How to reduce COVID vaccine hesitancy: Rely on primary care doctors

Americans trust their doctors.

An NPR/Ipsos survey found that 85% of adults trusted their personal doctor — with 84% of Republicans, 86% of independents and 89% of Democrats agreeing.

This trust is needed to combat vaccine hesitancy, especially among rural Americans and Black adults, where vaccine skepticism remains high.

In December, the Journal of the American Medical Association reported that the percentage of Americans who were “somewhat” or “very likely” to get vaccinated dropped from 74% to 56% from April to December 2020.

Similarly, the Kaiser Family Foundation found that only 47% of Americans either received or wanted the COVID-19 vaccine as soon as possible, an improvement from the 31% a month before.

Rural Americans are particularly hesitant to receive the COVID-19 vaccine. In a recent survey, 35% of rural Americans said they would “probably” or “definitely” choose not to be vaccinated — a nine-point differential from their urban counterparts.

Yet, rural Americans are just as likely as their urban and suburban peers to know someone who tested positive or died from COVID-19. This data suggests that there are other reasons for their hesitancy.

An NPR/Ipsos survey found that 85% of adults trusted their personal doctor — with 84% of Republicans, 86% of independents and 89% of Democrats agreeing.

Many rural Americans are increasingly distrustful of the mainstream media, academic experts and perceived liberal elites. Moreover, they believe that urbanites and suburbanites greatly exaggerated the pandemic.

What’s more, nearly two-thirds of rural Americans see vaccinations as a personal choice rather than as a broader responsibility to protect their community. The inverse is true for urban Americans living in closer quarters.

History of racial bias drives hesitancy

Surprisingly, polling suggests that the same percentage of Black adults and rural Americans are hesitant to receive the vaccine. Surveys show that 35% of Black adults will “probably” or “definitely” not get the vaccine. However, other polls suggest that number may be closer to 25%.

Regardless, the rationale for this vaccine hesitancy is different from that of rural Americans — namely, due to the historic systemic racial bias in the medical establishment.

Like many rural citizens, nearly half of the Black adults surveyed who were hesitant toward the COVID-19 vaccine said they simply don’t trust vaccines in general.

Subsequently, polls found that 71% of Black adults feared the side effects of the vaccines and 50% feared the possibility of getting COVID-19 from the shot. It seems like information and reassurance from a trusted source — such as a primary care physician already in the community — could assuage these concerns.

Moreover, the public trust and physical presence of primary care providers in the community will help deliver the vaccines in areas most prone to vaccine hesitation.

Pharmacies scarce in rural areas

In rural areas where large hospitals and retail pharmacies like CVS and Walgreens are scarce, primary care doctors can more efficiently reach patients.

Last month, there were 111 rural counties with no pharmacies equipped to deliver any COVID-19 vaccines. These “pharmacy deserts” underscore the need for primary care doctors to administer dosages outside of the retail pharmacy setting.

Most Americans don’t seek preventative medical care at a CVS or Walgreens. They do so mainly through their primary care physician, where they build a relationship.

Furthermore, University of Pennsylvania researchers found that Black Americans have more confidence in their providers than “the health care system” or “Big Pharma” writ large. This patient trust will help combat vaccine hesitancy and — in the process — save lives.

The timing of combating vaccine hesitancy could not be more urgent.

Suppose that the Pfizer, Johnson & Johnson, and Moderna vaccines provide less strength or shorter durations of antibody resistance against future coronavirus variants or existing strains from the United Kingdom, Brazil and South Africa than anticipated.

In that case, states will need more effective roll-out plans for future boosters or additional shots — with primary care physicians helping fill these gaps.

The Centers for Disease Control believes the UK variant is present in all 50 states, the South African variant in 25 states and the Brazilian in 10. The longer the virus remains in the population, mutates and infects vulnerable patients, the more deaths there will be. The sooner more Americans are vaccinated, the better.

Americans trust their doctors to do the right thing. By nature, patients trust their physicians with their most intimate medical information. That trust is needed now more than ever.

Allowing physicians to play a more prominent role in administering the COVID-19 vaccine makes sense and will save lives.

Mark E. Dornauer is a visiting fellow in health care at the Foundation for Research on Equal Opportunity. He writes on rural health and pandemic preparedness.

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