As the pandemic enters a new phase, a friend shows how patience and compassion can unpick vaccine hesitancy. By Melanie Cheng.
How to talk to the vaccine hesitant
Alice is not a patient but a friend. It is July and we are catching up over sushi and sake at a Japanese place in East Brunswick. Restrictions have eased and, as we eat, we remain blissfully unaware that the coronavirus is quietly seeding the northern suburbs of Melbourne. Alice has just left her job in Europe to return home to care for her ageing parents. When I ask about her homecoming, she says her overwhelming emotion has been one of shock. “You guys have been sheltered from Covid,” she declares between mouthfuls, “you have no idea what it’s like.” She goes on to describe how, towards the end of 2020, her best friend attended 32 funerals in a single month. More than one funeral a day. Now it’s my turn to feel shocked.
Alice has arrived home to discover that not one member of her immediate family – not even her elderly father with multiple comorbidities – has been vaccinated. Their reasons vary. Her father, who would willingly take the vaccine, is frail and relies on her mother to get to his appointments. Her mother, while not an anti-vaxxer, has expressed some vague concerns about the safety of the Covid-19 vaccines and the speed at which they’ve been developed. Her younger sister has only recently become eligible and has been so preoccupied with work she hasn’t got around to it. Her older sister, sadly, has been snared by the misinformation algorithms on Facebook and lives in a state of near perpetual terror.
Amid the jokes and the throwaway lines, I can sense Alice’s mounting frustration. I’ve been there – with my vaccine-hesitant patients. But that is where the similarities end. Because while my emotions are contained by the boundaries of the doctor–patient relationship, Alice’s emotions have no such limits – they are rendered wild and unruly by love. While my patients have gone to the trouble of making an appointment to seek my advice, Alice is sparking unwelcome conversations with loved ones in the sacred space of their own homes.
I don’t see Alice again for several weeks after that evening. The northern suburbs cluster has prompted yet another Melbourne lockdown. Confined to our respective homes, Alice and I communicate via WhatsApp messages: some anti-vaccine conspiracy content her older sister has posted on Facebook, a monologue from Russell Brand, highlights from a recent discussion Alice had with her family about the public health directions. We exchange a flurry of brain-explosion and face-plant emojis.
When we do speak again, Alice has excellent and unexpected news: her younger sister has finally made an appointment for her first dose of Pfizer and in a few weeks her parents will be receiving their second doses of AstraZeneca. Even Alice’s older sister – thanks to a recent brush with a tier 1 exposure site – seems to be softening to the idea of vaccination. At the very least, she no longer believes the entire medical profession is out to get her. How, I wonder, has Alice succeeded in changing their minds?
A few years ago, I read a brilliant book by Eleanor Gordon-Smith, titled Stop Being Reasonable. It documents the psychological acrobatics involved when an individual changes their mind. Using a series of illustrative case studies, Gordon-Smith demonstrates how it is often a slow process and almost always a messy one. She points out that while we are constantly being told “the ‘right’ way to change our minds is by entering a sort of gladiatorial contest of ideas where we leave the personal behind”, the reality couldn’t be more different. In fact, minds are changed in “moments between people – messy, flawed, baggage-carrying people – and our words have to navigate a space where old hurt and concealed fears and calcified beliefs hang stretched between us like spun sugar, only catching the light for a second or two before floating out of view again”.
These words certainly resonate with me as a GP who has encouraged people to lose weight, start exercising, stop smoking. Rarely, if ever, does a patient commit to change in the space of a 15-minute appointment. More often than not it takes months, sometimes years.
The skills I’ve developed in motivational interviewing are imprecise instruments. They can leave tiny dents which, over time, may weaken a strongly held belief system, but they are rarely capable of destabilising deeply rooted ideas in a single conversation. Occasionally a patient will surprise me by starting a consultation with “You’ll be glad to know…” and then proceed to tell me how they’ve stopped smoking or cut back on drinking or gone out and got their vaccine. While not rare, such moments are uncommon enough to feel a little precious.
And that is why I’m so taken aback by the speed and completeness of Alice’s achievement. Alice is not versed in the behavioural stages of change. She has not received training in motivational interviewing. Alice is operating on intuition and instinct – skills she thankfully holds in abundance. When I ask her to explain exactly how she changed her loved ones’ minds, she describes a process so sophisticated and nuanced it would impress any GP or psychologist.
In the case of her father, for whom the barriers were convenience and accessibility, Alice made him an appointment and drove him to the vaccination centre. In the case of her mother, whose concerns related to side effects, Alice used herself as an example of someone who had received the vaccine safely. She also spoke to her mother about the dangers of the disease the vaccine was designed to prevent. And she didn’t do this by quoting dry statistics about efficacy and mortality; she did it by recounting emotional stories about people she knew personally.
Humour would prove an important strategy with her younger sister, who didn’t like being told what to do. For her older sister’s conspiracy theories, empathy had been the most effective tool; rather than preaching, Alice listened to her very real fears about both the vaccines and the motivations of the politicians and medical professionals peddling them. Alice showed solidarity with her sister – “You know, I can’t stand politicians either” – and admitted that while she couldn’t vouch for the motivations of the entire health profession she did have trusted friends who were doctors. Surely they, at least, had good intentions?
Too many times in the past few months I’ve heard the refrain, “I can’t understand why people won’t get vaccinated.” But what Alice shows us is that it is actually a willingness to understand that holds the key to changing such people’s minds. It is a mistake to lump all the unvaccinated – an extremely heterogeneous group – into the militant anti-vaxxer camp. Vaccine hesitancy in Australia has dropped significantly since the start of 2021. Contrary to many people’s assumptions, people can and do change their minds.
We are all finding our own ways of getting through these final stages of the pandemic. For me, it involves cognitive reframing – a switch from focusing on the escalating case numbers to focusing on the soaring vaccination rates. It involves reminding myself that behind each vaccine statistic is a person, a family member, someone doing something to protect themselves and their community. And it involves a recognition that behind at least a few of those people is a daughter or a sister or a friend like Alice – gently encouraging their loved ones to do the right thing.
This article was first published in the print edition of The Saturday Paper on Nov 6, 2021 as "Gentle persuasion".
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