It’s prickly, so know the skills: Four common conversations about vaccination

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It’s almost hard to believe that vaccination was once a topic similar to sex, religion and politics: a subject only cautiously raised in our social interactions. Today, it dominates everyday conversation, sometimes with awkward results.

Talking about COVID-19 vaccination, in a way that doesn’t risk getting someone offside, is a skill we are all learning. It’s tricky: the decision to vaccinate is deeply personal, but with a real public impact.

Vaccines are an intimate individual procedure, with far-reaching impacts, so navigating these discussions can be complicated.Credit:iStock

“In vaccine conversations, we’re striking a fine balance between having a genuine interest in what someone is doing because of the way it affects the health of others, while also still respecting their autonomy,” explains Professor Julie Leask, of the University of Sydney’s School of Nursing and Midwifery.

Leask has been researching vaccine communication for more than two decades, developing guidance for Australian health professionals on talking to parents about childhood immunisations, and she says many of the concepts can be applied to our conversations about COVID-19 vaccination.

The latest University of Melbourne Taking Pulse of the Nation report, published this month, shows that more than one-in-five people remain vaccine hesitant, with a relatively even split between Australians who are unwilling or simply unsure.

Leask says we mustn’t lump everyone who has yet to book a vaccine into the same boat, as there can be myriad reasons, and only a small minority of people are anti-vaccination.

The fact we all have skin in this game – vaccines are, after all, our way out of this mess – ramps up the energy in these conversations, Leask says, but being pushy or judgmental can backfire.

Ahead, we look at how best to navigate four common encounters.

The person who may or may not be vaccinated

One question causing angst is whether to ask if someone – be it a friend, relative or your dentist – is vaccinated. Short of carrying flashing “vaccinated” signs above our heads, the only way to find out if someone has had a COVID-19 jab is through conversation (or, if they’ve posted a “vaxxie” on social media). But do we have the right to ask such a private question?

Yes, we do, according to The Ethics Centre executive director Dr Simon Longstaff, particularly if you’re expecting to be in close proximity with that person.

“The notion that you can make an informed decision about who you deal with and under what conditions [seems] uncontroversial,” he says. “It comes down to asking in a way that isn’t offensive or challenging.”

Longstaff recommends starting by simply volunteering your own status – “Just so you know, I’ve been vaccinated” – because it signals you think it’s important, creating an expectation of reciprocation.

A friend is likely to disclose, Longstaff says, but a service provider may choose not to, at which point you’re entitled to choose not to engage with them if you’re worried about transmission to yourself or others.

Leask is less convinced that we have the right to ask people if they’re vaccinated. She says that while we need high vaccination rates, we also need to have healthy social functioning for our overall wellbeing.

“If the way we try to encourage and require vaccination ends up being so imposing … it creates a whole new set of conflicts and hardships,” Leask says.

“The notion that you can make an informed decision about who you deal with and under what conditions [seems] uncontroversial.”

Although she hopes that more people will choose to be upfront about their vaccine status to reassure others, her position on asking someone is that it depends on your level of rapport.

“You do need to broach it sensitively with friends and family,” Leask says. “It might be perfectly fine to ask your mum or sister if she’s going to vaccinate, but with the clear intention that you’re concerned about her health first.”

When it comes to asking a service provider, Leask believes it’s best not to, and let government worry about the regulatory structures that will protect us.

“And remember,” she says, “if we’re fully vaccinated and wearing a mask, and your hairdresser is wearing a mask, the risk of transmission is markedly reduced.”

The person who just hasn’t gotten around to it yet

If someone wants to be vaccinated but isn’t yet, Leask says that laziness is rarely a reason. Rather, it’s often because they are isolated and unaware of government advice, or they are struggling to find supply, get an appointment or use the booking system.

If someone tells you they haven’t been able to get vaccinated yet, Leask’s advice is to ask if you can help them book in.

“Practical knowledge is one of the biggest factors in driving vaccination,” Leask says. “People are so confused because the recommendations have chopped and changed so much … so simply helping them figure out what they’re eligible for, where they can get it, when and how, is a great practical thing you can do.”

“Practical knowledge is one of the biggest factors in driving vaccination.”

Longstaff adds that sometimes when people are under stress, their world view narrows, so they might not see the significance to the wider community of lagging with their vaccine booking.

“It doesn’t mean they’re a bad person, it may mean they’re really struggling to cope,” he says.

The key to these conversations is to practise the skill of listening.Credit:iStock

The person who is ‘waiting for Pfizer’

The advice from authorities regarding the AstraZeneca vaccine has been confounding, to say the least, with fluctuating recommendations following fears of a very rare clotting condition, known as thrombosis with thrombocytopenia syndrome (TTS). This has left some people so-called “Astra-hesitant” and waiting to be eligible for Pfizer once more doses land on our shores, while the Delta variant continues to wreak havoc.

Data from a June survey, conducted by the Australian Bureau of Statistics, shows that 15 per cent of unvaccinated Australians are waiting for a different vaccine.

Leask says we can’t skirt over the fact that a person is being asked to take a risk, albeit very small, with the AstraZeneca vaccine. “But in the setting where there are outbreaks, it’s perfectly reasonable to encourage and recommend it.”

She says the best approach is to first respect that there is a choice to be made – having AstraZeneca now, or waiting for Pfizer – then explain the risk calculation.

“There are pros and cons to each of those options, but right now the benefits of getting the vaccine far outweigh any risks,” she says. “The risk is small: it’s about one in 50,000 of getting TTS and less than one in 1 million of dying. One in 50,000 is like a single person in the MCG or SCG, and the rest of those people – 49,999 – will be fine and have a good level of protection against COVID-19, particularly severe disease.”

“In the setting where there are outbreaks, it’s perfectly reasonable to encourage and recommend it.”

Leask adds that people should be aware that we know how to spot early signs of clotting, which helps to reduce the severity of the illness.

People can, of course, choose to wait, Leask says, but they need to plan how they’ll reduce the COVID-19 risk to themselves and others in the meantime.

“They may be waiting for a while … it might be three weeks, or it might be months.”

The person who is vaccine hesitant

We must first recognise this: not everybody who questions vaccination is a conspiracy theorist or anti-vaxxer. They may have various genuine reasons, including a phobia of needles, a history of anaphylaxis, concerns for their health or a fear of the unknown.

Longstaff stresses the importance of taking the views of others “entirely seriously”.

“One of the biggest mistakes when encountering someone who has an alternative point of view is to begin by trying to change their mind,” he says.

The person then starts to defend their position without ever hearing what you might have to say. This can also solidify their beliefs because they’re reciting their arguments.

On the other hand, Longstaff says, sincerely hearing someone out – and letting them know you understand their concerns – will remove their need to defend themselves, and gives you knowledge to unpick under what conditions they would or wouldn’t get vaccinated.

Leask recommends starting the conversation by listening and asking questions. You might want to ask straight up, “Do you think you’ll get vaccinated?” The aim is to figure out what their attitude is rather than make assumptions.

“If you jump in with your answers too early, and you haven’t fully explored all the barriers and issues for someone … your comments won’t match where they’re at, and then the conversation will begin to fail.”

Helpful phrases when talking to someone who is vaccine hesitant

• “Do you have any plans to vaccinate at the moment?”
• “What are some of your concerns?”
• “I think it’s reasonable to be looking to get information about [insert concern].
• “I can see you’ve done a lot of thinking about this.” 
• “Can I tell you about my experience?”
• “I thought a lot about this decision too. Can I tell you why I decided to get the vaccine?”
• “I’m not sure about that. Let’s look it up together.”
• “I saw a website recently that seemed to answer this really well, can I share the link with you?”
• “Can I show you how to check your eligibility and make a booking, in case you change your mind?”
• “I’d really love you to get vaccinated. I want to see you protected against COVID-19 because all of us are going to encounter it in our lives. It’s not going away.”
• “Have you thought about what not vaccinating might mean for you and your family?”
• “If you’re not planning to vaccinate, how are you going to best protect yourself and others?”
• “Let’s leave it for now, but maybe we can talk about it again later?”

It’s important to validate someone’s concerns as reasonable and ensure they know you’ve heard them, Leask says. “It can be a harsh environment for the vaccine hesitant, so you need to create a safe space and build rapport.”

Next, try to gently direct them to quality information that relates to them. Ask, “Do you mind if I share what I learnt?” Or: “Can I help you find the information that might address your concerns?” The National Centre for Immunisation Research and Surveillance and the Department of Health are great places to look.

“One of the biggest mistakes when encountering someone who has an alternative point of view is to begin by trying to change their mind.”

Leask also recommends trying to detect what someone’s motivation might be to vaccinate, then reinforce it. You might need to elicit what it is by asking, “What do you think the benefits of vaccination might be?” Then, say, “I agree, I’m concerned about this as well.”

You can also tell them what you’ve done, and if you’re comfortable, recommend vaccination in a respectful way. “Once you have that rapport, the recommendation is more likely to be heard and accepted.”

If you’re dealing with a more staunch vaccine refuser, it’s still worth having the conversation, Longstaff says. When a person is important to you, you owe them that.

If they still aren’t willing to budge, park the conversation for the sake of the relationship, Longstaff says, but remain prudent: “Don’t just accept they’re not going to change.”

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