Vaccine Hesitancy: Management Strategies for Pharmacy Teams

After completing this application-based continuing education activity, pharmacists will be able to

· Describe vaccine hesitancy and barriers to vaccination

· Recognize the how determinants of vaccine hesitancy contribute to behavioral outcomes

· Recall anti-vaccine claims and rebuttals

· Discuss situation-appropriate intervention strategies

After completing this application-based continuing education activity, pharmacy technicians will be able to:

· Recall the benefits of vaccination

· Recognize the various determinants of vaccine hesitancy

· List ways to promote vaccine acceptance

The material presented here does not necessarily reflect the views of The University of Connecticut School of Pharmacy or its co-sponsor affiliates. These materials may discuss uses and dosages for therapeutic products, processes, procedures and inferred diagnoses that have not been approved by the United States Food and Drug Administration. A qualified health care professional should be consulted before using any therapeutic product discussed. All readers and continuing education participants should verify all information and data before treating patients or employing any therapies described in this continuing education activity.

Vaccines are responsible for reducing the incidence of vaccine-preventable diseases. While most people receive routine recommended vaccinations, a small portion of the population does not. Vaccine hesitancy and refusal are complex behaviors and the consequences of choosing not to vaccinate jeopardize both individual and societal health and safety. Pharmacists and pharmacy technicians must know the determinants and factors that contribute to vaccine hesitancy before they address and manage it appropriately. A comprehensive understanding of such influences can help pharmacists and pharmacy technicians identify and communicate with hesitant individuals better. Pharmacists and technicians are also able to screen patients for missing immunizations, provide patient education and support, and offer guidance.

Pharmacist Post-test

Pharmacist Learning Objectives:
1. Describe vaccine hesitancy and barriers to vaccination
2. Recognize the how determinants of vaccine hesitancy contribute to behavioral outcomes
3. Recall anti-vaccine claims and rebuttals
4. Discuss situation-appropriate intervention strategies

1. Which of the following MOST CLOSELY corresponds to the WHO definition of vaccine hesitancy?
A. Simple vaccine refusal in any context including lack of available vaccination services
B. Acceptance of any vaccine if the ability to access vaccination is convenient
C. Delay in acceptance or refusal of vaccines despite availability of vaccinations services

2. Select the influence category, source of influence, and determinants that are paired correctly.
A. Contextual influence—peer environment--costs
B. Vaccine-specific issues—specific vaccine—mode of administration
C. Group influences—political factors—reliability of vaccine supply

3. A mother indicates she does not and will not vaccinate her children. You use motivational interviewing and learn that she believes natural immunity is safer than vaccine-induced immunity. What is an appropriate rebuttal if she consents to listen?
A. Infection-induced immunity may elicit a superior immune response. However, the risks and complications associated with infection are significantly greater than those of vaccines.
B. A panel of experts from the Institute of Medicine reviewed more than 12,000 published reports and several high-quality studies; none indicate natural immunity is stronger.
C. The CDC’s system to track natural immunity vs. vaccine-induced immunity is called VAERS; you can examine the data in VAERS and see that your assumptions are wrong.

4. Susan comes to the pharmacy and your technician reminds her she is due for her second HPV vaccination. Susan glances to the pharmacist’s workstation and quickly says, “Ummm, not today.” The technician gently says, “You’re here, and we’re not busy. Why don’t we get it done?” Susan replies, “No, not today. That guy gave me the last one and left a huge bruise. Not today.” What type of barrier is keeping Susan from her second shot?
A. Vaccine accessibility
B. Distrust of provider
C. Gaps in knowledge

5. Dave arrives at the pharmacy to pick up his “sugar meds” and you notice that he hasn’t received his flu shot yet. After providing him with a clinical recommendation for the vaccine, Dave replies, “Why do I need to? I work from home and have never gotten the flu before. What’s the point?!” Which barrier is preventing Dave from getting the flu shot?
A. Distrust of vaccine
B. Misinformation
C. Perceived need for vaccine

6. Manny is a regular customer who appears to be up to date on all of his vaccines except for the shingles vaccination. When you ask him why, he states that it’s for religious reasons, but says “I’d give it a try if there’s a shot without any pork in it.” Which intervention strategy would be most appropriate for Manny’s situation?
A. Motivational interviewing about worldview
B. Debiasing techniques to address overkill
C. Offering Shingrix as an alternative

Pharmacy Technician Post-test

Pharmacy Technician Objectives:
1. Recall the benefits of vaccination
2. Recognize the various determinants of vaccine hesitancy
3. List ways to promote vaccine acceptance

1. Which of the following is a benefit of vaccination?
A. Vaccines reduce the incidence of some diseases
B. Vaccines completely eradicate vaccine-preventable diseases
C. Vaccines only benefit vaccinated infants and children

2. Which of the following types of vaccine coverage ensure the success of a vaccination program?
A. Only high-risk people receive recommended vaccines
B. Most people receive recommended vaccines on schedule
C. Most infants and children receive some vaccines

3. Mary tells you that she has not been vaccinated because the only place that is covered by her insurance requires a subway ride and then a taxi ride. Which of the following is the most likely determinant of Mary’s vaccine hesitancy?
A. Geographic restrictions imposed by insurance
B. Poor communication with her healthcare provider
C. A bad attitude about necessary health care

4. Joe lives in a rural area, and your pharmacist suggests he receive a flu shot. Joe says that his own doctor said that flu shots are fine, but not necessary for healthy folks. (The doctor said he hasn’t gotten one, and isn’t worried about it.) Which of the following is the most likely influence category to explain Joe’s vaccine hesitancy?
A. Vaccine/ vaccination-specific issues
B. Individual and group influences
C. Contextual influences

5. Which of the following is a way to promote vaccination in hesitant individuals?
A. Ask the pharmacist to increase motivation using pressure
B. Debunk any misinformation an individual may reference
C. Listen to the individual’s concerns before taking action

References

1. Meko H. School Will Pay $9.1 Million to Settle Lawsuit Over a Student’s Suicide. The New York Times. July 29, 2023. Accessed August 20, 2023. https://www.nytimes.com/2023/07/29/nyregion/new-jersey-student-suicide-settlement.html?searchResultPosition=1
2. Murphy B. Why bullying happens in health care and how to stop it. American Medical Association. Published April 2, 2021. Accessed August 4, 2023. https://www.ama-assn.org/practice-management/physician-health/why-bullying-happens-health-care-and-how-stop-it
3. Survey Suggests Disrespectful Behaviors Persist in Healthcare: Practitioners Speak Up (Yet Again) – Part I. Institute for Safe Medication Practices. February 24, 2022. https://www.ismp.org/resources/survey-suggests-disrespectful-behaviors-persist-healthcare-practitioners-speak-yet-again
4. Intimidation: Practitioners Speak Up About This Unresolved Problem (Part I). Institute For Safe Medication Practices. Published March 11, 2004. https://www.ismp.org/resources/intimidation-practitioners-speak-about-unresolved-problem-part-i
5. Disrespectful Behaviors: Their Impact, Why They Arise and Persist, and How to Address Them (Part II). Institute for Safe Medication Practices. April 14, 2024. Accessed August 4, 2022. https://www.ismp.org/resources/disrespectful-behaviors-their-impact-why-they-arise-and-persist-and-how-address-them-part
6. Knapp K, Shane P, Sasaki-Hill D, Yoshizuka K, Chan P, Vo T. Bullying in the clinical training of pharmacy students. Am J Pharm Educ. 2014;78(6):117. doi:10.5688/ajpe786117
7. Calvello M. Constructive vs. Destructive Feedback: Examples + Template | Fellow. Fellow.app. Published April 25, 2023. https://fellow.app/blog/feedback/constructive-vs-destructive-feedback-examples-template/
8. Ryan M. Besting the Workplace Bully. Reference & User Services Quarterly. 2016;55(4):267-269.
9. The Joint Commission. Bullying has no place in health care. www.jointcommission.org. Published June 2021. https://www.jointcommission.org/resources/news-and-multimedia/newsletters/newsletters/quick-safety/quick-safety-issue-24-bullying-has-no-place-in-health-care/bullying-has-no-place-in-health-care/
10. Manzoni JF, Barsoux JL. The Set-Up-To-Fail Syndrome. Harvard Business Review. Published March 1998. https://hbr.org/1998/03/the-set-up-to-fail-syndrome
11. Stein M, Vincent-Höper S, Schümann M, Gregersen S. Beyond Mistreatment at the Relationship Level: Abusive Supervision and Illegitimate Tasks. Int J Environ Res Public Health. 2020;17(8):2722. doi:10.3390/ijerph17082722
12. Caring for Our Caregivers Caring for Our Caregivers Workplace Violence in Healthcare. https://www.osha.gov/sites/default/files/OSHA3826.pdf
13. Infrontadmin. The 6 Stages of Bullying. https://truesport.org/bullying-prevention/stages-of-bullying/
14. “Disruptive” doctors rattle nurses, increase safety risks. USA TODAY. Accessed August 3, 2023. https://www.usatoday.com/story/news/2015/09/20/disruptive-doctors-rattle-nurses-increase-safety-risks/71706858/
15. Bullying in the workplace. www.independentpharmacist.co.uk. Accessed August 3, 2023. https://www.independentpharmacist.co.uk/services/bullying-in-the-workplace
16. Ariza-Montes A, Muniz N, Montero-Simó M, Araque-Padilla R. Workplace Bullying among Healthcare Workers. International Journal of Environmental Research and Public Health. 2013;10(8):3121-3139. doi:https://doi.org/10.3390/ijerph10083121
17. Glenn R. Grantner, PharmD, BCPS Clinical Pharmacist Sacred Heart Hospital Pensacola. Pharmacist Burnout and Stress. www.uspharmacist.com. Published May 15, 2020. https://www.uspharmacist.com/article/pharmacist-burnout-and-stress
18. Medscape: Medscape Access. Medscape.com. Published 2023. Accessed August 9, 2023. https://www.medscape.com/slideshow/2022-physicians-misbehaving-6015583?icd=login_success_email_match_norm#13
19. Staff B. Customer Harassment, Bullying Affecting Pharmacists’ Ability to Do Their Jobs. www.uspharmacist.com. https://www.uspharmacist.com/article/customer-harassment-bullying-affecting-pharmacists-ability-to-do-their-jobs
20. Lamia M. The psychology of a workplace bully. the Guardian. Published March 28, 2017. https://www.theguardian.com/careers/2017/mar/28/the-psychology-of-a-workplace-bully
21. Smith PK. Commentary III: Bullying in Life‐Span Perspective: What Can Studies of School Bullying and Workplace Bullying Learn from Each Other? J Community Appl Soc Psychol. 1997;7:249-255.
22. Vramjes I, Elst TV. Griep Y, De Witte H, Baillen E. What Goes Around Comes Around: How Perpetrators of Workplace Bullying Become Targets Themselves. Group Organ Manag. 2023;48(4):1135-1172.
23. Bullying and harassment. Pharmacist Support. Accessed August 3, 2023. https://pharmacistsupport.org/i-need-help-managing-my/work-life/bullyin-fact-sheet/
24. Harassment | U.S. Equal Employment Opportunity Commission. www.eeoc.gov. https://www.eeoc.gov/harassment#:~:text=Harassment%20becomes%20unlawful%20where%201
25. Anti-Harassment Policy Requirements By State. getimpactly.com. Accessed August 9, 2023. https://www.getimpactly.com/resources/anti-harassment-policy-requirements-by-state
26. United States Department of Labor. The Whistleblower Protection Programs | Whistleblower Protection Program. Whistleblowers.gov. Published 2019. https://www.whistleblowers.gov/
27. Koelmeyer S. An elbow in the waist: What is and isn’t bullying in the workplace. SmartCompany. Published May 20, 2019. Accessed August 3, 2023. https://www.smartcompany.com.au/business-advice/legal/bullying-workplace/
28. Harassment Training Requirements by State. Project WHEN (Workplace Harassment Ends Now). Accessed August 4, 2023.
29. Building positive workplace relationships. Pharmacist Support. https://pharmacistsupport.org/i-need-help-managing-my/work-life/building-positive-workplace-relationships/

Vaccine Hesitancy: Management Strategies for Pharmacy Teams

Learning Objectives

Accreditation Statements

Disclosure of Discussions of Off-label and Investigational Drug Use

Faculty

Faculty Disclosure

ABSTRACT

CONTENT

Content

Pharmacist Post Test (for viewing only)

Pharmacy Technician Post Test (for viewing only)

References

Full List of References