“We are … locking people out who have not got vaccinated to protect themselves and protect everybody else.”
THOSE were the words of Victorian Premier Dan Andrews as he recently announced the joyous news of Melbourne’s release after 262 days of strict stay-at-home orders.
While Premiers are announcing different road maps out of lockdown when 80% of their state populations (aged over 16 years) are fully vaccinated, many of our patients remain potential victims of the predicted “COVID-19 pandemic of the unvaccinated”.
Despite ongoing treatment for his cancer throughout 2021, my GP husband and I felt compelled to return to general practice to vaccinate isolated rural communities in central Victoria because of long-standing health workforce shortages. It’s time for health practitioners like us, who have collectively rolled up our sleeves to provide over 19 million vaccine doses in small Medicare-funded primary care clinics across the country, to share some observations about why some Australians remain unvaccinated and to share effective ways to respond to them in practice.
Vaccine access has been limited in some regions
Despite our best efforts to collaborate, the local state-funded hospital failed to cooperate with the general practices in our region, which resulted in a duplication of surge vaccination clinics on the same weekends and a waste of precious resources and vaccines when supply was short.
Government websites only provided booking information about far away vaccine clinics with no reference to local providers in general practices and pharmacies.
Vaccine supply and eligibility only opened up in rural areas like ours as recently as September 2021. Even so, it was not easy for many people, especially those with disabilities or limited English language skills, to make vaccine appointments, as online booking systems did not function with poor internet and local health service telephones were often blocked due to high demand.
Vaccine hesitancy requires empathy
We underestimated how many patients hated having needles. Needle phobia has been exacerbated by frequent media images of people “getting jabbed” and the roaming “jabber bus”. At our clinics, it was not uncommon for grown men to well up with tears while recounting their memories of waiting in vaccination queues as children.
There was a high level of distrust of the frequently changing “best medical advice” espoused by politicians, because it often varied from state to state. A lot of effort was required to counter the mountain of bizarre vaccine misinformation spread widely via social media, including by politicians. Many of our patients were concerned about the lack of research on long term side effects of the vaccines. One 14-year-old patient defiantly told me the vaccine would result in her future baby having a “deer head”, but happily returned for her second vaccine after the facts were carefully explained.
Beneath the high levels of patient angst and uncharacteristic anger in our consulting and waiting rooms were deep fears that lockdowns and the possibility of mandatory vaccination were an assault on their human rights.
However, they often readily accepted vaccination when we adopted a straightforward, harm-minimisation approach, rather than an authoritarian stance. It also helped to be transparent with patients who had antivaccination sentiments about all the advantages and disadvantages of vaccination with statements such as this:
“It is your choice. I am not forcing you to have the vaccine. But while you are here, would you like me to give you some facts?
“The vaccines have now been provided to billions of people worldwide and they are safe and effective. We know what the side effects are. We also know how to treat the extremely rare side effects including thrombosis after AstraZeneca or myocarditis after Pfizer or Moderna vaccines. All these side effects are far greater if you get the virus than after you receive the vaccine.”
And for patients who continued to refuse the vaccine:
“If you choose not to get the vaccine, it is important you know what to do when you get the virus. It’s true many people only have mild symptoms. Call the testing clinic before you present. Otherwise, stay home in isolation, away from your family and your community. Please make early arrangements for your children to be cared for by a family member, relative or friend while you are unwell.
“Do not visit any health service unless you call first. Your GP may be able to help you via telehealth consultations only. There are very few visiting nurses to help you if you become ill at home. If you experience any deterioration in your condition, including shortness of breath, call 000 early because there is a limited number of ambulances. You are likely to experience a prolonged wait. Inform the ambulance you have COVID 19, as special arrangements will be made to transfer you to a major hospital with special COVID-19 facilities including ventilation equipment.
“Please talk to your relatives, friends or neighbours now about arrangements to support your family before this occurs.”
We attribute the 95% first dose vaccination rate in our local postcodes to this caring, non-judgmental approach. After fully informing vaccine hesitant patients about ways to manage COVID-19 infection, most responded: “Just give me the vaccine”.
There is so much more we can all do to protect our communities
As many areas of Australia have never had a case of COVID-19, most people have not been confronted personally with the risks of acute suffering, long symptoms, or the lonely death associated with COVID-19, but they soon may be.
When the Delta variant spreads in our beautiful region as our population increases with the easing of metropolitan restrictions, local people will be competing with tourists for the three urgent care cubicles at the local hospital for both COVID-19 and non-COVID-19 conditions. They will also be faced with the stark reality that people, including sick children, requiring transfer out of our isolated region to a major hospital via ambulance will be alone.
Now that our local community (over the age of 16 years) is over 80% double dose vaccinated, my husband and I, like many health workers who have health risks of their own, are torn about leaving due to concerns about personal safety. In doing so, and with the deepest admiration and respect, we are acutely aware that in the next few months, our colleagues at the front line will courageously continue to treat the predicted surge in COVID-19 infections in a public hospital system already in crisis. The ongoing uncertainty surrounding the access of health workers to a booster vaccination is another major concern.
In this perfect storm, it is challenging to remain empathetic towards unvaccinated patients. But unless we do so, we risk inadvertently shaming them, potentially resulting in more preventable patient deaths at home because of attitudinal barriers deterring access to health care.
More research is required on why people continue to be unwilling or uncertain about the COVID-19 vaccines in Australia (here, here, here, here and here). In our clinical experience, having talked to many patients in one small rural GP clinic, the most effective way to increase vaccination rates further is to treat everyone, including patients and colleagues, with understanding and compassion. What is your experience?
Clinical Professor Leanne Rowe AM has served as a rural general practitioner for over 25 years and is author of the book Every Doctor: healthier doctors = healthier patients www.everydoctor.org and a website on medical writing www.medicineisbeautiful.com
The statements or opinions expressed in this article reflect the views of the authors and do not represent the official policy of the AMA, the MJA or InSight+ unless so stated.