Educating the next generation of pharmacy students to address vaccine hesitancy

By:  Nicole Rigone, Pharm D candidate and Lauren A. O’Donnell, PhD

 “For those who wanted a world with no vaccines… here’s the world without ONE vaccine.” Tweet by Carlos A. Rodriguez (@CarlosHappyNPO) in regard to the COVID-19 pandemic; 3-29-2020  

Vaccine Hesitancy Concerns

With the FDA approval of COVID-19 vaccines, pharmacists have a vital role in vaccine counseling and administration. Recent reports suggest that there is public support for COVID vaccination programs; however, concerns and hesitancy remain.  The wavering support for vaccination is not unique to the current pandemic, as confusion and resistance to vaccines persists. Given the significant and visible role of pharmacists and student pharmacists in delivering vaccinations, it is critical to consider how to best prepare for engagement with vaccine-hesitant patients.  

Curricula Needs: Addressing Vaccine Hesitancy

While immunization certificate programs are standard in pharmacy curricula, there is not a clear framework for addressing vaccine hesitancy.¹  In a 2019 study, a majority of student pharmacists reported feeling responsible for advocating for vaccines and educating patients, but less than half felt confident in establishing a dialogue with patients on the topic.  With this mis-match between intention and confidence in mind, how can educators better prepare pharmacy students to address vaccine hesitancy?

Existing Approaches from the Literature & Uncertain Impacts

Greater Efficacy 

There are a handful of published exercises that aim to develop skills for counseling vaccine-hesitant patients.  In one study, student pharmacists were asked to counsel two standardized patients who were vaccine-hesitant, as part of a unit in addition to the APhA Pharmacy-Based Immunization Delivery Certificate Training Program.² The students were given detailed feedback from a rubric used by the standardized patients and reflected on their first attempt before engaging with a second standardized patient. Students demonstrated significant improvement in areas such as validating patient’s concerns, expressing empathy and identifying underlying concerns on their second attempts. Importantly, they were more likely to persuade their second standardized patient, even when confronted by new vaccine myths. 

Unclear Impacts on Vaccination Rates

A similar study with physicians examined the efficacy of a training tool developed to improve communication and trust between vaccine-hesitant parents and physicians.³ Similar to the results with student pharmacists, the physicians felt more comfortable engaging with parents who were unsure or planned on delaying vaccination. However, they reported feeling “the same or less” effective engaging with parents who refused vaccinations, and the vaccine coverage in their practices remained unchanged after training.  While these programs empowered healthcare professionals to engage with vaccine-hesitant patients, it is unclear whether such training translated into improved vaccination rates in practice.   

Potential Toolkit

With pharmacy’s visible public role, it is critical that the profession is ready and willing to advocate for vaccines and appropriately address patients’ concerns. Here, we discuss three means of preparing student pharmacists. 

Increase confidence in advocating through exercises with standardized patients or case studies

To better address vaccine hesitancy, it may not be feasible to employ standardized patients or incorporate an intensive training program in all pharmacy schools. However, alternative approaches exist that could be incorporated into curricula. The American Academy of Pediatrics developed a case studies collection for small group discussions called the Vaccine Hesitancy Practice Improvement Project. The patient cases feature a range of ages and concerns, including fear of vaccines causing autism to vaccination of immunocompromised individuals. Group discussions are tailored to create a better understanding of the mindset and information seeking of vaccine-hesitant patients. Such materials may be a helpful tool for student pharmacists and could be incorporated into opportunities to practice motivational interviewing skills.

Development of a communication plan  

The Strategic Advisory Group of Experts (SAGE) on Vaccine Hesitancy suggests that pharmacies build a four-step communication plan for anticipating vaccine hesitant patients. We propose that such a communication plan, involving preparing responses to anti-vaccine statements and understanding the source of patients’ concerns, can be modified as a classroom exercise to think more deeply about approaches to vaccine hesitancy. Although providing information is insufficient alone, it is important for student pharmacists to understand the literature related to vaccines and the vaccine approval process so that they provide accurate information.

Reflection on personal opinions regarding vaccination

            The origins of vaccine hesitancy are “complex and encompass more than just a knowledge deficit.”⁴ Even within pharmacy, some degree of vaccine hesitancy exists. One study found that fewer pharmacy students felt that it was important for them to be vaccinated compared to other healthcare professionals. The CDC reports that 81.1% of health care professionals reported receiving the 2018-2019 influenza vaccine, including 91.5% of pharmacists, with lower rates in ambulatory and long-term care settings. Educational approaches should include self-reflection on personal biases and misconceptions regarding vaccines and outward engagement with patients. 

Help us continue the discussion and develop educational tools that address this gap. What strategies have you used to train students on this important issue?

References

1. Prescott WA, Jr., Bernhardi C. Immunization Education in US Pharmacy Colleges and Schools. Am J Pharm Educ. 2019;83(5):6765.
2. Vyas D, Galal SM, Rogan EL, Boyce EG. Training Students to Address Vaccine Hesitancy and/or Refusal. Am J Pharm Educ. 2018;82(8):6338.
3. Glanternik JR, McDonald JC, Yee AH, et al. Evaluation of a Vaccine-Communication Tool for Physicians. J Pediatr. 2020;224:72-78 e71.
4. Shen SC, Dubey V. Addressing vaccine hesitancy: Clinical guidance for primary care physicians working with parents. Can Fam Physician. 2019;65(3):175-181.

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Pulses is a scholarly blog supported by a team of pharmacy education scholars