A Pandemic’s Role on Vaccine Hesitancy in the Pediatric Population

Chrystina Manero, PhD, RN, CPNP-PC

The COVID-19 pan D em IC has D era I le D r O ut I ne vaccine delivery services to children and adolescents, leaving them at risk for vaccine-preventable diseases. Vaccination is a measure of a community’s health, and we must do better. When routine vaccinations are not prioritized, our patients and community are vulnerable to sporadic outbreaks of vaccine preventable illness. COVID-19 has had a substantial impact on routine childhood vaccination. The World Health Organization reported Tdap immunization rates have decreased for the first time in nearly 28 years (1). This is thought to be caused by factors related to the COVID-19 pandemic including decreased number of in-person healthcare encounters, newfound vaccine hesitancy, and misinformative social media campaigns related to vaccinations. Pediatric nurses, health care providers, and medical homes are in a unique position to impact this phenomenon while considering the role of atraumatic care and effective communication.

We have seen a decrease in the number of in-person health care encounters over the past two years. Initially this was related to fear of COVID-19 exposure in clinic settings and now is more likely a feature of convenience. Immunizations cannot be administered at virtual visits leading to a delay of routine vaccination of children of all ages.

Newfound vaccine hesitancy is related to the spread of immunization inaccuracies surrounding the development and distribution of the COVID-19 vaccine. This, combined with widespread increasing rates of vaccine hesitancy, the reluctance or refusal to vaccinate despite the availability of vaccines, has the potential to seriously impact community health (2).

Misinformation campaigns are powerful. False claims about vaccinations undoubtedly undermine public trust. Data gathering often precedes decision making. When large quantities of easily accessible data are inaccurate, false, or misleading, vaccine hesitancy is encouraged. Unlike traditional media campaigns, social media offers users the ability to create, and disseminate, content rapidly without editorial oversight. This has increased the frequency of exposure to mistruths, and the sheer number of misinformation campaigns far outweighs the ability of a healthcare professional to correct mistruths and interrupt these campaigns via in-person consultation. This is particularly impactful for people with low health literacy, anyone with difficulty accessing data addressing alterative views, and people without access to a trusted healthcare provider. In these cases, mistruths become reality and contribute to vaccine hesitancy and refusal.

The process of educating, vaccinating, and interrupting the spread of mistruths should happen at all healthcare encounters, including episodic and mental health visits. This is especially true and relevant since many healthcare encounters were missed due to the pandemic. Each in-person healthcare encounter should be an opportunity for education and ideally vaccination. Sharing objective information and creating a non-judgmental environment that prioritizes shared decision making with caregivers and children is critical to effective communication about vaccines and to dispel the anti-vaccine myths.

Pediatric nurses and pediatricians are embedded within the community. Yet, as it relates to their profession, they tend to take a passive role when interfacing with social media. Eighty-five thousand new anti-SARS-CoV-2 vaccine Facebook accounts and 60 million followers of these accounts emerged over the course of the post-vaccine era of the COVID-19 pandemic (3). Fewer than 60% of HCPs use social media for professional purposes and most interactions are passive (3). Nurses are the most trusted profession in the world for the twentieth year in a row (4). It is the responsibility of nurses and other HCPs to engage with social media to dispel myths and spread scientific facts. Connection with the community, in this case via social media, can enhance trust, rapport, and relationships via education. These factors can be impactful when considering vaccine hesitancy of all kinds.

Relationships between nurses and families begin with infant vaccines and are fostered within medical homes. Medical homes provide comprehensive care by establishing partnerships with families, the community, specialty care, family support, and education. The approach, education provided, rapport with the parent, and trust of the child are formed early on for pediatric patients. In some cases, this rapport and trust have been established for a family in the context of older siblings or even by the parents themselves as patients. Pediatric nurses and providers can greatly influence a family, based on their credentials and rapport, when making recommendations, sharing fact-based information, supporting, and educating families. This relationship is a bridge to close the anti-vaccination chasm as it relates to the COVID-19 vaccine and other childhood immunizations that were missed and/or are currently due.

Consistently incorporating principles of atraumatic care into routine vaccine administration facilitates ongoing vaccination. For example, distraction tools such as the “shot blocker,” can decrease the patient’s perception of pain during injections. Frequently, fear of injections, post-injection soreness, fear of syncope, or general health care anxiety are barriers to a patient’s desire and agreement to get vaccinated. This can also contribute to a caregiver’s willingness to consent in the moment versus delaying vaccination to another healthcare encounter. Addressing and controlling for these factors in the pediatric setting by educating the patient and their family on the pain management and distraction tools available and on symptomatic management of post-vaccine symptoms as well as incorporating developmentally appropriate anxiety mitigation techniques into routine vaccine protocol have the potential to impact overall vaccine hesitancy. This, in conjunction with offering routine and recommended vaccinations at each healthcare encounter, encouraging in-person health maintenance visits, as well as communicating with families via an electronic health record portal about immunization gaps, can help restore our community vaccination rates post-pandemic.

Effective communication, atraumatic care, engagement with social media, and considering each healthcare encounter an opportunity to vaccinate are critical tools as we battle vaccine hesitancy. Pediatric nurses and physicians have a professional responsibility to use strategies to enhance COVID-19 and pediatric routine vaccination hesitancy. +

Chrystina Manero, PhD, RN, CPNP-PC, Assistant Professor – UMass Chan Medical School and Tan Chingfen Graduate School of Nursing

REFERENCES

1. Olusanya OA, Bednarczyk RA, Davis RL, Shaban-Nejad A. Addressing Parental Vaccine Hesitancy and Other Barriers to Childhood/ Adolescent Vaccination Uptake During the Coronavirus (COVID-19) Pandemic. Frontiers in Immunology. 2021;12.

2. Akbar R. Ten threats to global health in 2019. World Health Organization. 2019.

3. Hernandez RG, Hagen L, Walker K, O’Leary H, Lengacher C. The COVID-19 vaccine social media infodemic: healthcare providers’ missed dose in addressing misinformation and vaccine hesitancy. Hum Vaccin Immunother. 2021;17(9):29622964.

4. Saad L. US ethics ratings rise for medical workers and teachers. Gallup, Inc. 2020.