Calgary

'A very charged situation': Talking to our loved ones about COVID-19 vaccine hesitancy

Vaccine hesitancy during the high-stakes months of COVID-19 can put tremendous pressure on the connections that matter to us most, but an expert says we can approach these conversations constructively.

Conversations often emotional, but we can approach them constructively, expert says

Experts say a vaccine-hesitant person feels pressure and judgment that they're making the wrong decision. Meanwhile, family members and friends feel pressure and responsibility to change their mind. This dynamic can be emotionally charged. (The Canadian Press)

Andrew Magnus had a handful of reasons why he didn't plan on getting vaccinated for COVID-19.

The 55-year-old Calgarian felt the provincial government's messaging for the vaccines was too fear-based, and he worried the vaccines had been rushed to market.

Information seemed to be missing about the gap between doses, and he wondered if side-effects were underreported, he says.

"I didn't feel like I was getting the information I needed. So that led me to hesitancy on the vaccine, just because of a general mistrust," Magnus said.

He isn't an anti-vaxxer or a conspiracy theorist. He just had his doubts.

But his position still caused a lot of tense conversations with both his business partner and his wife, Corrina Munro-Magnus, who pestered him relentlessly to get vaccinated. 

"We got into some fairly heated discussions," Magnus said. 

"[My business partner] was just ready to argue at the drop of the hat all the time. We got to the point where we wouldn't talk about it anymore."

An April Angus Reid poll suggested that Albertans have the highest rate of COVID-19 vaccine hesitancy in the country. Twenty-eight per cent of respondents said they either would not get the vaccine or were unsure. (Angus Reid)

Finally, his wife just went ahead and booked him an appointment, and with the whispered possibility of having business travel limited if he went unvaccinated, Magnus relented.

"I was successfully pressured," Magnus said. "Put it this way. Left alone, I wouldn't have done it. I don't think so."

In spite of how divisive their conversations about vaccines had become, Magnus says there wasn't any lasting impact on his relationships. But this is not the outcome for everyone. 

Dr. Cora Constantinescu is a pediatric infectious diseases specialist with the vaccine hesitancy clinic at Alberta Children's Hospital, where doctors can refer anxious patients for counselling about vaccines.

She says conversations surrounding vaccine hesitancy can escalate quickly, and there are techniques that can help.

"It's a really difficult situation, especially in families," she said.

A really difficult situation

That's the case for Priyanka, a 37-year-old teacher who has been trying to cope with her mom's increasing vaccine hesitancy since the pandemic started.

To keep from damaging the relationships within her family, Priyanka's real name isn't being used for this story.

Surrounded by students and often sent home to isolate because of outbreaks, Priyanka's work makes her high risk for exposure to COVID-19.

Meanwhile, her mom is 71 and has underlying health conditions that make her a high risk to severe outcomes if she gets COVID-19.

From Priyanka's perspective, her mother's vaccine hesitancy happened gradually.

"I think the change [in her] kind of came along with the isolation that happened out of the COVID crisis," Priyanka said.

As kids, Priyanka and her sister were vaccinated and regularly taken to the doctor.

But shortly before the pandemic, her mom lost her partner of over 40 years to cancer.

It left her mom with medical trauma, and distrust that grew as her sources of information shrank to videos of self-professed doctors who were quickly removed from YouTube, or questionable studies shared by relatives on Facebook.

"I think [my mom's] exposure to really negative messaging — really fearful and kind of oversimplified understandings of things — has worsened during the pandemic," Priyanka said.

'Our common ground sort of slips away'

Priyanka's mom eventually broke the news to her: she doesn't plan on getting vaccinated.

She told Priyanka she is worried about complicating her health conditions and just has a bad feeling she can't explain.

What has unfolded between them since are a lot of circular conversations that Priyanka said seem rooted in her mom's anxiety, and her own fear for her mother's safety.

But Priyanka has discovered she can't negotiate with an instinct, or a bad feeling.

"I can't really get to the root of what she's feeling or thinking in any tangible way," Priyanka said.

"It's upsetting, because our common ground sort of slips away."

The subject has had a corrosive effect on them — and to preserve their relationship, Priyanka stopped bringing it up.

To keep her mom safe, Priyanka won't see her until one of them is vaccinated, so they haven't been able to visit very much during the pandemic.

It has made rebuilding their relationship difficult, she says.

A very emotional decision

Constantinescu says that either side of this kind of back-and-forth is a very hard place to be.

The vaccine-hesitant person likely feels pressure, accusations and judgment that they're making the wrong decision, and as they feel that they're trying hard to make the right one.

Meanwhile, family members and friends feel pressure and responsibility to change their mind.

A doctor with expertise in vaccine hesitancy answers questions about COVID-19

Canada

3 months ago
9:11
Dr. Cora Constantinescu, from the Alberta Children's Hospital in Calgary, says people should take the first COVID-19 vaccine that is available to them. 9:11

"That can be a really stressful and emotionally a very charged situation, where you feel like you need to convince somebody," Constantinescu said.

"What I want people to understand is, at the heart of every vaccine hesitancy appointment is a parent or a person trying to make the best decision they can to protect themselves or their family.

"And they have to overcome fears and anxieties. This is a very emotional decision."

Those fears and anxieties aren't uncommon. According to an Angus Reid poll, 10 per cent of Canadians don't plan on getting vaccinated, and six per cent are unsure if they will.

When we look to Alberta, that picture changes. It has the highest rate of vaccine hesitancy in the country.

Twenty-eight per cent of Albertans say they are either unwilling or unsure about getting a COVID-19 vaccine.

Three main causes of vaccine hesitancy

There can be many reasons why a person is vaccine hesitant, and those reasons can change — but they are always intensely personal, Constantinescu says.

To engage constructively, it helps to have a sense of what is behind a person's apprehension.

There are often three main categories.

The first is confidence. If a person does not trust the government, health agencies or the media, Constantinescu says there is an opportunity for vaccine hesitancy to rise and misinformation to carry more influence.

Nicole Fuerderer, 23, receives a COVID-19 vaccine from public health nurse Nashrin Valani at the Telus Convention Centre mass-vaccination clinic in Calgary on April 19, 2021. (Leah Hennel/AHS)

The second is complacency. If a person perceives both the benefit of the vaccine and the threat of disease to be low, it can exacerbate hesitancy.

"In the third wave, complacency has played a huge role," Constantinescu said. "We're not so complacent anymore, because the threat is so much worse than ever before."

The last is convenience and accessibility. Language barriers, technological literacy and taking unpaid time off to get vaccinated can all play a role in enhancing vaccine hesitancy. 

"Vulnerable essential workers, racialized Canadians, ethnic minorities — this hesitancy may not at all come from confidence or from, you know, conspiracy theories," Constantinescu said.

Two steps for how to engage

Constantinescu offeres two steps for engaging with someone about vaccine hesitancy in a positive way.

The first step is to meet people where they are, instead of where you want them to be, to understand where they are coming from.

It involves being truly and non-judgmentally curious about why someone has not been vaccinated.

It also means keeping the conversation primarily about their feelings and anxieties, and avoiding a "philosophical debate," so it becomes clear your goal is supporting them.

If trust is lost, so is the conversation, Constantinescu says.

The second step is to become what she calls a "vaccine champion."

This involves speaking with presumptive language.

"You're gonna say, 'I just had my COVID vaccine, when are you booked to get yours?'" Constantinescu said.

This ensures your boundaries within the conversation are clearly stated.

It also includes sharing your own story of booking a vaccine appointment or getting vaccinated, so that the two parties can build common ground, which is integral.

"People are going to listen and be influenced by their trusted social network," she said.

Next, help put the risks of forgoing the vaccine into the context of someone's life.

A common challenge

While Priyanka waits to get vaccinated, she is coping with persistent fear for her mom's health, and the growing gulf between them, in therapy. She is also leaning on her friends.

"There's a bit of a grief process, I think, happening," Priyanka said.

"I've come to understand that this shift in our relationship, and our understanding of the world, and our circumstance — this isn't temporary … in how we relate to one another. And I miss before."

But Constantinescu says it's never too late to support someone in making the decision to get vaccinated.

And for Priyanka, it's reassuring to know these conversations are emotional by their nature.

"It helps to know it's not just me, and that it's a common challenge that lots of people are feeling," she said.

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