Vaccine compliance must be supported with regulatory enforcement

Australia recently instituted rebates for general practitioners who provide counseling about Covid-19 vaccines.  

Patients' medical appointments reimbursement from insurers, including Medicare and Medicaid, must include a question about how the provider counseled the patient about vaccines!

Echo opinion essay published in The New York Times: Doctors and Nurses Are the Key to the Final Vaccine Push by By Saad B. Omer, the director of the Yale Institute for Global Health.

Maine Center for Disease Control (Maine CDC) Director Dr. Nirav Shah, M.D.

America was in the midst of a summer of celebration, with cases and deaths from the coronavirus on the decline. Although the collective relief was well deserved, parts of America remained vulnerable to outbreaks because of spotty vaccination rates, between states and even counties.

Any risk of future surges and loss of life is almost entirely preventable, given the availability of vaccines. 

And yet there’s reason to believe that the plateauing vaccinations will cause the nation to fall short of President Biden’s target of 70 percent coverage before July 4 among eligible Americans. 

That’s despite the fact that an overwhelming majority of COVID-19 deaths are among the unvaccinated.

So, what happens now? There’s no reason the United States should settle for patchwork vaccination rates and easily preventable death. There are ways to overcome low vaccine demand. It starts with doctors and nurses.

Twenty years of research on how to persuade people to get vaccinated shows that health care providers are the most trusted source of vaccine information, even among vaccine refusers. 

In fact, the nation’s doctors and nurses must talk to patients about Covid-19 vaccines at every opportunity.

This may seem obvious, and yet very few providers have been trained in the most effective approaches for talking to people about vaccines.

For example, doctors and nurses may assume they need to offer patients more information about the vaccines in order to persuade them. But, research shows that often a lack of knowledge is not the main problem. Many people refuse vaccines because of their worldview, values or mistrust of the health system. 

While people on the fence about vaccinations may need more information to help make up their mind, at this stage, there’s actually information overload.

Strategies like framing vaccination as the default choice — “It’s time for you to get vaccinated,” versus, “Maybe you should think about receiving the Covid vaccine” — can be effective. It doesn’t take away someone’s autonomy, but still serves as a verbal nudge toward vaccination.

But how can the nation ensure that its doctors use these approaches? There needs to be a continuing medical education program — a tool used by physicians to keep their skills and knowledge of medicine up-to-date and to maintain their license — to train them in effective vaccine communication techniques. Yale started such a program.

Another way to ensure that health care providers spend sufficient time on sometimes challenging conversations about vaccines is to make vaccine counseling reimbursable.

Right now, providers are compensated if they vaccinate their patient; they don’t get reimbursed if the patient ends up refusing the vaccine.

But doctors don’t always know if their conversations with patients persuaded them to be vaccinated or not. They should be compensated for having the conversation in the first place. Many other countries do so. For example, Australia recently instituted rebates for general practitioners who provide counseling on Covid-19 vaccines.

Persuading people to get vaccinated often requires multiple discussions. Ideally, as part of any appointment, physicians will urge unvaccinated patients to get the Covid-19 vaccine, and talk through any concerns. If the physician does so for more than a few minutes (e.g., more than three minutes, similar to the threshold for reimbursing physicians for smoking cessation counseling), the doctor can seek reimbursement. Physicians should be able to bill for multiple counseling sessions with the same patient up to a reasonable limit of three times per year.

Other continuing efforts, such as increasing vaccine access and making the vaccination process simple, remain important. To this day, there are many people who are concerned about the cost of the vaccines even though they are free. Vaccination sites should stop asking for insurance information.

The most effective vaccine message is one that comes from a trusted source and not only leads the listeners to get vaccinated but also motivates them to encourage others around them to do so as well. This is what we need, as people become complacent with the benefits of others getting vaccinated. 

Health care providers hold this sway, and all health workers need to push toward higher vaccination rates together.

Saad B. Omer (@SaadOmer3) is the director of the Yale Institute for Global Health and a professor of internal medicine and epidemiology at the Yale School of Medicine and the Yale School of Public Health.