Hesitancy around vaccines more than misinformation

As thousands of Ohioans cheer as they receive their COVID-19 vaccinations, not everyone in the state is rejoicing.

Nearly 40% of Americans said they won’t take the coronavirus vaccine, according to the Pew Research Center. And in Ohio, more than 2 million people said they won’t get a vaccine, according to a Census experimental survey.

This uncertainty about the vaccine is called vaccine hesitancy, and work by Cedarville University researchers has found that there is more to hesitancy than misinformation. The World Health Organization considers vaccine hesitancy as one of the top 10 threats to global health.

“Vaccine hesitancy goes way beyond misinformation or a lack of understanding,” said Justin Cole, director of Cedarville’s Center for Pharmacy Innovation and associate professor of pharmacy practice.

Health beliefs also play into vaccine hesitancy and health decisions, said Aleda Chen, interim dean of Cedarville’s School of Pharmacy and associate professor of pharmacy practice. For example, she said, some people believe in going to the doctor and getting medicine when they have a cold, others believe in the body healing itself or healing through prayer.

“Understanding how people think what causes disease and how they can address disease is a really important thing when we’re having these conversations with patients,” Chen said.

While Ohio coronavirus cases continue to slowly decline, Gov. Mike DeWine said last week he can’t predict when remaining health orders might be lifted.

The governor directly connected the decrease in virus numbers to the state’s massive effort to vaccinate. But with more supply coming in, DeWine and other state leaders are running into vaccine hesitancy among certain groups, including the elderly and young people. Ohio is planning to address that with a number of TV and ad campaigns aimed at those individuals and their specific concerns around the virus.

“We continue to see the numbers trending downward and that is great for everyone,” he said. “We are making progress. But the battle has to be fought every single day.”


Oftentimes, patients are making decisions based on what they have come to believe about information, Cole said. So simply relying on education isn’t enough, because that information is filtered through a person’s health beliefs and they may come to a different conclusion when they think about their own values and beliefs, he said.

Cole said some people believe the COVID vaccine would put mRna into their bodies and change their DNA. As a health care provider, his first instinct may be to say that’s not true, but that person with that belief can walk away from the conversation feeling dismissed. Not truly listening or trying to understand where a patient is coming from will not help their vaccine hesitancy, Cole said.

Credit: Scott Huck

Credit: Scott Huck

“Instead of giving information first, saying ‘tell me more about that,’ and potentially as the conversation continues you can provide them with accurate information,” Cole said. “People don’t care what you know until they know that you care.”

Cole and Chen started studying vaccine hesitancy in pediatrics a few years ago. They found that vaccination refusals went down when using motivational interviewing, including refusals for the influenza vaccine.

When the pandemic started and a vaccine was being developed, the two pivoted their vaccine hesitancy work to focus on the COVID vaccine.

The two pharmacy professors said they’ve talked with people who are hesitant to take the vaccine because it is the first vaccine the world has seen come to market so quickly and people have doubts on whether it is safe or effective. Others have concerns over a lack of long-term side effect knowledge, concerns that the vaccine will cause them to get COVID or concerns that the vaccine is a way that the government is tracking people.

Cole and Chen believe that patient-centered communication practices, such as motivational interviewing to engage people who express vaccine hesitancy, will help this growing problem. Motivational interviewing is a way of talking with a person or patient by first trying to understand their reasoning.

They also believe that this technique will help reach minority communities who have a deep-rooted distrust toward the medical community and are the most likely to have vaccine hesitancy.

“There is a lot of distrust related to healthcare providers in minority communities given the history of unethical research and trials of many drugs and vaccines in vulnerable populations. So for minority communities, vaccine hesitancy is rooted in mistrust of the profession and whether we are going to be fair and equitable to them,” Chen said. “A lot of our research efforts focus on trying to change the approach to engaging people and building trust. Rather than simply telling patients what to do, we seek to understand their perspective and what is causing hesitancy. Then, we can share information honestly and start building equitable relationships.”


The Rev. Rockney Carter, senior pastor of Zion Baptist Church in West Dayton, said he has concerns about safely reopening his church because some in his congregation are still skeptical of the COVID vaccine.

“We’re praying on that. In the African American community there’s an inherent distrust of vaccinations of that type. Sometimes it takes our people a longer amount of time to do their research and that’s a process,” he said. “We’ve been subject to such systemic racism and racial disparities, in healthcare especially throughout the years, that we have distrust for it.”

Carter said he received his vaccines.

“I’m trying to encourage our congregation to participate in that process to the extent that they can, because we actually believe that it’ll help save your life,” he said.

Some people who contracted the virus never got medical attention and died in their West Dayton homes, Carter said.

With the closure of Good Samaritan Hospital, residents are short that community resource, he said. Other factors, including lack of health insurance, also made some people hesitant to seek health care, Carter said.

“We’ve got to make sure that we have equal access to quality health care,” he said. “They don’t go to the hospital. People are staying inside and a lot of people are perishing right there in their house.”

Credit: Scott Huck

Credit: Scott Huck


Cole and Chen said health care providers need to work to build trust and confidence and motivational interviewing is one way to do that. Talking with a trusted health care provider or a family member who is in the health field can also help answer some questions or ease hesitancy.

“The whole goal of it is to build a relationship with the person you’re taking to and I think that’s the best approach for building any sort of communication,” Chen said.

Cole said health care professionals can be people who promote vaccines, but are still empathetic to concerns of their patients.

Cole and Chen created a podcast last week outlining their findings on vaccine hesitancy and motivational interviewing. The audio is available for listeners through Apple Podcasts, Google Podcasts, Spotify, Overcast, Castro, Stitcher, Pocket Casts, Cast Box and TuneIn.

Dayton Daily News Staff Writer Chris Stewart contributed to this story.

CDC: Here is why getting the COVID vaccine is important

According to the U.S. Centers for Disease Control and Prevention, the reasons for people to get the COVID-19 vaccination are:

It will help keep you from getting COVID-19

  • All COVID-19 vaccines currently available in the United States have been shown to be highly effective at preventing COVID-19.
  • All COVID-19 vaccines that are in development are being carefully evaluated in clinical trials and will be authorized or approved only if they make it substantially less likely you’ll get COVID-19.
  • Based on what the CDC knows about vaccines for other diseases and early data from clinical trials, experts believe that getting a COVID-19 vaccine may also help keep you from getting seriously ill even if you do get COVID-19.
  • Getting vaccinated yourself may also protect people around you, particularly people at increased risk for severe illness from COVID-19.
  • Experts continue to conduct more studies about the effect of COVID-19 vaccination on severity of illness from COVID-19, as well as its ability to keep people from spreading the virus that causes COVID-19.

COVID-19 vaccination is a safer way to help build protection

  • COVID-19 can have serious, life-threatening complications, and there is no way to know how COVID-19 will affect you. And if you get sick, you could spread the disease to friends, family, and others around you.
  • Clinical trials of all vaccines must first show they are safe and effective before any vaccine can be authorized or approved for use, including COVID-19 vaccines. The known and potential benefits of a COVID-19 vaccine must outweigh the known and potential risks of the vaccine for use under what is known as an Emergency Use Authorization (EUA).
  • Getting COVID-19 may offer some natural protection, known as immunity. Current evidence suggests that reinfection with the virus that causes COVID-19 is uncommon in the 90 days after initial infection. However, experts don’t know for sure how long this protection lasts, and the risk of severe illness and death from COVID-19 far outweighs any benefits of natural immunity. COVID-19 vaccination will help protect you by creating an antibody (immune system) response without having to experience sickness.
  • Both natural immunity and immunity produced by a vaccine are important parts of COVID-19 disease that experts are trying to learn more about, and CDC will keep the public informed as new evidence becomes available.

COVID-19 vaccination will be an important tool to help stop the pandemic

  • Wearing masks and social distancing help reduce your chance of being exposed to the virus or spreading it to others, but these measures are not enough. Vaccines will work with your immune system so it will be ready to fight the virus if you are exposed.
  • The combination of getting vaccinated and following CDC’s recommendations to protect yourself and others will offer the best protection from COVID-19.
  • Stopping a pandemic requires using all the tools we have available. As experts learn more about how COVID-19 vaccination may help reduce spread of the disease in communities, CDC will continue to update the recommendations to protect communities using the latest science.

Source: U.S. Centers for Disease Control and Prevention

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