Army Spc. Angel Laureano holds a vial of the COVID-19 vaccine, Walter Reed National Military Medical Center, Bethesda, Md., Dec. 14, 2020. (DoD photo by Lisa Ferdinando) Image licensed under the Creative Commons Attribution 2.0 Generic license.

When it became clear in late 2020 that COVID-19 vaccines would soon become available, it felt like a rare bit of good news after an overwhelming year. Few questioned the decision to make health care workers closest to the point of care one of the first groups offered the vaccine.

A few weeks into the rollout, however, many health care workers across the US are less than eager to roll up their sleeves for this new shot. A recent KFF survey found that “roughly three in ten health care workers (29 percent) express hesitancy about getting the COVID-19 vaccine.”

To address these concerns, as part of our work with the AHRQ ECHO National Nursing Home COVID-19 Action Network, IHI worked with our partners to develop a guide for conversations with nursing home staff about vaccine hesitancy. The suggestions can be easily modified for discussions with any health care workers. The following excerpt is adapted from the guide:

With COVID-19 vaccines being distributed now, nursing home staff and others have many questions. Some staff members may not have the most up-to-date, accurate information. Rumors and misinformation may be influencing some peoples’ decisions. To protect ourselves and others, it is vital that as many eligible people as possible receive the vaccine. However, we understand that there are legitimate questions and concerns.

We developed COVID-19 Vaccine Education: A Guide for Conversations with Nursing Home Team Members and an accompanying slide presentation to guide leaders in conversations with staff members and residents. These materials are designed to help each individual think through whether they would like to receive the COVID-19 vaccine and to address any questions or concerns.

Script Outline (current as of January 14, 2021)

Here are some questions or concerns you are likely to hear:

• Are currently approved COVID-19 vaccines safe?
• How do COVID-19 vaccines work?
• I’d rather wait until other people (my coworkers) have gotten the vaccine and see how they do; then I’ll consider getting it with the second clinic. Is that ok?
• What are short and longer-term side effects?
• How soon after vaccination will protection start and how long will I be protected?
• Could I get COVID-19 from the vaccine?
• Could someone in my family (household) “catch” COVID-19 from me if I get vaccinated?
• I am pregnant and not sure of safety during pregnancy.
• I’m not pregnant but I might want to get pregnant and I worry about fertility.
• Can I still get the vaccine if I’m under 18 years old?
• I’m worried about missing work and not getting paid – I need the money.
• I’m not sure that I can trust the health care system.
• I get my information from Facebook or other social media. Is that ok?
• If I already tested positive for COVID-19 antibodies or had the illness, should I still get the vaccine?
• Are there medical or other contraindications to getting the vaccine?

These questions are addressed in the slide presentation as well as in CDC, AMDA, and other toolkits. Some answers may depend on the situation or your location. We may not have evidence yet and we need to be honest when we don’t have an answer. All guidance is subject to change due to the rapidly evolving COVID-19 situation. Check back frequently for any updates from your State Department of Public Health, CMS, and CDC. It is vital to share the most recent information from reputable sources.

Please identify any questions that were not addressed and contact Alice Bonner at abonner@ihi.org for further information. Thank you for your dedication and efforts to support nursing home residents, their care partners, and each other.

Editor’s note: For detailed guidance how to prepare for and have conversations about COVID-19 vaccines, download the free COVID-19 Vaccine Education conversation guide and the accompanying slide presentation.

You may also be interested in:

Video — COVID-19 Vaccinations: Perspectives from a Nursing Home CNA

University of Florida Center for Public Interest Communications — A practitioner's guide to the principles of COVID-19 vaccine communications

A Guide to Promoting Health Care Workforce Well-Being During and After the COVID-19 Pandemic