PhD/PsyD Treating vaccine hesitancy

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So vaccine hesitancy is coming up quite a bit lately in my position. People have divulged their reasons for avoiding the vaccine and soliciting my opinion on it. I think they're looking for my approval, which I do call out in therapy. but nevertheless it does raise the issue. When people ask me (and they do) if I think they should get the vaccine, I usually respond with providing a degree of scientific education and some motivational interviewing. I'm not sure this is the best approach hence the thread. How are folks handing this issue clinically?

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Oof, I struggle with this especially in the VA where you're supposed to avoid "politics" (a vaccine should not be political yet here we are).

I do remember an MI for vaccination protocol being tossed around one of the listservs, though.
 
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Oof, I struggle with this especially in the VA where you're supposed to avoid "politics" (a vaccine should not be political yet here we are).

I do remember an MI for vaccination protocol being tossed around one of the listservs, though.

Thanks, that's validating. People have responded well to it so far and a few folks made a decision to get vaccinated, but in those cases, they had a person in their lives that was putting pressure on them to get the vaccine.
 
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Is the client there to get treatment for vaccine hesitancy? Is it causing them profound distress and functional impairment because they are not vaccinated? If not, then no, I don’t “treat it.”

Clients do all kinds of problematic things that I don’t agree with, but if they are not there for that issue and it’s not causing functional impairment, then no I don’t treat it.
 
Is the client there to get treatment for vaccine hesitancy? Is it causing them profound distress and functional impairment because they are not vaccinated? If not, then no, I don’t “treat it.”

So working in a primary care clinic, it's not uncommon for me to get referrals from people for all issues under the sun. Being clear, I use MI so I'm not approaching it with any agenda. If people want the science, I'll give to them. Also, "we don't talk about that" doesn't seem like great psychotherapeutic practice to me, but maybe we can agree to disagree on that one.
 
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I offer whatever the latest science/CDC info is and encourage them to speak with their PCP. If/When they ask me if I was vaccinated, I review the latest data that informed my choice to get vaccinated and tell them that there were very very few legitimate reasons to not get vaccinated per the scientific data. I've had at least two (likely 3) patients die from COVID and they were very anti-vaxx and it wasn't productive to even engage about anything related to COVID, as they didn't believe it was a problem.
 
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Like I told an SDNer: if they actually 100% believed it was a non-issue, they’d have put everything they own into the market. Why haven’t they gotten a second mortgage, a margin account, and shorted the ever living hell out of the vaccine companies, the medical supply companies, and larger hospital systems? It’s not real, right? They’re smarter than everyone. People made billions doing this in 2008.

Or are they not 100% sure? Why? They’re already taming a substantial financial risk. What are the actual risks of not getting vaccinated to include financial, medical, and social? What are actual, not the what if, the risks of getting vaccinated?
 
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Its hard to to use logic on someone who think there is a microchip in the vaccine; I think quoting facts to people of that level is fruitless. The definition of a delusion is a fixed false belief after all.

Some people who have honest fear, its worth providing education and allowing them a non judgmental open forum of asking questions. Some people though, I don't think you can reach because in their mind we have been corrupted by "big pharma" or "the government" or someone else.
 
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Wasn’t sure where this belonged, but I’m a vaccine supporter but am really getting tired of the contradictions and reversals from news outlets and the CDC recommendations that may not actually be based on science (CDC said massless among vacc’ed ok, then reversed it, etc., then said 10-day quarantine, then cut it in half suddenly, etc.). I understand that we don’t know everything yet and our knowledge changes, but I don’t feel like enough research is actually being cited to give us real answers.

Particularly concerning to me is the pushing for boosters, starting with recommending one 6-12 months after vaccination, but now companies are rolling out additional boosters (some saying even before 6 months!) rather than showing us longterm studies of the original vaccine’s effectiveness 18 months out from the original trials, and working toward a longer lasting vaccine rather than boosters that have little research support and that the FDA seems to be rubber-stamping extremely quickly.

News outlets also regularly publish articles that contradict each other about each brand of vaccine’s effectiveness or the length of booster’s effectiveness. I also notice pharma proposing overly-rosy figures about how long they think their booster or vaccine will be effective, then reported by news outlets, which then have to backtrack (although they do not acknowledge this change and do not track their own statement changes) and post the updated length of effectiveness.

I’m no conspiracy theorist by any means, but I think the FDA is giving drug companies a bit more benefit of the doubt than they deserve when it comes to boosters and their effectiveness (not the vaccines, though, which have likely saved lives). I’m leery of companies pushing multiple boosters with questionable efficacy just because they say we need it without much data.

This article about a doctor’s concerns over a 2nd Moderna booster captures some of my concern well:

I don’t think it’s helpful to have federal recommendations for boosters with extremely limited effectiveness in terms of duration. I’m starting to wonder about the driving reason for additional boosters (ie a 2nd booster).

Per NPR: FDA shortens the wait time between Moderna vaccine and booster to 5 months

The Moderna vaccine’s effectiveness only lasted 5 months, down from the earlier reports and speculation put out by news media (remember the days when they thought it could last a year or more?).

Are we really going to be pushing the country to get up to 2-3 boosters/vaccines this year?

In sum, I myself have seen many contradictions in the news about Covid, the vaccines, and the boosters (recently I saw an article that said mRNA vaccines were more effective, then days later saw an article that the Non-mRNA vaccines—the traditional type—are more effectvie). If I’m getting overwhelmed by the contradictions, I’m sure the rest of America is probably also getting fatigued by the back and forth statements, and I’m guessing this is contributing to anti-vaxxers’ arguments (someone posted Fauci’s contradictory recommendations side by side, for example). Pharma, news outlets, and the CDC need to stop saying things based on speculation that they then have to reverse later, and we could do this if (longer term) research was behind all of the statements rather than speculations and using very short-term trials. I also wonder if economic/political pressures play into recommendations at times rather than safety, even at the highest levels (look at state or county guidance and how they handle mask recommendations, for example). It’s complicated, certainly, and also frustrating to watch play out.
 
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I guess I have a much different take on this, as I don't think there has been much in the way of contradictions, as opposed to changing guidelines as more data became available, with the exception of some of the muddled messaging that came out these past 2 weeks. Also, of course some of this is speculation. This is an evolving situation with a rapidly mutating denominator. I guess we could chide scientists for not having a time machine or clairvoyance, but that just seems petty. It's normal for lay people to not understand how science works, but we should expect more from those within our profession. Well, besides the diploma millers, maybe.

Tl;dr, messaging could use improvements. Science in general is bad at communicating with the unwashed masses. Changing guidance/projections when presented with real world data is how science works, not a contradiction.
 
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I guess I have a much different take on this, as I don't think there has been much in the way of contradictions, as opposed to changing guidelines as more data became available, with the exception of some of the muddled messaging that came out these past 2 weeks. Also, of course some of this is speculation. This is an evolving situation with a rapidly mutating denominator. I guess we could chide scientists for not having a time machine or clairvoyance, but that just seems petty. It's normal for lay people to not understand how science works, but we should expect more from those within our profession. Well, besides the diploma millers, maybe.

Tl;dr, messaging could use improvements. Science in general is bad at communicating with the unwashed masses. Changing guidance/projections when presented with real world data is how science works, not a contradiction.
You can’t seem to resist being rude when you disagree with people, can you? Classic WisNeuro tactic to patronize and belittle when you feel strongly about something. Do believe that patronizing makes you more persuasive?

My point was nuanced, and not reductionist or black and white, but you seem to fail to grasp that. I mentioned that at times, I don’t think science is actually driving some of what is reported or told to us, which is one of my concerns. The booster research in particular is extremely shaky at best, and the FDA seems to fast track these with very little to go on, which is a concern as well. If we’re vaccinated, why can’t we wait until the research is more robust before recommending boosters?

I do expect more than muddled messaging constantly (by news outlets, not necessarily exclusively the CDC), so yes, that’s where we differ. I even gave an example of direct contradiction (mRNA more effective, days later, non-mRNA said to be more effective). Perhaps Covid news gets more clicks so they overreport speculative statements rather than waiting and reporting more robust research findings.
 
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I try to stay on brand, keeps the sponsors happy. As for the booster, feel free to wait. No skin off my nuts. The real world Israel data looks pretty compelling for it as opposed to someone's cousins uncle's Subway sandwich artist saying otherwise on Facebook. As for reporting, which is different than scientific guidance, that's a different ballgame as some outlets get a hold of pre-prints and run with it without vetting.
 
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At minimum I'd I say "the scientific foundation of and justification for the vaccine in addressing COVID is based on the same methods of scientific inquiry that guide my work in addressing/treating ( ) with you." I'd probably have difficult time NOT adding "If you are comfortable with my treatment, it logically follows that you'd be comfortable with receiving the vaccine." I'd want to add- but wouldn't- "and if you're eligible for the vaccine with no contraindicated medical conditions, we can schedule our next appointment once you provide proof of vaccination." Of course most of my clients can't talk and none are eliglble for the vaccine, so I don't really have to worry about this.
 
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This is where having experts in Science Communication pays off. The MESSAGING has been pretty poor by the gov't for decades, but particularly in regard to COVID-19. The fringe / anti-vax types have decades of experience in twisting talking points and data, so it is that much more important that the public facing officials get it right....and they haven't. The anti-science people harp on the changes, but they refuse to acknowledge that scientific understanding is nuanced and ever evolving. They love mucking it all up to encourage doubt and confusion.
 
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I've seen a lot of frustration about the CDC and its messaging being expressed by virologists on Twitter.
 
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At minimum I'd I say "the scientific foundation of and justification for the vaccine in addressing COVID is based on the same methods of scientific inquiry that guide my work in addressing/treating ( ) with you." I'd probably have difficult time NOT adding "If you are comfortable with my treatment, it logically follows that you'd be comfortable with receiving the vaccine." I'd want to add- but wouldn't- "and if you're eligible for the vaccine with no contraindicated medical conditions, we can schedule our next appointment once you provide proof of vaccination." Of course most of my clients can't talk and none are eliglble for the vaccine, so I don't really have to worry about this.

This + motivational interviewing is what I ended up doing back at the primary care clinic when I was referred these cases.
 
It's been an easier question to tackle since I'm in a hospital. I lean on the recommendations of the broader hospital and the CDC. I'm also transparent about my own experiences with the shots and booster and make it very conversational. I've gotten a couple of clients ask for directions on how to get them for themselves which was a lovely feeling. In my case, if they're asking about it, they're usually in a receptive mood.
 
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