Fighting vaccine hesitancy by targeting “fence-sitters”

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Could focusing on fence-sitters increase vaccine uptake? AJ_Watt/Getty Images
  • A study looked at people’s attitudes towards vaccines at different stages of the COVID-19 pandemic.
  • The study focuses on older people, as they are more likely to suffer serious illnesses and deaths related to COVID-19.
  • The authors conclude that in future pandemics, public health officials should focus on addressing vaccine ambivalence among people they describe as “fencekeepers.”

A new study, published in the Community Health Journalstresses the importance of educating people who have mixed feelings about getting vaccinated.

The study examined the attitudes of participants aged 55 and older toward vaccines at different stages of the COVID-19 pandemic.

The researchers accessed data from the COVID-19 Coping Study to identify people in the United States who were receptive, ambivalent or opposed to vaccination against the disease.

To date, the Centers for Disease Control and Prevention (CDC) reports that 75% of the adult population is fully immunized, having received two doses of an mRNA vaccine or one dose of a single-dose vaccine.

However, although studies indicate that receiving a booster dose reduces severe disease from 92%the CDC reports that only 47.1% of fully vaccinated adults received at least one of these additional doses.

The study used data collected from April 2020 to May 2021 from 2,358 participants. Some of the questions in the study were about social distancing, wearing masks and feelings about vaccines.

The researchers looked at vaccine-related responses at the start of the pandemic, around the time vaccines became available, and then in late spring 2021, when vaccines were readily available.

Based on the responses, the researchers categorized the participants into three groups:

  • vaccine acceptors
  • ambivalent vaccine
  • vaccine rejecters

Data collected early in the pandemic indicated that 88.9% of participants were acceptors, 8.6% were ambivalent, and 2.5% were rejecters.

The final set of responses indicated that 90.7% of acceptors had received the vaccine, 62.4% of ambivalent participants had received the vaccine, and 30.7% of the rejecters had received the vaccine.

Dr. Katharina Hauck spoke with Medical News Today on the discoveries. Dr Hauck is Professor of Health Economics and Deputy Director of the Abdul Latif Jameel Institute for the Analysis of Diseases and Emergencies, at Imperial College London’s School of Public Health.

“This is an interesting but broadly descriptive analysis of sociodemographic factors associated with vaccine hesitancy in older adults,” Dr. Hauck said. “The strength of the paper – and the most interesting finding for me – is the analysis of prior vaccination attitudes with subsequent observation of the actual decision to get vaccinated.”

“The results are good news,” continued Dr. Hauck. “The authors mainly focus on the high proportion of ambivalent vaccines that are ultimately vaccinated – 62% – but I also find it remarkable that 30% of vaccine rejecters are ultimately vaccinated.”

The results of the study could help doctors and other public health actors encourage the adoption of future vaccines.

“These findings have important implications for public health messaging and planning. Fence guards are probably the easiest people to target for certain health promotions,” says study lead author Dr. Abram Wagner, an assistant professor of epidemiology at the University of Michigan, Ann Arbor..

“The next time we need to introduce a new vaccine into the population, we can quickly identify who these bums are,” continues Dr. Wagner. “We tracked them for a while, and there was a strong relationship between their hesitation in how we group them and their actual behaviors.”

The authors note that ambivalence in some people may stem from medical discrimination and that community leaders could reach out to this group. They suggest that these leaders could also help encourage “risk-reducing behaviors.”

Dr. Nicole Hassoun, a professor at Binghamton University, New York, and head of the Global Health Impact project, spoke with DTM On paper.

“To overcome vaccine hesitancy, it may also be important to ensure that people of all racial, ethnic and cultural backgrounds, as well as women and other disadvantaged groups, are included in clinical trials,” said said Dr. Hassoun. “It’s important for scientific validity, but potentially also for encouraging trust in the approval process.”

The authors note that the manner used to recruit participants may have been limiting. Those who participated registered either online or by mail.

“The non-probability sampling strategy means that our sample is not representative of the population,” the authors write.

Even so, they say the study included people from all 50 states and the District of Columbia, so geographic representation was strong.

Dr. Hauck pointed out that the authors were unable to determine the factors that influenced the decision to get vaccinated.

“So overall, the conclusion that ‘targeting the ambivalent vaccine can be an effective way to increase vax coverage’ is not supported by the results, in my view,” she said. “Many factors likely contributed to positive vaccine decisions. The authors did not assess the causal impact of an ambivalent vaccine-targeted intervention, which would be necessary to make this statement.

Dr. Hassoun also expressed concern about the results of the study.

“My main concern about the study is that it doesn’t have a representative sample – or even a particularly large sample – of even the elderly population in the United States, and the internet platform makes it particularly unlikely to represent the elderly population well.”

Since vaccine hesitancy can significantly harm public health, it is essential to seek ways to address it before the next pandemic.

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