The speed with which the Covid-19 vaccines have been developed has led to fears and doubts about their safety among certain members of the public – but why do some pharmacy professionals feel the same way?

Healthcare professionals are a trusted source of information about vaccinations and immunology, but studies are showing that a surprising number of them are in fact ‘vaccine-hesitant’.

Vaccine hesitancy among healthcare professionals including pharmacists is nothing new. Dr Ryan Hamilton is a specialist pharmacist in microbiology and infectious disease who undertakes research in antimicrobial stewardship and patient and public engagement. As a ‘peer vaccinator’ of hospital staff, he has encountered a number of pharmacists and pharmacy technicians who refuse the annual flu vaccination.

“Research that I have undertaken amongst hospital pharmacy staff showed that around a third (16.7 per cent for pharmacists alone) did not intend to be vaccinated against influenza,” he says.

“The main reasons are fear of needles, belief in their own immunity or they do not think they need it – that is, they’ve never had flu, but also never had the vaccine so don’t [think they] need it,” he says. “Some people also perceive the influenza vaccine to be ineffective, quoting numbers they read in the mainstream media from years where the vaccine may not have been the best fit for the circulating strains.”

Hamilton sees it as his role to tackle these myths – particularly in younger people who trust their own immunity and don’t think they need the vaccine. “Needle phobia and misunderstanding efficacy seem to be fairly easy barriers to overcome by telling them the facts and figures of flu vaccine effectiveness, but there is little that can be done to change someone’s mind when they trust their own immunity, don’t believe they are at risk, or mistrust vaccines generally.”

Information and influences

When it comes to the Covid-19 vaccines, there are other drivers behind hesitancy. If knowledge is power, then it is the information sources people use to make their decisions about the vaccines – and whether or not to have them – that are at the root.

According to Hertfordshire County Council behaviour change unit’s report on Covid-19 Vaccination: Reducing Vaccine Hesitancy, studies show that internet users are more likely to believe that healthy individuals do not need to be vaccinated and even that it is harmful. This, says the report, may partly be explained by the internet’s ready ability to increase “exposure to anti-vaccine conspiracy beliefs”, as well as “perceptions of powerlessness and disillusionment and mistrust in authorities”.

Chartered psychologist Dr Hannah Family from Bristol Medical School says we shouldn’t be surprised that pharmacists’ views vary as much as the public. “Certainly there will be some pharmacists who have reservations around the Covid-19 vaccines – just as there are psychologists who would have reservations about talking therapy for themselves,” she says. “But it is not a common phenomenon and we need to be wary of talking it up and potentially talking it into existence.

“Hesitancy is understandable and could be down to having a bad reaction based on past experience of other vaccines, needle phobia, or whether they are ethically justified in getting early access to the vaccination. Another reason could be simple lack of time to get the vaccine or investigate their own questions around the speed of development of the vaccines, their efficacy, and so on.

“While these reservations are understandable, there are a number of recently published documents addressing the concerns that the public and health professionals have about the Covid-19 vaccines with links to and summaries of the efficacy and safety data, to allay those concerns.” (See Further information.)

Cautious colleagues

Martin Bennett, managing director and superintendent pharmacist of Wicker Pharmacy in Sheffield, says a few of his team were initially wary of taking up their vaccinations. “I had a chat with them individually and I think part of it was the pressure that almost everyone else had said yes, although when I tried to find out more they didn’t seem to have a real reason.

“I told them to go away and talk to their families about it because, by not having the jab, they are putting them at risk. When they came back they said they would have it after all, which was good news.”

Tony Schofield, superintendent pharmacist and owner of Flagg Pharmacy in South Shields, Tyne and Wear, says that while he has been impressed by the large numbers of his staff electing to receive the Covid-19 vaccine, he is still surprised when he meets pharmacy professionals who are reticent.

“I’ve always been very pro-vaccination,” he says, “but I have spoken to others in the profession who aren’t. They tell me in the main it is because they feel the vaccines have been rushed through or are not safe. I tell them the reason it was able to be rushed is because researchers put their other projects on hold and moved all their resources into developing these vaccines.

“I suspect the only way you will change many people’s minds is if they need to prove they’ve had a vaccination before they go to Benidorm...”

But it is not just pharmacy staff who are hesitant. One pharmacist, who wanted to remain anonymous, admits he won’t be rushing to get involved in offering Covid vaccinations because, “as professional pharmacists we don’t give unlicensed medicines unless they are for ‘immediate need’, which this vaccine is not”.

A debatable view, but another anonymous pharmacy business owner says: “I won’t be having it for many reasons. The main one is that I feel these vaccines have been rushed and adverse effects are not getting as widely reported in the mainstream media as they should be. Being vaccinated doesn’t stop Covid infection or transmission, although it stops severe symptoms, which is OK for the elderly and vulnerable but the rest of the world needs to get on with things.

“Lockdowns are causing untold mental health problems, not to mention all the cancer treatments that have been cancelled. Herd immunity is the solution. If we keep doing what we are doing, we are going to cause more problems than those from this respiratory disease.” Another contentious view in many ways but one that is often heard at the moment.

Reassuring the reluctant

Ade Williams from Bedminster Pharmacy in Bristol says he has noticed that colleagues who are reluctant to be vaccinated against Covid seem to be “expressing a lot of anxieties the public have. It seems like being exposed to vocal public misinformation is eroding confidence”. He suggests there are practical steps that pharmacists can take to make things easier for their own staff, such as assuring people they can take time off to attend vaccinations and having open discussions about false claims.

Dr Family says The Covid-19 Vaccine Communication Handbook & Wiki is a useful resource that pharmacists can use to allay both staff and patients’ fears around the Covid vaccine development process. For example, it explains how many tens of thousands of people signed up to participate in Covid-19 vaccine trials in 2020, compared to the 12-18 months it often takes to recruit far fewer participants for such trials, which means the vaccines have been tested with more participants than many earlier vaccines for other diseases.

Further myth-busting

Professor Mahendra Patel, RPS English Pharmacy Board member, is also working hard to dismantle some of the myths and misinformation about the Covid-19 vaccines.

“I would refute that a lot of pharmacy professionals won’t have the vaccine,” he says, “but it is understandable that some people will have questions that need to be answered.

“In particular I am keen to reach out to the BME workforce, living sometimes in crowded conditions or among extended families. Forty-four per cent of registered pharmacists come from a BME background with their own cultural beliefs and attitudes, but it is important that any decisions they make about the vaccine are evidence-based. For example, as with the guidance around EHC supply, while you should not be compromising your own beliefs, you should also not be putting them onto someone else either.”

When asked about its official stance with regards to how pharmacy professionals communicate with patients about the Covid-19 vaccines, the GPhC’s response is that it strongly encourages all phar- macy professionals to consider getting vaccinated against Covid-19, and to encourage their staff to get vaccinated as well. “We expect all pharmacy professionals on our register to provide accurate and evidence-based advice to patients and mem- bers of the public, and always to work within our guidance on religion, personal values and beliefs.”