Vaccine Hesitancy and the Frontline: A Review of How Nurses, Pharmacists, and Emergency Medical Services Personnel Can Collaborate as Trusted Messengers for Health Security and Community Immunity
Abstract
Background: Vaccine hesitancy—the delay in acceptance or refusal of safe vaccines despite their availability—has been identified as one of the greatest threats to global health, a challenge that intensified during the COVID-19 pandemic as misinformation proliferated and immunization rates declined worldwide.
Aim: This narrative review examines the critical role of nurses, pharmacists, and Emergency Medical Services (EMS) personnel as trusted healthcare professionals in addressing vaccine hesitancy, synthesizing evidence on effective communication strategies, the impact of interprofessional collaboration on vaccination uptake, and the barriers these frontline providers face.
Methods: A comprehensive literature search was conducted across academic databases and government publications for peer-reviewed articles, systematic reviews, and policy analyses published between 2010 and 2024.
Results: The review highlights barriers to vaccine uptake, such as misinformation, inadequate communication tools, time constraints, and systemic obstacles, while identifying facilitators like trusting patient relationships and access to educational resources. It discusses effective communication strategies, including motivational interviewing and empathetic-refutational interviewing, that positively influence vaccine attitudes and uptake. Additionally, interprofessional education initiatives, particularly involving EMS personnel, are noted for their potential in fostering collaborative vaccine advocacy, as they work closely with vulnerable populations in both routine and emergency contexts.
Conclusion: Nurses, pharmacists, and EMS personnel play crucial roles in combating vaccine hesitancy. Their effectiveness can be increased by addressing systemic barriers, offering training in evidence-based communication, promoting interprofessional collaboration, and aligning efforts with health security priorities.
Full text article
References
Angell, S. Y., & Newsom, G. A. V. I. N. (2020). California Department of Public Health. Sacramento, USA: California Department of Public Health.
Atkins, L., Francis, J., Islam, R., O’Connor, D., Patey, A., Ivers, N., ... & Michie, S. (2017). A guide to using the Theoretical Domains Framework of behaviour change to investigate implementation problems. Implementation science, 12(1), 77. https://doi.org/10.1186/s13012-017-0605-9
Beckwith, V. Z., & Beckwith, J. (2020). Motivational interviewing: a communication tool to promote positive behavior change and optimal health outcomes. NASN School Nurse, 35(6), 344-351. https://doi.org/10.1177/1942602X20915715
Betsch, C., Schmid, P., Heinemeier, D., Korn, L., Holtmann, C., & Böhm, R. (2018). Beyond confidence: Development of a measure assessing the 5C psychological antecedents of vaccination. PloS one, 13(12), e0208601. https://doi.org/10.1371/journal.pone.0208601
Brunson, E. K. (2013). The impact of social networks on parents’ vaccination decisions. Pediatrics, 131(5), e1397-e1404. https://doi.org/10.1542/peds.2012-2452
Cane, J., O’Connor, D., & Michie, S. (2012). Validation of the theoretical domains framework for use in behaviour change and implementation research. Implementation science, 7(1), 37. https://doi.org/10.1186/1748-5908-7-37
Cassidy, C., Langley, J., Steenbeek, A., Taylor, B., Kennie-Kaulbach, N., Grantmyre, H., ... & Isenor, J. (2021a). A behavioral analysis of nurses’ and pharmacists’ role in addressing vaccine hesitancy: scoping review. Human Vaccines & Immunotherapeutics, 17(11), 4487-4504. https://doi.org/10.1080/21645515.2021.1954444
Cassidy, C., Stratton, L., Taylor, B., Steenbeek, A., Langley, J., & Isenor, J. (2021b). Characterizing nurses’ and pharmacists’ role in addressing vaccine hesitancy and/or refusal: A scoping review protocol. http://hdl.handle.net/10222/80630
Chan, J., Griffith, L. E., Costa, A. P., Leyenaar, M. S., & Agarwal, G. (2019). Community paramedicine: a systematic review of program descriptions and training. Canadian Journal of Emergency Medicine, 21(6), 749-761. doi:10.1017/cem.2019.14
Coombs, W. T. (2007). Ongoing crisis communication: Planning, managing, and responding. Sage.
Davis Jr, T. P., Yimam, A. K., Kalam, M. A., Tolossa, A. D., Kanwagi, R., Bauler, S., ... & Larson, H. (2022). Behavioural determinants of COVID-19-vaccine acceptance in rural areas of six lower-and middle-income countries. Vaccines, 10(2), 214. https://doi.org/10.3390/vaccines10020214
Dror, A. A., Eisenbach, N., Taiber, S., Morozov, N. G., Mizrachi, M., Zigron, A., ... & Sela, E. (2020). Vaccine hesitancy: the next challenge in the fight against COVID-19. European journal of epidemiology, 35(8), 775-779. https://doi.org/10.1007/s10654-020-00671-y
Dubé, E., Laberge, C., Guay, M., Bramadat, P., Roy, R., & Bettinger, J. A. (2013). Vaccine hesitancy: an overview. Human vaccines & immunotherapeutics, 9(8), 1763-1773. https://doi.org/10.4161/hv.24657
Fasce, A., Karlsson, L., Verger, P., Mäki, O., Taubert, F., Garrison, A., ... & Soveri, A. (2023). Endorsement of alternative medicine and vaccine hesitancy among physicians: a cross-sectional study in four European countries. Human Vaccines & Immunotherapeutics, 19(2), 2242748. https://doi.org/10.1080/21645515.2023.2242748
Freimuth, V. S., Musa, D., Hilyard, K., Quinn, S. C., & Kim, K. (2014). Trust during the early stages of the 2009 H1N1 pandemic. Journal of Health Communication, 19(3), 321-339. https://doi.org/10.1080/10810730.2013.811323
Fusco, N. M., Foltz-Ramos, K., Kruger, J. S., Vargovich, A., & Prescott Jr, W. A. (2023). Interprofessional simulation to prepare students to address medical misinformation and vaccine hesitancy. Journal of Interprofessional Education & Practice, 32, 100644. https://doi.org/10.1016/j.xjep.2023.100644
Gagneur, A., Lemaître, T., Gosselin, V., Farrands, A., Carrier, N., Petit, G., ... & De Wals, P. (2018). A postpartum vaccination promotion intervention using motivational interviewing techniques improves short-term vaccine coverage: PromoVac study. BMC Public Health, 18(1), 811. https://doi.org/10.1186/s12889-018-5724-y
Gallant, A. J., Harding, A., Johnson, C., Steenbeek, A., & Curran, J. A. (2023). Identifying H1N1 and COVID-19 vaccine hesitancy or refusal among health care providers: a scoping review. JBI Evidence Synthesis, 21(5), 913-951. DOI: 10.11124/JBIES-22-00112
Garett, R., & Young, S. D. (2021). Online misinformation and vaccine hesitancy. Translational behavioral medicine, 11(12), 2194-2199. https://doi.org/10.1093/tbm/ibab128
Gautier, S., Hammarlin, M. M., Paulik, E., Montagni, I., Mueller, J. E., Vaux, S., ... & Delarocque-Astagneau, E. (2024). New pedagogical tools for vaccine education: preparing future healthcare workers for the next pandemic. BMC medical education, 24(1), 1314. https://doi.org/10.1186/s12909-024-06274-5
Glenn, M., Zoph, O., Weidenaar, K., Barraza, L., Greco, W., Jenkins, K., ... & Fisher, J. (2018). State regulation of community paramedicine programs: a national analysis. Prehospital emergency care, 22(2), 244-251. https://doi.org/10.1080/10903127.2017.1371260
Hornsey, M. J., & Fielding, K. S. (2017). Attitude roots and Jiu Jitsu persuasion: Understanding and overcoming the motivated rejection of science. American psychologist, 72(5), 459. https://doi.org/10.1037/a0040437
Hornsey, M. J., Harris, E. A., & Fielding, K. S. (2018). The psychological roots of anti-vaccination attitudes: A 24-nation investigation. Health psychology, 37(4), 307.
Jamison, K. C., Ahmed, A. H., Spoerner, D. A., & Kinney, D. (2022). Best shot: A motivational interviewing approach to address vaccine hesitancy in pediatric outpatient settings. Journal of Pediatric Nursing, 67, 124-131. https://doi.org/10.1016/j.pedn.2022.08.012
Kada, A., Chouikh, A., Mellouli, S., Prashad, A. J., Straus, S. E., & Fahim, C. (2022). An exploration of Canadian government officials’ COVID-19 messages and the public’s reaction using social media data. PLoS One, 17(9), e0273153. https://doi.org/10.1371/journal.pone.0273153
Kholina, K., Harmon, S. H., & Graham, J. E. (2022). An equitable vaccine delivery system: Lessons from the COVID-19 vaccine rollout in Canada. PLoS One, 17(12), e0279929. https://doi.org/10.1371/journal.pone.0279929
Larson, H. J., Jarrett, C., Eckersberger, E., Smith, D. M., & Paterson, P. (2014). Understanding vaccine hesitancy around vaccines and vaccination from a global perspective: a systematic review of published literature, 2007–2012. Vaccine, 32(19), 2150-2159. https://doi.org/10.1016/j.vaccine.2014.01.081
Larson, H. J., Jarrett, C., Schulz, W. S., Chaudhuri, M., Zhou, Y., Dube, E., ... & Wilson, R. (2015). Measuring vaccine hesitancy: the development of a survey tool. Vaccine, 33(34), 4165-4175. https://doi.org/10.1016/j.vaccine.2015.04.037
Leask, J., Kinnersley, P., Jackson, C., Cheater, F., Bedford, H., & Rowles, G. (2012). Communicating with parents about vaccination: a framework for health professionals. BMC pediatrics, 12(1), 154. https://doi.org/10.1186/1471-2431-12-154
Lemaitre, T., Carrier, N., Farrands, A., Gosselin, V., Petit, G., & Gagneur, A. (2019). Impact of a vaccination promotion intervention using motivational interview techniques on long-term vaccine coverage: the PromoVac strategy. Human vaccines & immunotherapeutics, 15(3), 732-739. https://doi.org/10.1080/21645515.2018.1549451
Lewandowsky, S., Ecker, U. K., & Cook, J. (2017). Beyond misinformation: Understanding and coping with the “post-truth” era. Journal of applied research in memory and cognition, 6(4), 353-369. https://doi.org/10.1016/j.jarmac.2017.07.008
Lin, Y., Hu, Z., Alias, H., & Wong, L. P. (2022). The role of nurses as human papillomavirus vaccination advocates in China: perception from nursing students. Human vaccines & immunotherapeutics, 18(1), 2030169. https://doi.org/10.1080/21645515.2022.2030169
MacDonald, N. E. (2015). Vaccine hesitancy: Definition, scope and determinants. Vaccine, 33(34), 4161-4164. https://doi.org/10.1016/j.vaccine.2015.04.036
Martin, A. (2022). Perspectives on Community Paramedicine Through Multiple Stakeholder Lenses: An Exploratory Study (Doctoral dissertation, La Trobe). https://doi.org/10.26181/20346786
Michie, S., Van Stralen, M. M., & West, R. (2011). The behaviour change wheel: a new method for characterising and designing behaviour change interventions. Implementation science, 6(1), 42. https://doi.org/10.1186/1748-5908-6-42
Omer, S. B., Salmon, D. A., Orenstein, W. A., Dehart, M. P., & Halsey, N. (2009). Vaccine refusal, mandatory immunization, and the risks of vaccine-preventable diseases. New England Journal of Medicine, 360(19), 1981-1988. DOI: 10.1056/NEJMsa0806477
Orenstein, W. A., & Ahmed, R. (2017). Simply put: Vaccination saves lives. Proceedings of the National Academy of Sciences, 114(16), 4031-4033. https://doi.org/10.1073/pnas.1704507114
Oudin Doglioni, D., Gagneux-Brunon, A., Gauchet, A., Bruel, S., Olivier, C., Pellissier, G., ... & Mueller, J. E. (2023). Psychometric validation of a 7C-model of antecedents of vaccine acceptance among healthcare workers, parents and adolescents in France. Scientific Reports, 13(1), 19895. https://doi.org/10.1038/s41598-023-46864-9
Quinn, S. C., Jamison, A. M., An, J., Hancock, G. R., & Freimuth, V. S. (2019). Measuring vaccine hesitancy, confidence, trust and flu vaccine uptake: Results of a national survey of White and African American adults. Vaccine, 37(9), 1168-1173. https://doi.org/10.1016/j.vaccine.2019.01.033
Salmon, D. A., Dudley, M. Z., Glanz, J. M., & Omer, S. B. (2015). Vaccine hesitancy: causes, consequences, and a call to action. Vaccine, 33, D66-D71. https://doi.org/10.1016/j.vaccine.2015.09.035
Scheres, J., & Kuszewski, K. (2019). The Ten Threats to Global Health in 2018 and 2019. A welcome and informative communication of WHO to everybody. Zdrowie Publiczne i Zarządzanie, 17(1), 2-8.
Shariff, S. Z., Richard, L., Hwang, S. W., Kwong, J. C., Forchuk, C., Dosani, N., & Booth, R. (2022). COVID-19 vaccine coverage and factors associated with vaccine uptake among 23 247 adults with a recent history of homelessness in Ontario, Canada: a population-based cohort study. The Lancet Public Health, 7(4), e366-e377. https://doi.org/10.1016/S2468-2667(22)00037-8
Vernon-Wilson, E., Tetui, M., Nanyonjo, A., Adil, M., Bala, A., Nelson, D., ... & Grindrod, K. (2023). Unintended consequences of communicating rapid COVID-19 vaccine policy changes–a qualitative study of health policy communication in Ontario, Canada. BMC Public Health, 23(1), 932. https://doi.org/10.1186/s12889-023-15861-y
World Health Organization. (2022). Guiding principles for recovering, building resiliency, and strengthening of immunization in 2022 and beyond. World Health Organization.
Authors
Copyright (c) 2024 Faris Minshut Saeed Alshahrani, Yazeed Mohammed Salem Alatawi, Kheder Moussa Yahia Gabarri, Ali Mohammed Ali Qaysi, Tariq Ahmed Hamoud Al Khairat, Abdullah Solan Mhnashi, Eissa Mohd Essaily, Taher Mohammed Yahya Muhr, Ali Hadi Mohammed Kariri, Haitham Ali Mohammed Akkur

This work is licensed under a Creative Commons Attribution 4.0 International License.
