Vaccination should be seen as 'next step in the arsenal' against COVID-19, says doctor

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As scientists around the world race to find a COVID-19 vaccine, a pediatric infectious disease doctor in Calgary says tackling hesitancy around immunization often starts with a conversation.

"We work very hard at not making this some kind of philosophical debate," says Dr. Cora Constantinescu, who works in the Vaccine Hesitancy Clinic at the Alberta Children's Hospital.

"And I think it works well because, at the end of the day, everybody is for the same goal. They just want to be protected and have the best health."

The Angus Reid Institute published new data last week that shows less than half of Canadians — 39 per cent — would be willing to get a COVID-19 vaccine once it becomes available. That's down from 46 per cent in July, when the institute first posed the question to Canadians.

Another 38 per cent now say they want to wait a bit before taking the vaccine, while everyone else is either undecided or against vaccination altogether.

The Current's Matt Galloway spoke with Constantinescu about why some people might be hesitant about getting a COVID-19 vaccine, and why she believes a vaccine is important. 

Here is part of their conversation.

What do you hear specifically from your patients who might be resistant to vaccines?

You know, I think at the heart of every vaccine-hesitant patient is somebody working really hard to make the best decision they can to protect themselves or their child. And people battle fears and insecurity, a lot of misinformation, and sometimes a lack of trust. So we do hear concerns about safety, which are often the most common ones … and this perceived risk of disease.

What we've noticed a bit with COVID, and I think with other vaccines as well, is this idea of exceptionalism — that somehow I'm exceptional, I'm different, I may not be at the same risk as everybody else in my age group.

But the same [exceptionalism] applies to this risk of vaccine. 

So somehow I'm exceptional and not going to get a disease, but I might be exceptional enough to get some untoward event coming from the vaccine itself. 

And that's for sure interesting with a COVID vaccine, because [even though] we know that age is a concern for COVID disease, some studies had indicated that even people in their 70s who are in good health may not perceive age as a risk for COVID and therefore may not get the vaccine.

Can you just briefly give a snapshot as to who the people are who come to see you — people who we're characterizing as vaccine-hesitant? Because there's the phrase anti-vaxxers gets thrown around a lot. Are these people who are opposed to all vaccines? Who are they?

It's a good question. I think there's a very clear difference between the vaccine-hesitant and the anti-vaccine people or the anti-vaccine advocates. The people who are vaccine-hesitant are anywhere between 15 to 30 per cent of Canadians, and they tend to come from all walks of life. They're pretty educated about their own health. And they are defined as people who may not take vaccines despite their availability.

Often these are people who have not immunized their children at all, or who have immunized and have concerns or have partially immunized their kids in our clinic. What I say for sure is that these are pretty motivated people and it takes a lot of bravery and courage to face this fear that a lot of people have lived with for a long time, and to come in and have a conversation about it.

How do you talk to them without dismissing those concerns and those fears?

As I said before, you know, these are people who are battling a lot of fears and lack of trust. So we spend a lot of time building rapport and trust with them. We listen. We find out about this child and their family. We personalize their concerns about that. So we work very hard at not making this some kind of philosophical debate. We keep the conversation very tailored to the child, the schedule tailored to the child. 

And I think it works well because, at the end of the day, everybody is for the same goal. They just want to be protected and have the best health. So we realize that, and we pair up with a parent and support them as they're making this decision to vaccinate.

[If you] take a look at those Angus Reid numbers about a lowered percentage of people who would get this vaccine right away, does that surprise you at all?

My hope is that every Canadian will have the opportunity of having the COVID vaccine and therefore have to make this decision. So I'm not surprised, but maybe a little bit disappointed because of what this global pandemic has meant to all of us. 

But in some ways I think it's good that here we are, you and I, talking about vaccine hesitancy, about a vaccine that hasn't even been licensed yet. 

I think it's good for each and every one of us [to think about] because we will have to make this decision, to reflect on our own feelings around the COVID vaccine, or check our hesitancy around it. 

Maybe it's a good thing that people are already thinking about this and already thinking of how they would approach it.

If someone is feeling hesitant about this COVID-19 vaccine, they're concerned about the politicization of it, they're concerned about the speed at which it's being developed, what's your advice to them right now?

I would say we all need to think of all we have done for this pandemic. So many of us have — even the ones who haven't been infected or lost a sick one with COVID — we have done so much. People have changed their social lives, [stayed] away from family and friends, reinvented themselves professionally, lost jobs, home-schooled their kids. 

We've done so much. And I think we need to think about the cost of this pandemic … to each of us and to the Canadian society, and make the idea of vaccinating … just a next step in the arsenal of fighting this virus.

Written by Kirsten Fenn. Produced by Rachel Levy McLaughlin.