‘One size fits all’ won’t work on the unvaccinated, Quebec behavioral experts say

Quebec’s deputy health minister has been tasked with creating a program to reach the unvaccinated.

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A new program is being created to reach Quebecers not yet vaccinated against COVID-19, Prime Minister François Legault announced Thursday.


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Despite attempts to motivate the population through vaccine lotteries, passports and a planned “anti-vax tax,” about 565,000 eligible Quebecers have yet to receive a first dose, Legault said. Among them are more than 10,000 health and social services employees, including more than 4,000 in Montreal, according to provincial data last week.

Deputy Health Minister Lionel Carmant has been tasked with finding ways to convince these people to get vaccinated “by explaining that the vaccine is safe, by explaining that when we are vaccinated, we are much less likely to end up in intensive care than if we are not vaccinated, ”said Legault. “It’s important for everyone’s safety, but it’s also important for hospital staff.”


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For behavioral experts in Quebec, understanding where hesitation and opposition come from is crucial to getting more people vaccinated.

“There are several reasons why people do not get vaccinated,” explains Roxane de la Sablonnière, professor of psychology at the University of Montreal. “Some are completely anti-vax and others have other concerns. … To this day, I don’t think we have a very good understanding of the group, which is more heterogeneous than homogeneous. We really need to understand .

The National Institute of Public Health of Quebec (INSPQ) has conducted surveys of vaccination intention, including reasons for resistance, which have shown over time that approximately 5% of the population has not intend to get vaccinated, said Ève Dubé, an anthropologist. and researcher at the institute.


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For that five percent — which is an underestimate because it doesn’t include certain demographics with lower vaccination rates like people who are homeless or people who don’t speak English or French — “the main reason for not wanting to get vaccinated is vaccine safety, or the perception that vaccines are not helpful,” Dubé said.

“I think we are at a stage where the most common educational or promotional interventions have reached their maximum capacity. I don’t think it’s another media campaign that will change the minds of people who are determined not to get vaccinated.

Dr. Kim Lavoie, Canada Research Chair in Behavioral Medicine and professor of psychology at the University of Quebec in Montreal, said that while the province’s approach so far – a mix of advocacy and restrictions – may have motivated some, it will not motivate everyone. Punitive measures might work on those who felt they did not need vaccine protection, but a different approach is needed for those who are fearful or skeptical.


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“You can’t process fear and mistrust without first validating them,” she said. “Emotions themselves are valid. Their worries aren’t necessarily grounded, but the feelings are there and they act on the feelings.

Ignoring these feelings will cause people to put up walls, she said.

“The government really needs to… move away from a one-size-fits-all approach, because even if one group of people are anxious, that doesn’t mean they’re all anxious for the same thing,” Lavoie said.

Dubé said an effective approach among groups concerned about vaccine safety is one-on-one interventions with professionals trained in communication skills “to talk to people with empathy, ask open-ended questions, not impose facts on people , to understand what makes them hesitant to get vaccinated and try to promote vaccination in a non-confrontational way.


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With health care resources already stretched, Dubé said it would be difficult to take this approach at this stage, but other strategies can be effective.

“For example, by working with a community organization that serves people who are marginalized or have barriers to accessing immunization services – you can earn about one percent of the immunization there,” she said. “You can work with religious leaders, community leaders, for communities that may be more distrustful of government. You need different strategies that are really suited to why certain groups or individuals are hesitating at that time.

The CIUSSS du Nord-de-l’Île-de-Montréal – which serves parts of the city that appear to be behind on vaccination in certain age groups – said it is taking this approach to reach the unvaccinated. on its territory.


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“We are monitoring our territory and deploying vaccination clinics in targeted locations,” spokeswoman Emilie Jacob said. “On weekends, for example, we set up pop-up clinics in cultural centers and places of worship in Saint-Laurent, Cartierville and Montreal North. The mobile clinics in March will also allow us to reach more isolated groups in our territory.

In addition to examining why people choose not to get vaccinated, Lavoie said it’s important to examine why most do. A Montreal Behavioral Medicine Center study found people getting vaccinated” are extremely motivated by altruistic things,” like wanting to protect others, she said. This doesn’t resonate as much with the fearful and not at all with those who are completely anti-vaccine.


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“So what that tells us is that if you have messages targeting anti-vaxxers in particular to say ‘care about the community, do it for grandma’ – forget it,” she said. declared. “It’s a complete waste of time.”

Measures like a health care tax punish the unvaccinated, “but is that the point?” said Lavoie.

“If that’s the goal, tax them. Get ’em away from it all, kick ’em out the door or whatever you want to do. Should this, from a behavioral point of view, make them more likely to get vaccinated? If that’s the goal, then my answer is no, because you’re not solving the problem.

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Maria D. Ervin