Vaccine Confidence

I. Refugees/Newcomers

1. a)  Fears and misinformation about vaccine side-effects and harms

2. b)  Limited knowledge of preventable diseases and vaccines, and COVID.

3. c)  Distrust of host country’s health systems and their intentions. The most common being purposeful sterilization and population

   control and microchipping to monitor citizens.

4. d)  Language Barrier

5. e)  Perceived incompatibility between vaccine acceptance and particular group’s religion. An example is the HPV vaccine, which

   may be perceived as contrary to religious beliefs and cultural norms. It may be perceived that the HPV vaccine encourages promiscuous behavior for children and pre-marital sex. The contents of the vaccine may be of concern to adherents of Islam and Judaism because of the possibility of porcine-based ingredients.

6. f)  Fragile trust in the host government and alienation from available public healthcare services such as vaccination.

II. Parents

1. a)  Concerns about fear of needles and short-term side-effects such as pain and discomfort and possible long-term effects

2. b)  Concerns about the ingredients in vaccines: effectiveness and safety

3. c)  Lack of perceived need to vaccinate; belief that children are at low risk of contracting Covid and that they do not become

   seriously ill

4. d)  Suspicions about business motives of companies producing vaccines and other pharmaceuticals

5. e)  Concerns about testing vaccines and drugs on children

6. f)  Mistrust of the health care system

7. g)  Religious reasons

Several studies have demonstrated Motivation Interviewing as the most effective way to encourage Vaccine Confidence. Motivational interviewing (MI) is a style of conversation that emphasizes collaborative communication between practitioners and clients. It is characterized by guiding, evoking, and responding mindfully. MI focuses on the healthcare professional working with the patient rather than talking to/lecturing the patient/parent/caregiver. MI conversations focus on creating change to strengthen and support a client’s motivation and commitment. MI is used in various professional environments such as counselling, psychotherapy, health care, coaching, and social work. When MI is specifically implemented in healthcare, patients have significant positive outcomes if they modify their lifestyles, medications, and become active participants in their health and wellbeing. It offers a style of communication whereby the practitioner takes on the role of a guider rather than a fixer. MI is shown to be time efficient and helpful in creating conversations to encourage Vaccine Confidence.

Motivational Interviewing

Information on vaccines can be found readily in the Saskatchewan Medical Association’s Guide:

https://www.sma.sk.ca/resources/70/covid-19-info-for-physicians.html and https://www.vhguide.ca/

This guide is a supplementary tool based on tools and guides and handbooks from the CDC, University of Geneva Medical School, University of Pittsburgh School of Medicine, University of British Columbia, Public Health Agency of Canada, and University of Calgary. Preparation for conversations about vaccine confidence is to summarize and validate the patient’s concerns and questions about C-19 vaccinations and general vaccinations.

Aim for the patient to consider the vaccine rather than immediately accepting one. A series of conversations creates space and supports evolutions in the patient’s thinking. A conversation modelled in the style of MI follows a basic pattern of Engaging, Affirming, Asking, Sharing and Evoking.

Affirming patient’s/client’s concerns and worldview creates trust and establishes the practitioner as an ally.

Engage with your patient by starting a conversation about vaccinations with OPEN ENDED questions to show your interest. This opens a safe environment for them to share their concerns, fears or anxiety about vaccinations. When in engaging in subsequent sets of questioning ask permission to ask more questions or to share information.

Broaching the Subject:

• If I may ....?
• If you don’t mind....?
• Is it OK to take to talk about....?
• How do you feel about taking the vaccine? How do you feel about vaccinating ____ (name of child)? • What are your thoughts/feelings about having the vaccine?
• What concerns do you have about the vaccine?

Repeat their responses to affirm their concern/worldview and anchor your position as a supportive ally. Trust is established through repeating what the patient/client has said. This indicates to the patient that the practitioner has heard and understands what the patient has expressed.

Avoid defensive postures

6

Summarize their concerns as it helps the patient to feel understood.

• Assess the readiness by using CONFIDENCE SCALES. Ask the patient, “on a scale from 1 to 10, 1 not ready and 10 is very ready, what number would you give for your readiness for the vaccine?”

• Why did you give 5 or less such a low number?

• What would help you evaluate your number to 7 or higher?

• The goal is to assist the patient to be more open to move to a higher number - (vaccination)

• Expressing their level of comfort out loud – creates a change in how they process their choices and can develop a shift

  towards vaccination.

• People who are vaccine hesitant are well versed and practiced in explaining why they haven’t yet been vaccinated. Reverse

  this by asking the patient to express what they believe are the benefits of vaccination.

  Attempt to identify reasons for hesitancy: safety concerns, political values, religious views (ingredients, stigma), historical and cultural reasons (systemic racism, experimentation, colonization), concerns about getting the vaccine (past reactions, pain, fear of needles), access and logistical barriers (time of day, daycare, transportation), may need a reminder to take vaccine (go with a support person such as an aide or friend).

  ASK, AFFIRM, SHARE
  Presenting information that is tailored to the needs of patients/clients: Ask – EVOKE – Ask

  ASK

  How do you understand...?
  What would you most like to know more about...? What do you know about...?

  EVOKE

  What do you think?
  What do you feel?
  What would help you feel okay or confident? Do you have more questions?
  What makes you feel uneasy?
  May I offer....?
  May I share...?

  ASK

  What are your thoughts?
  What will help you feel more assured? Do you have any more questions?

  EVOKE

  Clarifying the patient’s/client’s decision:
  This your choice. What would you like to do?
  Would you like to make a decision now or take some time to think it about it? What do you think is best?
  How do you feel now about taking the vaccination?

  Encourage patients/clients to imagine various scenarios based on their choice to vaccinate, remain unvaccinated, or remain undecided.

  The practitioner may offer to be a resource for vaccine information or ask how they may be of further assistance.

  https://www.vhguide.ca/ offers peer to peer suggestions for vaccine hesitancy conversations focusing on the following: Listening closely and reflectively

  Affirming the patient’s worldview
  Drawing the patient in
  Finding a shared, positive goal
  Desensitize, then motivate
  Checking oneself on the way into the conversation De-escalating

  Extending the conversation

The recommendation is that all pregnant women, regardless of how far along they are in pregnancy, should receive the COVID-19 vaccine. Pregnancy and breastfeeding are not reasons to be excluded from vaccination. Accumulated evidence from around the world is on-going and has shown no major side-effects. There are no differences in the rates between vaccinated and non-vaccinated pregnant women in the occurrence of miscarriage, pre-term births, stillbirths, or birth defects.

Data has shown that unvaccinated pregnant women who contract C-19 have a higher risk of hospitalization and are three times more likely to be admitted to the ICU. If you are pregnant and unvaccinated with chronic illnesses such as diabetes, lung or heart disease, asthma, hypertension, kidney or liver diseases, or a smoker or overweight you are likely to develop serious illnesses from COVID-19.

There are also perinatal risks with C-19, that is, a pregnant woman infected with C-19 may risk a pre-term delivery, an increased risk of a low birth weight, stillbirth or dangerously high blood pressure. A pre-mature baby with C-19 would likely mean ICU care for the baby and could result in respiratory problems.

The mRNA vaccine is not new and has been shown to be safe. There is no evidence at all that by administering the vaccine, there is a negative impact on the developing fetus. Unvaccinated pregnancies infected with COVID-19 have been shown to have increased incidents of pre-term births and admissions of newborns into the neo-natal intensive care.

The vaccine stimulates the production of antibodies. If the vaccine is received during pregnancy, the antibodies will cross the placenta and protect the newborn.

The vaccine is safe whilst breastfeeding. The antibodies will be transmitted to the newborn through breast milk. The initial worry of the vaccine with pregnant women in the first trimester. The only concern was pregnant women developing a fever at this stage. This was the reason vaccine hesitancy amongst pregnant women developed and escalated. However, pregnant women can be assured there are no risks during the first trimester. The safest option during pregnancy and breastfeeding is to be fully vaccinated.

Why can pregnant women can receive the COVID vaccine and not other vaccines?

Vaccines that contain weakened, but live viruses can cause a very mild infection. The COVID-19 vaccines trigger your immune system to make antibodies of the spike protein but not the virus itself.

Other vaccines that are safely given during pregnancy and breastfeeding include: tetanus, diphtheria, pertussis, and influenza.

Pregnant with Allergies:

You can receive the COVID-19 vaccine if you have allergies to nuts, eggs, shellfish, latex and other drugs. There are 2 exceptions:

A PEG allergy – polyethylene glycol – can illicit an allergy response but is extremely rare or an extreme reaction to the first dose. It unequivocally does not affect fertility. It may alter one’s menstrual cycle, only one or two cycles and this is not associated with fertility. The Covid-19 vaccines do not affect female nor male fertility.

• C-19 is mild in most children; however, some children can become quite unwell. One dose of a C-19 vaccine gives good protection against your child becoming very sick. Vaccinating your child will not only offer protection from severe illness for him/her, but also help in reducing transmission to others.

• The Pfizer vaccine is a slightly different formulation for children and is smaller dose than that used for vaccinating adults and older youth.

• All vaccines have undergone thorough clinical review by Health Canada and are safe and approved for use in Canada. Studies on the vaccines for 5 to 11-year-olds show that expected side effects, such as soreness at the injection site or headache, muscle aches and chills, were well tolerated by children and usually resolve in 1-2 days.

• In Canada, the National Advisory Committee on Immunization (NACI) recommends vaccination for youth and young adults who are eligible, as the benefits of vaccination to prevent COVID-19 and associated complications outweigh very rare cases of myocarditis/pericarditis following COVID-19 mRNA vaccination.

• There is no evidence the COVID-19 vaccine will affect puberty or fertility.

• One of the effects of COVID-19 infection in children is Pediatric Inflammatory Multisystem Syndrome (PIMS). It may be
  a delayed immune response to the COVID-19 virus. PIMS is incredibly rare – even in the regions hit hardest by COVID-19. When detected early, with appropriate clinical care, children typically recover and do well.

• Approximately after 4-6 weeks of infection with the COVID-19 virus, PIMS can cause severe inflammation of all vital organs and blood vessels. Other symptoms such as rashes, vomiting, diarrhea, fever, sore red eyes, swollen hands and feet, cracked swollen lips, abdominal pain, and lethargy. If left untreated, PIMS may cause long-term cardiac issues.

The following information has been taken from saskatchewan.ca

How do I obtain proof of vaccination for my child? Will it be available on MySaskHealthRecord

(MSHR)?

Parents and legal guardians with a MySaskHealthRecord account can have access to the health information of their children under the age of 14, including proof of COVID-19 vaccination. Please note that once your child turns 14, they will have to sign up for their own MySaskHealthRecord account and you will no longer have access to their health information in MySaskHealthRecord. For parents/ guardians ineligible for or unable to access MySaskHealthRecord, a manual process is available to receive the COVID-19 vaccination record of a child under age 14.

Do I have to set up a separate MSHR account for my child or will it show up on my account?

Parents and legal guardians of children under 14 who want access to their child(ren)’s health information in MySaskHealthRecord must have their own MySaskHealthRecord account, as your child’s health information will be directly connected to your account. If you do not already have a MySaskHealthRecord account, you can sign up at eHealthSask.ca.

Before you can link the child’s information, you will need to complete a request form: Request for Access to Child’s

MySaskHealthRecord at eHealthSask.ca.

Parents and legal guardians will then need to submit proof of parentage/guardianship documentation with their completed request form. They can refer to Section 3 of the form, but some examples include a long-form birth certificate, adoption order or guardian- ship order. If you do not have proof of parentage and your child was born in Saskatchewan, eHealth has developed an interim process where an eligible person can provide authorization for Vital Statistics to provide verification of proof of parentage. Please contact the eHealth Privacy Service at privacyandaccess@ehealthsask.ca or 1-855-347-5465 for more information.

Email the completed form and proof of parentage/guardianship documentation to: PrivacyandAccess@eHealthSask.ca

Once the request has been received, the eHealth Privacy Service will complete the request. Once the account is linked, parents/ guardians are notified. They can then log into their MySaskHealthRecord account and click/tap the round green button (top right of the screen) containing their personal initials, to call up a menu and access the child’s information. For any questions, please contact eHealth at PrivacyandAccess@eHealthSask.ca or 1-855-eHS-LINK (347-5465).

For parents/guardians ineligible for or unable to access MySaskHealthRecord, a manual process is available to receive the COVID-19 vaccination record of a child under age 14. Information is on eHealth’s website.

If you haven’t yet received your COVID vaccine, please check all that apply:

o Fear of needles o Contains toxins that will damage immune system o Mistrust of healthcare system
o Safety of the vaccine’s ingredients
o Pain and/or discomfort

o Suspicious of motives of pharmaceutical industry
o Product safety o Too many dangerous side effects reported in the news o No need to vaccinate
o Vaccine is ineffective
o Long-term effects
o Religious
o Others are vaccinated so I do not need to
o Political o Do not trust government
o Perceived harm to fertility
o Pregnant
o Breast Feeding
o Micro-chip / Artificial Intelligence
o Previous adverse reactions to vaccines
o Not treated well previously by medical staff
o Vaccine is an experiment
o Vaccine developed too quickly
o mRNA changes DNA
o Side-effects will interrupt my fitness training/performance
o Want to build my immune system in a natural way
o Managed through other viruses and don’t need vaccination
o Can use Ivermectin or hydroxychloroquine
o Too much media hype about pandemic
o Mainstream media does not broadcast accurate information

o Children have a stronger immune system
o COVID doesn’t cause severe effects in children
o Vaccines developed too quickly and don’t know how it will affect children o Vaccine contains toxins
o Will cause infertility
o Too many side-effects
o Dangerous or long-term side-effects

General Vaccination of Children

o Children will develop immunity if exposed to childhood illnesses o Will build child’s immune system naturally
o Children are too young to receive vaccines
o Vaccines contain toxic chemicals

o Vaccines cause autism
o Vaccines cause infertility
o Others are vaccinated, so my children/child does not need to o Too many side-effects
o Dangerous or long-term side-effects