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Vaccine hesitancy in healthcare workers, from the viewpoint of social-behavioral health. A note: I have not been talking to vax hesitant HCW, all the patient facing HCW I know have gotten their vax. But my background is in how/why people make risky health decisions...(1/22)
And I think there's a lot to unpack here. First of all, don’t conflate HCW COVID vax hesitancy with the narrative about anti-vax movements & MMR refusal. This is different, there are reasonable concerns that would cause a HCW to refuse. (2/22)
Some HCW may feel that they shouldn’t be first in line. Maybe they already had COVID & are willing to rely on their disease-induced immunity for now so that others can get the vax. Maybe they are working in telehealth & don’t absolutely need to be patient facing. (3/22)
But there are other reasonable worries. The vax is currently under an FDA Emergency Use Authorization, that does not mean it’s fully tested & approved. Early vaccines DO sometimes have problems, look at RotaShield, it was pulled & eventually replaced by a safer vax. (4/22)
HCW know this & some may be rationally reluctant to go first. Particularly pregnant HCW since this vax has not been fully tested in pregnancy… we have reasons to believe think it is safe, but the data isn’t fully there. (5/22)
(Flip side: we know there are higher risks from COVID in pregnancy, so other pregnant HCW may be enthusiastic about getting the vax because it’s probably safer than getting COVID. There's no one right decision.) (6/22)
HCW may not have a lot of trust in the FDA since they so badly bungled the early testing situation & may feel like the CDCs lack of leadership has left hospitals & practices in the lurch. That distrust is not illogical given how the White House has politicized everything. (7/22)
Secondly: Some HCW may be making irrational decisions on vaccination. They have been under a TON of stress for months on end now, how do you expect them to be logical? I’ve heard stories from ER & COVID ICU providers that would make your hair curl. (8/22)
They go home & have to go through lengthy decontamination before seeing their families (or some don’t see their families for long stretches). The long hours, stress & isolation are taking a hard toll on HCW. This can affect rational decisionmaking in a lot of ways. (9/22)
Some may have families or loved ones who have been sucked into anti-vax activism or affected by fears about the virus. If those are the ONLY people you see outside the hospital, maybe it’s easier to say “I’ll wait” & avoid having your social support system angry at you. (10/22)
With things as bad as they are in LA County right now, there may even be providers who’s decision is subconsciously influenced by the need to get out of the trenches of direct patient care. Conditions are BRUTAL right now. (11/22)
And there may even be a small number who are subconsciously attempting suicide by vaccine refusal. It sounds horrible, but self-destructive acts are never logical & these people are under SO MUCH UNRELENTING STRESS right now. (12/22)
However, lets think a bit about what happens when we stigmatize & blame individual HCW for making a decision we don’t agree with. When we criticize people as individuals, we often harden people into defensiveness… this is a lesson from HIV & drug abuse epidemiology. (13/22)
In this case, it can harden hesitance or delay into outright vax refusal. Or worse yet, it can push HCW into the welcoming arms of the anti-vax movement, because society has not attempted to understand where they’re coming from, the media is just stigmatizing them. (14/22)
Anti-vax in HCW is a much more dangerous position to our whole society than hesitancy. But once a person has been backed into a wall by blame & stigma, that may be where they go. (15/22)
Which leads me to my biggest point: The “problem” of vaccine hesitancy is a system failure not an individual choice. Right now there are fewer vaccines doses than people who want to get it. In a robust system, a HCW refusal would just push the vaccine to the next tier… (16/22)
nursing homes, outreach workers, fire & law enforcement. Individual hesitancy would not affect the overall penetration of vax in the population. As long as the vax is getting to high risk folks. Why is that not happening? Failure of planning at the federal level. (17/22)
The feds have pushed off all “last mile logistics” onto state health departments, who are overwhelmed & don't have the bandwidth to do contingency planning. We knew vax hesitancy would be a problem as early as Oct/Nov, why weren’t the feds planning to deal with this? (18/22)
The federal government should have provided a guideline or framework for dealing with higher than expected refusal, & helped plan for how to route excess doses. (19/22)
In a disjointed system without a framework, individual refusal can be a problem because it means wasted vaccine dosage. Why are individual hospitals handling vaccinating their employees, but CVS/Walgreens handling nursing homes? (20/22)
What system in place is there to divert 20 unused doses from a hospital into the nursing home system? Or to first responders? W/out a coherent stepdown plan, individual choices creates problems that wouldn’t be there if the system had accounted for the risk of refusal. (21/22)
Blaming a stressed & overworked individual for a system failure is heartless and cruel. Heaping stigma on top of that cruelty only isolates them and makes them more vulnerable. Please stop blaming individual HCW choices & put the blame where it belongs: Poor planning. (end)
And just so it’s clear: I am pro-vaccine. I definitely think HCW should be out getting vaccinated. But I feel like a lot of the current discourse is like yelling that homeless injecting drug users should just stop using & get their lives together.
It’s true. It’s also a position that is simplistic, and lacks nuance & compassion.
