The Urgent Need for National Medical Education on Vaccine Hesitancy

In June of 2019, two months before I temporarily paused my medical training at the University of Michigan to begin a master's degree at Columbia Journalism School, New York Governor Andrew Cuomo signed legislation banning religious exemptions for vaccines.

The move, inspired by outbreaks of measles across New York City, meant that approximately 26,000 children in the state of New York who had previously used these exemptions as a loophole to attend school were now faced with a decision: get vaccinated or get out.

My master's thesis, completed over the course of six months, focused on the social lives and educational impact on unvaccinated children whose parents had pulled them out of school and decided to homeschool. 

Believe me, I wanted it to be easy.

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I wanted to believe that parents who didn't vaccinate their children were irresponsible, selfish and uneducated. But medicine and journalism are complicated and nuanced disciplines. And so, instead of writing about how awful I might have previously believed these people to be, I took trains across Long Island and buses up to Albany, embedding myself with families who were against vaccinations across the state.

I was honest about my identity as both a journalist and a medical student. And over the next several months, I took hundreds of pages of notes, joined countless vaccine social media groups and spoke with experts in pediatrics, epidemiology and social work.

I listened.

Because of this experience, I am now more equipped to have fruitful conversations and build trust with families who are vaccine hesitant. I don't see them as the other. I understand how terrifying and realistic vaccine propaganda can be because I've seen it myself. I empathize with the idea that many parents make choices out of fear, poor prior communication with physicians and the belief that they are protecting their children. I understand their motivations and understand the science.

Although I feel comfortable with this information now, I didn't always feel this way.

In 2019, the World Health Organization named vaccine hesitancy a top ten global health threat. Yet, from my experience informally discussing the subject, medical students like myself are wholly unprepared to have these conversations, and many medical schools have extremely limited time allocated to this subject.

As the COVID-19 vaccines begin to roll out, understanding the growing international anti-vaccination movement is as important as ever.

What would a succinct vaccine hesitancy curriculum look like?  

Five key elements to utilize to confront vaccine hesitancy that could be condensed into a few educational workshops, with input from a few physicians who are leading the way:

1. Communication training. Communication training including the use of presumptive language (i.e. "You have two shots scheduled for today." vs. "What do you want to do about shots?") can be instrumental in capturing large proportions of vaccine-hesitant parents says Abigail Schnaith, M.D., a resident physician at the University of Minnesota who authored a paper on a medical school curriculum designed to address HPV vaccine hesitancy.

"We have no problems telling a patient with diabetes which labs he/she needs," Schnaith says. Why should vaccines be different? Other communication strategies may include motivational interviewing and having an elevator pitch or card ready when questions arise.

2. Lectures and Reading Materials. Lectures, reading materials or even podcasts can help students learn about vaccine hesitancy, as well as understand the negative and deadly effects of diseases we vaccinate against and why certain cultural groups and races may rightfully distrust the medical system.

These resources can also help future providers obtain the data needed to answer common questions from vaccine-hesitant parents.

3. Standardized Patient Cases. All physicians agreed that this was an important part of vaccine hesitancy training. Paul Offit, M.D., a world vaccine education expert and the director of the Vaccine Education Center team at the Children's Hospital of Pennsylvania explained to me that in his one-week long class, he often pretends to be the vaccine-hesitant patient, citing classic fears that he hears. If standardized patients cannot be funded, having students pair up to practice is helpful.

4. Outreach programs. Neila Afonso, M.D., the Assistant Dean for Community Integration & Outreach at Oakland University William Beaumont School of Medicine, says a key part of her vaccine hesitancy curriculum is her work with two groups – Alana's Foundation and the Franny Strong Foundation.

Afonso recently wrote a paper on COVID-19 vaccine hesitancy in medical students and has worked closely with medical students on these issues. The two foundations she noted were started in honor of two individuals who passed away from vaccine-preventable diseases with missions to promote awareness and prevention.

5. Identifying Propaganda: Finally, from my experiences, I believe that identifying propaganda and understanding how it is created can help students separate fact from fiction. While doing research for my thesis, I noticed that vaccine-hesitant blogs or websites often misinterpreted studies related to vaccines.

Presenting students with these types of posts or videos – and then asking students to find the actual scientific article – might be helpful when addressing patients if they bring in these types of articles in the future.

Although I understand that there are many individuals who will ultimately choose not to get vaccinated, I hope workshops such as the aforementioned will help medical students and a generation of future physicians help educate and encourage those interested in making healthy choices.

As a society, our focus right now is on beating COVID-19, but a large part of that is building trust between communities and the medical system. This means acknowledging why the mistrust is there, while improving communication and understanding for the future.  

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