COMMENTARY

To Fix COVID Vaccine Hesitancy, Trust Primary Care

Kenneth W. Lin, MD, MPH

Disclosures

March 30, 2021

Editorial Collaboration

Medscape &

Kenneth W. Lin, MD, MPH

Hi, everyone. I'm Dr Kenny Lin. I am a family physician at Georgetown University Medical Center, and I blog at Common Sense Family Doctor.

In the past few months, the availability of COVID-19 vaccines in the United States has been on a remarkable upward trajectory. In January, it was difficult for even prioritized groups such as healthcare workers and adults over age 75 to access vaccines in many regions. Some experts suggested that maybe we'd be better off giving people only a single dose of the two-dose vaccines to stretch the limited supply. But as I write, several states have already made vaccine appointments available to any adult resident regardless of health status, and the remaining states are likely to follow soon.

To date, family physicians have been largely left out of the vaccine rollout in favor of state and county health departments, hospitals, chain pharmacies, and mass vaccinations at convention centers and stadiums. A national survey fielded in mid-February found that only 1 in 5 primary care clinicians were administering the vaccines in their offices, even though nearly 90% wanted to be able to do so. Although the CEOs of the Medical Group Management Association and the American Academy of Family Physicians (AAFP) have both urged the Biden administration and state governors to give physicians' offices a more prominent role in vaccine distribution, their calls have so far largely been ignored.

That's bad news, as we are reaching a critical turning point in the vaccination effort, where there will be a shift from more vaccine demand than supply, to plentiful supply but insufficient demand. Patients who spend hours online to schedule an appointment or seek out mass-vaccination events do not need to be persuaded of the need to get vaccinated to protect themselves and their communities. But the many vaccine-hesitant patients in our practices aren't going to get their shots without personal engagement from a trusted primary care clinician who can reassure them about vaccine effectiveness and safety.

A recent study of Medicare and private insurance data by the AAFP's Robert Graham Center showed that US primary care practices delivered more than half of adult and childhood vaccines from 2012 to 2017. In a commentary, the Graham Center called for the federal government to ship 1000 vaccine doses to every primary care practice, noting that if every clinician vaccinated just 20 patients per week, the result would be an additional 3 million fully vaccinated individuals every week.

Not only are family physicians old hands at resolving patients' uncertainty about established and newer vaccines, but we are also well positioned to mitigate mistrust about vaccines among patients of color and among younger Republicans who are skeptical about vaccine science and may underestimate their personal risk of becoming ill from the disease. Some of my patients who are young women have asked me about rumors that the vaccines cause infertility, and I have been able to assure them that this misinformation has absolutely no basis.

Establishing trust and overcoming obstacles to vaccination will become even more important after vaccine trials are completed in children later this year. Although few children experience severe complications from COVID-19, they will need to be vaccinated in large numbers for most communities to achieve herd immunity, analogous to the routine vaccinations we give to prevent now-rare childhood diseases such as chickenpox and measles.

Pharmaceutical companies, vaccine scientists, the federal government, and state health departments deserve enormous credit for rapidly developing and distributing several safe and effective coronavirus vaccines to the majority of persons at the highest risk for death and complications. Now it's time to hand the baton to primary care for the final leg of the race to end this pandemic.

This has been Dr Kenny Lin for Medscape Family Medicine. Thank you for reading.

Kenny Lin, MD, MPH, teaches family medicine, preventive medicine, and health policy at Georgetown University School of Medicine. He is deputy editor of the journal American Family Physician.

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