AUBURN, Ala. (WRBL) – Treating vaccine hesitancy with care and compassion may just be what the doctor ordered. An Auburn University Emeritus Professor, who’s dedicated his professional life to improving treatment goals for patients, believes COVID-19 vaccine hesitancy is best addressed through compassionate conversations between healthcare providers and those who worry about getting the shot.

 Dr. Bruce Berger is a retired pharmacist and educator who is passionate about helping health care providers communicate effectively with the families they care for in a medical setting. Dr. Berger teachers a conversation technique called motivational interviewing, and Dr. Berger says the trust-building process is critical in saving lives.

“Right now, from what I’ve seen, almost 50% of the population is vaccine-hesitant and considering to reach herd immunity it’s 80% vaccinated, we have to improve on that 50%,” said Dr. Berger.

Dr. Berger believes there are three main concerns a person has that make them reluctant to receive the COVID-19 vaccine:

  1. They worry the vaccine will give them the virus.
  2. They worry the vaccine was rushed, and long-term impacts are unknown.
  3. They are confused about how the vaccine works to help the body build immunity and fear it will alter DNA.

Dr. Berger says these concerns are best addressed with a compassionate exchange of ideas between patients and healthcare providers. Conversations rooted in respect lead to long-term relationships where patients feel comfortable sharing concerns and feel a trusted partnership with their healthcare provider.

“We have to honor and respect how the patient came to those decisions, and we have got to make it safe for them to tell us about what their reluctance is and what their concerns are. Rather than saying you can’t get Covid from this, which puts them down in a sense, we need to be able to stay, you’re worried about getting COVID, and that’s making you reluctant to get the vaccine. Can we talk more about that,” said Dr. Berger.

In December, Dr. Berger wrote an article about why it’s essential to have a conversation not focused on convincing someone to get vaccinated but rather focused on compassionately listening to concerns of the patient: Using Care and Compassion to Respond to Vaccine Hesitancy

“Rather than beat them over the head with education, we ask would you mind if I share some thoughts with you on that and tell me what you think? We have found that two minutes of motivational interviewing is more effective than thirty minutes of the paternalistic approach. We also knew from research when people felt listened to and heard, they are far more open for new information that may alleviate their concerns,” said Dr. Berger. 

Dr. Berger says motivational interviewing can also be used as a tool when discussing the vaccine with your family and friends. The conversation should not be about convincing a person they are wrong, which can hurt feelings and lead to a fight. Instead, focus on sharing individual concerns and respectfully discussing them. If needed, invite a healthcare professional to guide the conversation. 

Dr. Berger says conversations about vaccines or really any topic that may seem controversial to some that lead to confrontation rarely work. Dr. Berger says kindness is really the best medicine when confronting COVID-19 vaccine hesitancy and other healthcare concerns.

Dr. Bruce Berger Biography:

Bruce is the President of Berger Consulting, LLC and Emeritus Professor at Auburn University. He has developed comMIt (Comprehensive Motivational Interviewing Training for health care providers) and AU MITI (Auburn University Motivational Interviewing Training Institute), and AU MITI (Auburn University Motivational Training Institute. He has taught motivational interviewing in health care and methods for improving treatment adherence for over 30 years. 

He was born in Cleveland, Ohio. Bruce received his BS in Pharmacy from The Ohio State University. After practicing pharmacy for two years, he returned to Ohio State and received his Masters and Ph.D. in social and behavioral pharmacy. He taught at Ohio State before moving to West Virginia University in January 1980. After two years at WVU, Bruce moved to Auburn University and taught there until he retired from the university in September of 2009. 

His research interests include health behavior change and improving treatment adherence. He has written three books, written or presented over 900 papers (88 peer-reviewed) or seminars (94 peer-reviewed) on these topics. He has attracted over $3.5 million in funding to support his research. He has been a consultant and trainer for the US Air Force, VA, US Army, Pfizer, Inc., Procter & Gamble, Abbvie, Novartis, Astra-Zeneca, Sanofi-Aventis, GSK, and over 50 health plans, including Humana, Harvard Pilgrim, Tufts Health, ConnectiCare, Medical Mutual of Ohio and numerous BlueCross BlueShield plans.

He is the recipient of numerous awards, including the Lyman Award and the first American Association of Colleges of Pharmacy’s Award of Excellence for his research. He is the 2001 recipient of the Jack L. Beal Postbaccalaureate Alumni Award from the Ohio State University. In March of 2004, Bruce was awarded a fellowship by the American Pharmacists Association (APhA) Academy of Pharmaceutical Research and Science for a lifetime of quality research. Bruce is the 2007 and 2009 winner of the APhA Wierderholt Prize for the best research publication in the social, behavioral, and administrative sciences in pharmacy in the Journal of the APhA. The first study focused on the impact of motivational interviewing. Bruce is the 2009 recipient of the American Association of Colleges of Pharmacy’s Robert Chalmers Distinguished Pharmacy Educator Award, one of the Association’s three highest honors. Bruce is the author of the book, Motivational Interviewing for Health Care Professionals: A Sensible Approach, APhA, Washington, DC, August, 2020, 2nd edition, and the 8 hour accredited Motivational Interviewing E-Learning Program for Health Care Professionals (2015), along with William A. Villaume.

Using Care and Compassion to Respond to Vaccine Hesitancy

Bruce Berger December 12, 2020

President at Berger Consulting, LLC, Motivational Interviewing Training and Professor Emeritus Auburn University

It’s such a critical time for health care professionals to be able to show empathy and respect for vaccine-hesitant patients. The focus should not be on convincing patients to take the coronavirus vaccine, but to listen to their fears, thoughts, and opinions (no matter how unsubstantiated) by using kindness and respect and then explore further BEFORE offering education. Rather than saying (to a concerned patient who worries that you can get coronavirus from the vaccine), “No, you can’t get coronavirus from the vaccine”, it is more powerful to say, “You’re worried that you’ll get coronavirus from the vaccine and that makes you reluctant to take it.” Next, we can ask if we could share some thoughts or information for them to consider to address that: “Would you mind if I shared some thoughts with you and you tell me what you think?” The same approach may be taken with a patient who says, “I don’t trust these people. They don’t know enough about the what the vaccine’s going do to us.” Rather than immediately countering with any education/information that would dispute this claim, first say, “You don’t feel comfortable that enough testing has been done to uncover potential problems.” Let the patient know you care and understand before you show them how much you know.

We have to build a relationship of trust, not confrontation if any education we do has a chance of sticking or having an impact.

When we are ready to educate the patient after listening and demonstrating understanding, that education must be clear, simple, to the point and done with confidence. I have been amazed at how much differently people view the vaccine when I have explained to them how these new vaccines work….that is, a dead virus is NOT being injected (like is the case with the flu vaccine) with these messenger RNA vaccines. I have explained it the following way: information about a small, but important part of the virus (the spike protein) is being injected that causes our body to build many of these spike proteins. Our body then builds antibodies to these so that when our body sees that protein again on the actual coronavirus, it is ready to fight it with the antibodies we have built. Because what is being injected is not the virus (and only a protein part of the virus), we cannot get Covid19 from it, even though we can build antibodies for the actual coronavirus with that protein. I have explained that the first shot is to start this process and the second shot is to “boost” the antibodies to provide better and longer-term protection. This explanation really helps people feel better about the safety and effectiveness of the vaccine. If they ask, I also tell them that I would be first in line to take the vaccine if I could.

Of course, you will have to find your own ways to talk with patients about getting vaccinated. I encourage you to be kind, patient and not feel like your objective is to convince your patients to be vaccinated. Rather, explore how they are thinking about it, offer education, then re-explore after they receive this new information (elicit – provide -elicit). Even if they say, “This whole thing is a hoax,” resist the temptation to say verbally or nonverbally, “You gotta be kidding me!” Instead, explore that with the patient. Calmly and kindly say something like, “Tell me more about that. What’s got you thinking it’s a hoax?” Listen carefully, reflect it back, and then ask, “What might make you change your mind…what would you need to learn or find out that would make you say, ‘I really do need to get this vaccine’?” They might say, “Nothing”. There are going to be people who just won’t be vaccinated. You cannot save them. But you don’t want to burn any bridges. Some may go home and think about it if they don’t feel confronted or criticized.

Let me know your thoughts about all this. I want to hear from you. What questions do you have about how to respond to patient challenges? Let’s have a forum for a discussion about this. It’s so important.