How to Talk to Patients about the Covid-19 Vaccine

HOW TO TALK TO PATIENTS ABOUT THE COVID-19 VACCINE

Your patients consider you their most trusted source of information when it comes to vaccines.

This document outlines some common questions patients may ask about the COVID-19 vaccine, along with information for your response. We also provide tips for having vaccine conversations with your patients.

Whether you have these discussions with your patients during an in-person office visit or telemedicine appointment, or through messages on your patient portal, your strong recommendation is the most important part of the conversation.

FAQs From Patients to Be Prepared to Address

How do we know if COVID-19 vaccines are really safe, especially since they were developed so fast?

What about long-term data?

It is a new vaccine, however, none of the normal steps in the vaccine vetting process were skipped in order to develop these vaccines. Large clinical trials were conducted with more than 70,000 individuals of different ages, races, and ethnicities, as well as those with different medical conditions, to make sure the vaccines meet safety standards. Rapid development was possible because of increased collaboration, new technology, more funding and the FDA and CDC prioritizing the review process for COVID-19 vaccines.

The CDC will continue to monitor vaccine data. At least eight weeks of safety data were collected during clinical trials. It is unlikely for side effects to appear more than eight weeks after vaccination.

The COVID-19 vaccines are messenger RNA vaccines – also called mRNA vaccines – which teach your immune system to recognize and fight the virus that causes COVID-19, and this protects you from getting sick with COVID-19. Unlike other vaccines, including the flu vaccine, mRNA vaccines do not use any part of a live or inactive virus to elicit an immune response. A flu vaccine is a diluted version of the virus that might provide a defense if the actual virus is introduced into the human body. After getting the COVID-19 vaccine, wait at least 14 days before getting any other immunizations, including the flu or shingles vaccine.

How does the COVID-19 vaccine work? Is it different from the flu vaccine?

Is it better to get natural immunity rather than immunity from vaccines?

Because the disease and vaccine are so new, it is not known whether getting COVID-19 will protect someone from getting it again, or if it does, how long that protection might last. If you get COVID, you risk giving it to loved ones who may get very sick. Getting the vaccine is a safer choice.

I’ve already had COVID so do I still need to be vaccinated?

Yes. Due to the severe health risks associated with COVID-19 and the fact that reinfection is possible, you should be vaccinated regardless of whether you already had COVID-19. It is unknown how long natural immunity lasts. There is some indication that immunity from antibodies lasts up to three months, with long-term immunity beyond that with T cells. However, reports are preliminary and recommendations may change. There are multiple strains of COVID and the vaccines appear to be effective against multiple known strains.

Who is eligible for the vaccine?

How will I know when it’s my turn?

The State of California has established phases and tiers for when different populations are eligible to receive the vaccination. Up-to-date information is available on the State of California’s vaccination website, or on the Santa Clara County Public Health website.

The Santa Clara County website, sccfreevax.org, will include the latest information on vaccine eligibility. Sign up for COVID-19 vaccine notifications at myturn.ca.gov to be notified when it’s your turn to get the COVID-19 vaccine. Talk with your health care provider to find out how they plan to notify you when you become eligible.

Where will eligible people go to get vaccinated?

Like other vaccines, many people will receive the COVID-19 vaccination from their primary care provider. Large health systems including Kaiser, Palo Alto Medical Foundation, the County’s hospitals and clinics, Stanford Healthcare, and some smaller community clinics may be allocated vaccine to vaccinate their eligible patients. People who don’t have a physician or health insurance can be vaccinated through the County’s Health and Hospital System, El Camino Health, and other providers offering vaccination to the broader community. Some large pharmacy chains may also offer the vaccine.

What will it cost to get the COVID-19 vaccine?

COVID-19 vaccines are available at no cost, but they are only available to eligible individuals.

Will the shot hurt?

Will the vaccine give me COVID?

Will it make me feel sick?

Your arm where you received the injection may be sore, red or warm to the touch for a few days.

No – none of the current vaccines available contain the live virus that causes COVID-19.

Serious side effects are very rare. Many vaccine recipients experience mild or moderate side effects, especially after the 2nd dose. Those are normal signs that your body is building protection. Common side effects include mild to moderate pain, swelling, or redness at the injection site and/or mild to moderate flu-like symptoms such as fever, fatigue, headache, and chills. All side effects should resolve in a few days.

How many shots will I need?

If you are receiving either the Pfizer-BioNTech or Moderna vaccine, you will need two vaccine injections, either 21 or 28 days apart depending on which vaccine you receive. You should receive the second dose from the same manufacturer as the first dose.

Is the vaccine effective?

Will I still need to wear a mask and socially distance after I am vaccinated?

Very effective. After two doses, the Pfizer-BioNTech vaccine demonstrated 95% effectiveness at preventing symptomatic COVID-19 while the Moderna vaccine showed 94.1% effectiveness.

Yes – the vaccine protects you against COVID-19, but less is known about the vaccine’s effectiveness at preventing transmission to others. You can still be a carrier and transmit the virus, so continuing to wear a mask is critical.

How long does it take for the vaccine to take effect?

One to two weeks after receiving the second dose.

I have allergies. Can I get the vaccine?

Seasonal allergies and food allergies do not exclude you from getting the vaccine. Individuals who have had a severe or immediate allergic reaction to the COVID-19 vaccine or its components (polyethylene glycol or polysorbate) or those with a known allergy to any of the COVID-19 vaccine components, should not get the COVID-19 vaccine at this time. Individuals receiving the vaccine should be monitored for 15-30 minutes after injection to ensure there are no severe allergic reactions.

What if I have had an allergic reaction to another vaccine. Should I get the COVID vaccine?

If you have a history of any immediate allergic reaction to any other vaccine or injectable therapy not related to a component of mRNA COVID-19 vaccines or polysorbate, we do not know at this time what the risk is of having a severe reaction to the COVID vaccine. You may wish to defer vaccination and/or talk to an allergist or immunologist as a precaution.

Is the vaccine safe if I’m pregnant or breastfeeding?

Clinical trials did not include pregnant or breastfeeding women so there is limited direct data on COVID-19 vaccine safety for this population. Discuss the risks and benefits of vaccination with your health care provider. Based on current knowledge, experts believe that the COVID-19 vaccines are unlikely to pose a risk to a person trying to become pregnant in the short or long term.

Can children be vaccinated?

Will I have a choice between the various vaccines available?

Not at this time but clinical trials are underway for children.

Current vaccine supplies generally do not permit a choice of the type of vaccine that individuals receive.

Vaccination Conversations

Check your pulse:

Address your own basic physiological needs Assess your perceptions and knowledge about COVID-19 vaccines Be prepared to answer patients’ questions

Know your audience – for those who are:

Ready – encourage their positive health behavior choices, answer questions and give instructions about how to get vaccinated Hesitant – use motivational interviewing to explore the patient’s concerns and discuss potential benefits and drawbacks of each course of action; more than one conversation may be necessary Refusal – respect their perspective, inform them of your vaccine recommendation and offer to be available to speak further if desired

Find the words:

Avoid medical jargon and controversial topics such as politics and religion; provide scientifically-based, plain language answers Normalize feelings, allow them to talk about concerns – behavior change is motivated by feelings rather than facts Using strategic self-disclosure (sharing your own or your family’s experiences with vaccinations) can humanize the experience Focus on universal values such as family safety, and protecting one‘s self, loved ones and those in the community Use language and visual representations that are culturally sensitive Verbalize respect for each patient’s right to choose and leave door open to future conversations

Consider the range of literacy in:

Health – the capacity to understand health information Digital – the capacity to discern the credibility of online sources Science – understanding the evolving nature of science

Start from a place of empathy and by asking open-ended questions:

How are you doing? How are you feeling about the pandemic? Acknowledge the stress and disruption COVID-19 has caused What have you heard about the vaccine? Acknowledge rather than challenge their hesitancy Validate and speak to their individual concerns

Address the unknown by relating to the known:

Explain that like the flu shot, some people have reactions and side effects – most often feeling lousy for the day Ask about their allergy history and any reactions they’ve experienced previously to medications or other vaccines Use foreshadowing to build trust – acknowledge that the situation and recommendations will continue to evolve and that is to be expected It is not yet known if the vaccine helps prevent illness AND spread due to the speed of development, but it IS safe

Share your personal concerns and experience:

This pandemic touches everyone – share your perspective as a fellow human Reference things people miss most, especially human connection and visiting with family and friends; acknowledging missed moments serves as a powerful reminder of the ultimate end goal with vaccination being a pathway to regaining these moments Consider sharing your own concerns and why you are still choosing to get vaccinated Assure them that you have already received the vaccine (or will get the vaccine), and share your experience with getting the vaccine Don’t downplay the immune response; share the range of possible responses and typical duration

Do not assume a position of authority:

Do not order your patients to get the vaccine or insist it’s the right course of action; be inviting and respectful rather than demanding Engage them in a discussion about their concerns to help lower their fears Ask, affirm and answer – let them come up with the solution and arrive at their own conclusion about vaccination (“the choice is yours to make“)

Acknowledge their realities:

Acknowledge that the pandemic has disproportionately impacted people of color Do not try to fight, defend or shutdown causes of distrust in the health care system

Connect more frequently, especially with telehealth patients:

Talk about the vaccine at every appointment Give a strong recommendation

Begin and end each appointment with a conversation about the vaccine

“I strongly recommend you get the COVID-19 vaccine when it is available to you.” “This shot is especially important for you because of your [job/underlying health condition].” “I believe in this vaccine so strongly that I have already been vaccinated myself,” or “I plan to be vaccinated as soon as it is available to me.”

Messaging to avoid:

Negativity - being reminded what a difficult year it‘s been tends to put people in a pessimistic, hopeless or frustrated frame of mind Fear - fear tactics do little to generate trust or address questions about vaccines Guilt - references to social responsibility or others already stepping up can come off as pushy or accusatory; those who are hesitant may be worried about being 'guinea pigs‘ for new vaccines Overpromising - avoid claims that are unproven and be clear about facts without sugarcoating; mass vaccination is a long-term process and the pandemic won‘t be resolved immediately Getting back to normal - for many, post-pandemic life will never be the way it was; focusing on economic recovery does not resonate with some

Resources for Patients

County of Santa Clara COVID-19 Vaccine Information for the Public: https://www.sccgov.org/sites/covid19/Pages/COVID19-vaccine-information-for-public.aspx What to Expect Handout from CDC: https://www.cdc.gov/coronavirus/2019-ncov/downloads/vaccines/facts-covid-vaccines-english-508.pdf FAQs about COVID-19 Vaccination from CDC: https://www.cdc.gov/coronavirus/2019-ncov/vaccines/faq.html Facts about COVID-19 Vaccines from CDC: https://www.cdc.gov/coronavirus/2019-ncov/vaccines/facts.html COVID-19 Pfizer BioNTech Vaccine Fact Sheet: https://www.fda.gov/media/144414/download COVID-19 Moderna Vaccine Fact Sheet: https://www.fda.gov/media/144638/download What to Expect after Vaccination from Vaccinate ALL 58: https://covid19.ca.gov/vaccines/#What-to-expect-after-vaccination Fact Sheet from Vaccinate ALL 58: https://www.cdph.ca.gov/Programs/CID/DCDC/CDPH%20Document%20Library/COVID-19/COVID_VACCINE_FACT_SHEET-ENG-08.pdf COVID-19 Vaccine FAQ from American Academy of Family Physicians: https://www.aafp.org/dam/AAFP/documents/patient_care/public_health/COVID19-Vaccine-FAQs.pdf COVID-19 Vaccine Myths from American Academy of Family Physicians: https://www.aafp.org/dam/AAFP/documents/patient_care/public_health/COVID19-Vaccine-Myths.pdf

Interim Clinical Considerations for Use of mRNA COVID-19 Vaccines Currently Authorized in the United States from CDC: https://www.cdc.gov/vaccines/covid-19/info-by-product/ clinical-considerations.html Immediate hypersensitivity to polyethylene glycols in unrelated products: when standardization in the nomenclature of the components of drugs, cosmetics, and food becomes necessary Allergy Asthma and Clinical Immunology; published February 19, 2019.: https://aacijournal.biomedcentral.com/articles/10.1186/s13223-019-0327-4 Hypersensitivity to Polyethylene Glycols & Polysorbates: Physician‘s Weekly; published December 30, 2019. https://www.physiciansweekly.com/hypersensitivity-to-polyethyleneglycols-polysorbates/

Santa Clara County Public Health vaccine information for the public: https://www.sccgov.org/sites/covid19/Pages/COVID19-vaccine-information-for-public.aspx and for health care providers: https://www.sccgov.org/sites/phd-p/Diseases/novel-coronavirus/Pages/COVID19-vaccine-information-for-healthcare-providers.aspx Vaccination Conversations: Influencing Critical Health Behaviors in COVID-19; Joshua C. Morganstein, MD; Psychiatric News, Psychiatry Online, American Psychiatric Association; December 23, 2020: https://psychnews.psychiatryonline.org/doi/full/10.1176/appi.pn.2021.1.32 How to Talk With Patients About the COVID-19 Vaccine; David C. Henderson, MD; HealthCity Newsletter, Boston Medical Center Health System; December 23, 2020: https://www. bmc.org/healthcity/policy-and-industry/how-talk-patients-about-covid-19-vaccine COVID-19 Vaccine FAQs from the American Academy of Family Physicians: https://www.aafp.org/dam/AAFP/documents/patient_care/public_health/COVID19-Vaccine-FAQs.pdf Recipient Education information from CDC: https://www.cdc.gov/vaccines/covid-19/hcp/index.html Ad Council COVID Collaborative 2020 Interim Clinical Consideration for Use of mRNA COVID-19 Vaccines: https://www.cdc.gov/vaccines/covid-19/info-by-product/clinical-considerations.html

Resources for Physicians

Information adapted from the following sources: