COVID-19 Vaccine Uptake and Hesitancy Q&A with Alex McDonald, MD, FAAFP, CAQSM Kim Yu, MD, FAAFP, and Jacinda Abdul-Mutakabbir, PharmD, MPH, AAHIVP

COVID-19 Vaccine Uptake and Hesitancy Q&A

People with substance use disorder (SUD) are at increased risk for adverse effects of COVID-19, but getting vaccinated can prevent severe illness, hospitalizations, and death from COVID-19. However, people with SUD may face unique barriers to getting vaccinated. For example, it can be difficult for providers to contact and reach people who use drugs, who may not have a usual place of medical care. Like many others, people with addiction may have vaccine hesitancy—often spurred by misinformation and distrust of the health care system. Past experiences of stigmatizing interactions with healthcare may contribute to these feelings and perceptions.

To bring you strategies to meet these challenges head-on, we talked with three providers working to expand access to vaccination among people with SUD and in under-resourced communities. The Q&A below was compiled from these interviews.

Alex McDonald, MD, FAAFP, CAQSM Family and Sports Medicine Physician Southern California Permanente Medical Group Dr. Alex McDonald is a co-founder of the This Is Our Shot campaign, focused on motivating people to get vaccinated by spreading factual information about the vaccines to dispel myths and rumors.

Jacinda Abdul-Mutakabbir, PharmD, MPH, AAHIVP Critical Care and Infectious Diseases Pharmacist Assistant Professor of Pharmacy Practice School of Pharmacy at Loma Linda University of Loma Linda Dr. Jacinda Abdul-Mutakabbir (Dr. Jam) has worked to expand vaccine access to minority and under-resourced communities—through working with faith leaders, setting up pop-up vaccine clinics, and developing “strike teams” to go door-to-door to share information about the vaccines and offer vaccination.

Kim Yu, MD, FAAFP Regional Medical Director for Aledade Inc. President Elect for the Orange County Chapter of the California Academy of Family Physicians Dr. Kim Yu has been working to expand access to COVID-19 vaccines by developing strategies to identify and reach out to those who have not been vaccinated, reduce barriers to access, and normalize the conversation about the vaccines with patients. She is also a member of the executive leadership team for the This Is Our Shot campaign.

Meet the Providers

Expanding Access to COVID-19 Vaccinations Among People with SUD—A Q & A with Providers

Q: How can I help improve access to vaccines for people with SUD? Meet them where they’re at. Reach people with SUD directly in their communities instead of expecting that they come to you—visit homeless and other shelters, barber shops, or attend Narcotics and Alcohol Anonymous meetings. Share information about the vaccines and offer it, if possible. Consider using paper forms to sign people up for the vaccine, which may help expand access to people who lack access to the internet, computers, or smart phones.

Dr. Jacinda Abdul-Mutakabbir shared that her organization has developed strike teams that go door-to-door in minority communities and homeless shelters to talk to people about the vaccine and provide vaccinations.

• Normalize vaccination. Discuss the vaccines with patients regularly. Ask for permission to share your story about getting vaccinated (and stories of your staff, family, friends, and other patients) to let them know that you are confident in its safety and effectiveness. • Make vaccines readily available. Increasing how often the vaccine is provided at your practice can help expand access to care—simply by being available at any time for patients to get vaccinated. • Partner with community-trusted sources.

Connecting with community leaders can help get the word out, often in a way that resonates with the community. Sharing talking points grounded in science can help provide a solid foundation for conversations on this topic.

“We partnered with faith leaders to establish pop-up vaccine clinics in minority communities, providing access to and information about the vaccines. We also hosted faith summits to deliver and clarify information about COVID-19 vaccines in a culturally sensitive way. We talked about the burden of COVID-19; vaccine hesitancy; mutations of the virus; the pharmacology of the vaccines (e.g., how they work, what they do); and the meaning of clinical studies.”

– Jacinda Abdul-Mutakabbir

Q: How can I address vaccine hesitancy among people with SUD?

• Start from a place of caring. With consideration of the historical mistrust between people with SUD and the health care system, ask patients to share their story to get to know them first. Once you establish a foundation of trust, ask them to talk about why they may be hesitant to get vaccinated, giving them space to discuss why they believe any misinformation they share. • Talk about the benefits of vaccination. Discuss how vaccination can allow people to maintain their health and the health of those around them, and to return to normal activities from before the pandemic (e.g., family gatherings, restaurants, weddings and parties, feeling safe at work). • Be clear and transparent. Be transparent about risk factors and side effects; it is important not to minimize them. When discussing the science behind the vaccines, use simple and clear language and try to make the conversation enjoyable and/or relatable.

If a patient asks whether they can continue to use substances, share information about side effects and discuss how people in their demographic group were accounted for in the clinical studies and what that means for them. • Clarify misconceptions. Common misconceptions include concerns about safety (e.g., causes infertility), that it was created too fast, and that

there is a microchip tracker in the vaccine. To clarify misconceptions and assuage concerns, ask patients to explain why they think those things. Listen to their reply and ask them if you can share your understanding of the vaccine, how it works, how it was developed (e.g., no safety steps skipped), and its safety. • Focus on shared decision making. It is the patient’s decision to get vaccinated, and using shared decision making processes can help you support them in their decision.

Myth Buster

Myth: The COVID-19 vaccine was created too quickly, and it’s probably not safe. Truth: [Coronavirus vaccines] have been in development since the original SARS outbreak in 2003, so the spike protein has been well-studied; the last mile was able to be pushed through because the regulatory burdens were reduced, and all safety steps were done concurrently.” – Dr. Alex McDonald

Q: What else can I do to help with vaccine uptake among people with SUD?

• Get additional resources. Visit the Centers for

Disease Control and Prevention (CDC) to read about common myths about the COVID-19 vaccines and get accurate information and facts to help stop them from circulating. The CDC also offers communications resources—including toolkits, graphics, factsheets and other tools—to help you talk about and share information about the vaccines with patients in a positive, proactive, and productive way. • Consider conducting personal outreach to patients.

Reach out to patients who have not received the

COVID-19 vaccines via phone, email, and or text messaging with information and access to vaccination.

Sharing information and messaging that encourages vaccination through patient portals, websites, social media, along with flyers and posters in practices can also raise awareness and motivate patients to get vaccinated. • Bring in students. When it comes to going into communities to reach under-resourced populations, include young people and students when possible.

The innovative community health work that is being implemented to increase vaccine uptake can be applied and translated to improve health outcomes for other public health needs.

“Include students in these activities, because COVID is not going to go away, but there are other diseases that impact minority groups and the work with COVID can translate to work in these fields. Students bring longevity and give them the tools to continue to create equity across health care.”