this suspiciously, just because the FDA now says, ‘OK, this has our approval,’ isn't going to change a lot of minds,” he said.
Dr. Jain added that more so than FDA approval, vaccination mandates from employers, airlines, and restaurants may be the clincher in getting more people vaccinated. “One person told me that his job required it, so he had to get it,” she said. “He wasn't against the vaccine; he just didn't see a reason to get it. But once his job required it, he got it.”
In addition to supporting the immunization of all health care workers, ACP said in September that employers and schools may appropriately require proof of vaccination for highly transmissible diseases, including COVID-19. “We need to ensure that as many members of our society are vaccinated as possible to protect the most vulnerable among us,” Dr. Abraham said in a statement.
Inspiring vaccine confidence
Patients' minds are changed about vaccines one at a time, not across huge populations, noted Dr. del Rio, who is executive associate dean at Emory University School of Medicine and Grady Health System in Atlanta. And sometimes COVID-19 itself is the wake-up call, he said.
“I think one thing that we are being able to change right now, to be honest with you, and that I see as a big change is … we're finally making sure that people understand that you can't wait anymore,” said Dr. del Rio, who is also a distinguished professor of medicine in the division of infectious diseases at Emory. “I've seen several people who end up in the hospital and those families say, ‘OK, it's time to get vaccinated.’”
In her clinic, Dr. Jain is trying to change her patients' minds as well, even though it can take significant time and effort. She said she meets patients where they are, listens to and addresses their concerns, and will even walk with patients across the street to the vaccination clinic and hold their hand while they get the shot.
“I have really close relationships with my patients, and as a team, we work so hard to get them healthy and to get the cancer under control,” Dr. Jain said. “We've gotten them through side effects and infections and hospitalizations, so the thought that they may die from something that is preventable, because I didn't spend that extra 10, 15 minutes explaining to them and answering their questions, I don't have it in me to not take that time.”
While vaccine misinformation can be a major barrier to increasing vaccination rates, an even broader contributing factor is longstanding distrust of the medical system, especially among Black, Indigenous, and people of color (BIPOC) who have been historically mistreated, noted Davidson H. Hamer, MD, FACP, a professor of global health and medicine at Boston University.
“That is harder to overcome, and it's really important to have people of color that are involved to do outreach and talk to people,” such as religious leaders and sports figures, he said.
Dr. Hamer noted that Bill Russell, the first Black coach in NBA history, is a prime example of a sports figure who has gotten involved in the vaccination effort. In a public service announcement earlier this year, the towering two-time Hall of Famer said, “I've just arrived to get my COVID shot. And this is one shot I won't block.”
“Having people that people respect that are also people of color really helps those communities overcome long-term distrust of medical care,” Dr. Hamer said.
Understanding the importance of celebrities in promoting trust in COVID-19 vaccines, Dr. del Rio and his colleague Kimberly Manning, MD, FACP, worked with Tyler Perry to create a video to provide information to the Black community. In the half-hour special, which aired on BET in January and is available online, the star sits down with Drs. del Rio and Manning to address questions and concerns about the COVID-19 vaccine.
An article published online in August by Open Forum Infectious Diseases offered this and other strategies to gain the trust of BIPOC communities, whose rates of reluctance about COVID-19 vaccines have ranged from 25% to 50% in several national surveys.
“There is a role for internists to respond to misinformation and get the facts to people. [It's] especially important to gain trust of BIPOC communities who are most at risk for COVID complications and vulnerable to misinformation,” said lead author Jasmine R. Marcelin, MD, FACP, an assistant professor of infectious diseases and associate program director of the internal medicine residency at the University of Nebraska Medical Center in Omaha.
Clinicians can earn the trust of BIPOC communities through cultural humility, empathy, transparency, and open-mindedness, bearing in mind that “A condescending or dismissive approach will be ineffective, particularly in the context of conspiracy theories or misinformation,” the article said.
For example, one common false concern among the Hispanic population, particularly Catholics, is that the vaccines contain aborted fetal cells, noted Dr. del Rio. He conducts media interviews in Spanish to reach this community directly and set the record straight. In addition, the Ad Council worked with the Pope and other leaders of the Catholic Church to develop an informational video in Spanish encouraging people to get vaccinated as “un acto de amor”— an act of love.
“We have to be continually dispelling myths,” Dr. del Rio said. “I think it's really important to … ensure that we communicate with the Latino population in their language and that we do it in a way that is credible, that is trustworthy, that they can feel that they're being listened to.”
Having young people accept COVID-19 vaccination has also been a problem. To inform young people, the Ad Council worked with the creators of “Family Guy” on a public service announcement to provide information about the vaccines. Dr. del Rio, who was one of their medical content advisors, applauded showrunner and voice actor Seth MacFarlane for agreeing to make the three-minute short.
Despite such efforts, some unvaccinated people will have fixed beliefs about the vaccines. But there are still others who simply need more time to get their questions answered. That's where internists can make a difference, said Dr. Marcelin, who reaches nearly 17,000 followers on Twitter via the handle @DrJRMarcelin. “We need to give them that space and grace to do that and help them with this need,” she said.