Patient-doctor trust and the COVID-19 Vaccine

The news that several viable COVID-19 vaccines will soon be available is positive news.But the bad news is that significant percentages of people may have reservations about getting the COVID-19 vaccine.Groups that are at a disproportionately higher risk of greater morbidity and mortality from COVID-19, also are potentially even more likely to indicate a willingness to receive a COVID-19 vaccination. Such findings imply that once a vaccine is available to people, some will choose either to delay getting it or decline to receive it altogether. Depending on how great these numbers become, it may negatively impact our collective ability to develop herd immunity to the illness and lessen its incidence in certain communities. This would mean additional lives lost and more time to recover socially, educationally, and economically from the devastating effects of the pandemic.It also would exacerbate existing health care disparities.

What influences people to be hesitant about receiving a COVID-19 vaccine appears to be a complex issue. A recent study found several different factors — gender, race/ethnicity, concerns about vaccine safety and efficacy, and the source for vaccine endorsements, e.g. public health experts versus politicians — may influence people’s likelihood of getting a COVID-19 vaccine. But the most important underlying cause is the lack of trust people have that a vaccine will do what it is supposed to do and will not result in any adverse health impacts for themselves or their children. The importance of trust in a vaccine is nothing new. Around the world, significant numbers of individuals remain less trusting in the safety and efficacy of vaccines generally.

One important potential source for people gaining greater trust in the COVID-19 vaccine is the doctor, specifically a patient’s primary care doctor, or a child’s pediatrician. There is plenty of evidence that doctors are an important source of trust for all sorts of medical advice. This includes advice to patients about receiving different types of vaccines, either for themselves or family members.But many of us do not have these trusting, ongoing relationships with doctors.

In the United States, for example, the percentage of people without a regular source of primary care continues to increase. Particular groups such as males and, more specifically, non-White males have been shown to be disproportionately affected, with their percentages higher than the rest of the population. Access to regular primary care is also maldistributed geographically, with one study showing census tracts with higher proportions of Black Americans twenty-eight more times likely to be in a lower access area for primary care providers compared to census tracts with a low proportion of Black Americans. Higher percentages of younger millennials also state that they do not have a regular doctor to go to, compared to older generations. Even where there is access to a regular primary care doctor, the ability to develop ongoing, trusting relationships is hindered by the lack of time available to spend with the doctor, heavy physician workloads that lead to burnout and less attentive physicians, and quality metrics that do not reward the establishment of doctor-patient trust.

Without a regular source of primary care that patients can turn to for expert advice, reassurance, listening, and empathy when it comes to questions, concerns, and anxieties about getting a COVID-19 vaccine, a critical voice of legitimacy is lost, making the loudest voices on the vaccine topic become those of politicians, who are less trusted, and public health agencies and experts, who also now increasingly suffer from public crises of confidence. When the call comes to receive a COVID-19 vaccine, many of us would like to call up a doctor whom they have seen for a long time, who they believe on matters such as this, and help be convinced it is the right and necessary thing to do. The millions of people who have no regular source of physician-based primary care will be left having to convince themselves and be potentially more subject to influence by misinformation and half-truths.

Make no mistake, this will result in fewer people getting a COVID-19 vaccine.

For years now, we have continually downplayed the growing crisis that involves too many of us not having a regular and trusted source of primary care. We have downplayed the important role played by primary care doctors. The health care system has encouraged episodic, fast-food sources of episodic primary care such as urgent care centers and retail clinics, where the potential for ongoing, trusting doctor-patient relationships is non-existent. It is during a time like this, in the middle of a global pandemic where the main way out of it is getting as many as possible vaccinated, when we see how much not trying to fix this problem may impact not just the health of individuals, but the public at large.

Timothy Hoff, PhD, is professor of management, healthcare systems, and health policy at Northeastern University in Boston; a visiting associate fellow at the University of Oxford, and author of Next in Line: Lowered Care Expectations in the Age of Retail- and Value-Based Health.