Program that convinces new parents to vaccinate kids could work for COVID-19 shots, too, experts say

A program that puts vaccine counsellors right in hospital birthing centres may hold key lessons for getting vaccine-hesitant Canadians to roll up their sleeves for COVID-19 immunization, experts say.

PromoVac puts vaccine counsellors in birthing centres across Quebec

Nikita Potvin with her second baby, Riley, in Fleurimont Hospital in Sherbrooke, Que., received vaccine counselling through a program that has reduced vaccine hesitancy in the province by 40 per cent and could hold clues for getting Canadians to roll up their sleeves for COVID-19 shots. (Brian Goldman/CBC)

Originally published on Dec. 19, 2020.

A program that puts vaccine counsellors right in hospital birthing centres may hold key lessons for getting vaccine-hesitant Canadians to roll up their sleeves for COVID-19 immunization, experts say.

Called PromoVac, the program, which hinges on a non-judgmental approach to parents' concerns about immunizations, was found to have decreased vaccine hesitancy in Quebec by 40 per cent and led more parents to vaccinate their children.

As the biggest vaccine campaign in our country's history gets underway, PromoVac's method of building confidence in vaccines through respectful dialogue with those who have questions about things like side effects could help get people on board, said Dr. Noni MacDonald, one of Canada's top experts on vaccine hesitancy.

"I think PromoVac is exactly the right technique because it's really listening with and working with the patient. It's not about hammering something home to them. It is really about becoming a team and making this decision together," MacDonald told White Coat, Black Art host Dr. Brian Goldman.

An Ipsos poll last month found seven out of ten Canadians surveyed said taking a vaccine that was created and approved so quickly makes them nervous. 

Dr. Noni MacDonald, a pediatrician and infectious disease specialist, said rising vaccine hesitancy was already identified by the World Health Organization as one of the top 10 public health threats even before the COVID-19 pandemic started. (Dalhousie University)

MacDonald, a professor of pediatrics and infectious diseases at Dalhousie University in Halifax who also sits on the World Health Organization's strategic advisory group on immunization, said growing vaccine hesitancy was a concern even before the pandemic came along.

"In 2019, pre-COVID, the WHO listed vaccine hesitancy as one of the 10 most important global health threats," said MacDonald. "And hesitancy about receiving a vaccine doesn't mean you're not going to receive it, but it means we need to work with you to determine what it is that is making you anxious about being immunized."

That's especially critical now that the goal is immunizing 70 per cent of the world's population in order to achieve enough herd immunity to control the pandemic, she said. "We have a lot of work to do and vaccine hesitancy could undermine that if we don't do this well."

Tragic start

The Quebec program has a sad origin story.

It was founded by Dr. Arnaud Gagneur, a neonatologist from France now living and working in Quebec.

While working in a pediatric ICU in France, he cared for a six-month-old infant who died of bacterial meningitis. There was a vaccine, so the death was preventable.

Dr. Arnaud Gagneur, a neonatologist originally from France, was inspired to start the PromoVac vaccine counselling program after caring for an infant who died of bacterial meningitis, a disease that's preventable through a vaccine. (Brian Goldman/CBC)

"I tried to to have a discussion with the mother to try to understand why this child wasn't vaccinated," Gagneur told Dr. Brian Goldman during a pre-pandemic visit to Fleurimont Hospital in Sherbrooke, Que., to see how the PromoVac program works. "The answer of the mother was terrifying for me because she said, 'I did not know.'

"'I do not know the vaccine exists. I do not know the disease exists. I do not know I should vaccinate my child.'"

What struck Gagneur was that among all the lifesaving instruments at his disposal in the ICU, the most powerful tools were effective vaccines and accurate information about them. The key was to give the information when parents were ready to listen.

When you tell someone to do something but don't explain why, it doesn't work.- Arnaud Gagneur, neonatologist and PromoVak founder

He and some other colleagues in France started doing research on a new type of vaccine counselling aimed at new parents, stemming from work they did to get parents on board with a new rotavirus vaccine.

"Most of the time, educational methods fail to change behaviour and attitude about immunization …  I think because when you tell someone to do something but don't explain why, it doesn't work," he said. What did work was providing the information in a non-judgmental way long before anyone comes near their child with a syringe.

Once settled in Sherbrooke for a new career opportunity in 2008, those findings became the basis of PromoVac there, and extended province-wide starting in 2017 in a program known in French as EMMIE.

It uses a method of counselling called motivational interviewing, an empathic, non-confrontational communication style developed by psychologists to bring about behavioural change.

"We are here to understand them and to give them the answers they need to make a good decision about immunization, and to help them to build a stronger decisional process about immunization of the child," said Gagneur.

WATCH | Vaccine counsellor Mathieu Savard chats to a new mom about vaccines:

Vaccine counselor Mathieu Savard offers a tip to Nikita Potvin on how to reduce the pain from vaccination for her newborn daughter Riley.

2 years ago
Duration 1:22
Vaccine counselor Mathieu Savard offers a tip to Nikita Potvin on how to reduce the pain from vaccination for her newborn daughter Riley.

Natasha Coulis was once one of those new moms who felt quite unsure about getting her babies vaccinated on the schedule prescribed by public health.

"I thought they were so young, too young, to be getting any vaccinations and I thought that delaying felt like a wise and reasonable compromise between listening to the pamphlets I was given with bare-bones information and listening to full-on anti-vaxxers," said Coulis, now a mother of four.

Just 19 and living in rural Alberta at the time she had her first child, Coulis said she did a lot of reading, a lot of which she didn't understand fully. "I felt confused and unable to parse the information about this study versus that study." 

Message was 'trust us, we've done the thinking for you'

Coulis recalls big claims in the anti-vaccination literature that weren't acknowledged by the government materials or by public health nurses.

"The message from public health was, 'Just trust us, we've done the thinking for you,'" she said.

In the end it wasn't a public health initiative or a medical professional that brought Coulis around to vaccination and prompted her to get the kids caught up on their shots.

"I think I just learned to trust my peers more than any other source. I picked individuals to look to and listened to them until I was able to attend university and learn more about how to critically analyze studies and articles about studies. How to spot an agenda."

Dr. MacDonald, who has collaborated with Gagneur to research the impact of PromoVac in Nova Scotia during a study at four sites across Canada, said the time to reach parents like Coulis who may have questions about vaccines is right at the birth of their child, not once they're due to bring baby in for that first shot.

"One of the other reasons we think PromoVac works so well [is] when your baby's born, you actually fall in love with your baby, and you want to do what's really best for that baby," she said. "It's a really opportune time to provide that time to build trust around immunization and trust in that health-care provider."

While the Pfizer-BioNTech vaccine approved in Canada is currently only available for people 16 and older, MacDonald thinks that trust and dialogue would be useful around the COVID-19 vaccination campaign too. 

"We all want to have 'our lives back.' And that's part of what the vaccine can do for us. If we can get 70 per cent of people to accept the vaccine, I think there's a great incentive for why the PromoVac technique might work."

Personal support worker Michael Gellizeau gets a dose of COVID-19 vaccine from nurse practitioner Victoria Pierri at a vaccine clinic for care home workers put on by the University Health Network, in Toronto, on Dec. 15. (Evan Mitsui/CBC)

The closest Canada has come to anything like the COVID-19 vaccine campaign was the rollout of a new vaccine to combat H1N1 flu in 2009.

Toronto mom Grace Sanchez MacCall was initially wary of the newness of the H1N1 vaccine, even though she'd been on board with routine vaccinations for her son Dexter, then 2.

After all, she'd seen a lot of "doom and gloom" headlines that year that had predicted a death toll much higher than what had come to pass, leaving her to wonder if the whole thing hadn't been quite overblown.

Sanchez MacCall said she was also a little unsure the new vaccine was right for her son, who was born two months premature.

"At that point, I didn't know what my kid was allergic to. Was he allergic to eggs [contained in the vaccine]?"

In the end, it was good relationships with both her son's pediatrician, and a cousin who is a physician, that got her on board with the vaccine.

Grace Sanchez MacCall, right, was unsure about whether to get the H1N1 vaccine back in 2009 for her family, including son Dexter, left, who was just two years old at the time. A pediatrician who respectfully listened to her concerns assuaged her fears. (Philip Warnes Photography)

"I have a very good pediatrician who did not poo-poo me. She really listened. She was respectful and she answered my questions. Same with my cousin."

Sanchez MacCall said she has since learned more about the vaccine approval process and won't hesitate to get the COVID-19 vaccine as soon as it's available to her family members.

"I cannot wait to think about COVID in the same way I think about polio or TB or whatever…. I cannot wait to hug my family and friends again.

"The people who are lining up and rolling up their sleeves to get vaccinated — the physicians, the care workers — are the ones who are going to save our lives if we get in trouble. If we trust them to save our lives, we should trust them when they say to get the vaccine."

Produced by Dawna Dingwall.


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