The magnitude of the COVID-19 pandemic is mind boggling, and the toll that it’s taking on people’s lives, health, and livelihoods is monumentally tragic. And experts estimate that unless we get a very large percentage of our population immunized, this tragedy will continue to unfold.

There are many logistical challenges in vaccinating this many people — the most ambitious effort of its kind in history. But there’s also a psychological challenge, in that around 25 percent of Americans are undecided whether they want to get the vaccine.

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Are some of the people in your life among the vaccine nay-sayers? That may make you very frustrated. How should you handle those conversations?

Let’s take a look at which strategies work and which ones don’t.

1. The direct approach

Your first impulse may be to lead with logic.

"You’ve got to get vaccinated because COVID-19 could make you very sick or even kill you.”

“You’ve got to get vaccinated because it’s the only way to stop this pandemic and get life back to normal.”

“The vaccine is safe; the clinical trials prove it.”

All of these statements are true. But will hearing them change your loved ones’ minds about getting the vaccine?

Probably not. More likely, this kind of approach might trigger a defensive response and actually make people more determined not to get vaccinated.

Why? Because you’re not meeting them where they are. If you’re not trying to understand and validate why they feel the way they do, then you could come across as pushy and insensitive.

2. Lead with empathy

Before you can change your friends’ minds about getting vaccinated, you have to take the time to know their minds.

There are a lot of reasons why people may not want to get vaccinated. For instance, many people of color are inclined to distrust the vaccine.

And unfortunately, this lack of trust is based partially on real experiences of historical and current abuse and bias in medical care, including the racist exploitation of people of color in medical research — from the Tuskegee experiment to Henrietta Lacks.

There is a very real and troubling history of these communities being lied to by the U.S. medical establishment as well as continuing concerns about the underrepresentation of Black participants in safety trials. If you fail to understand and acknowledge why people of color may not trust the vaccine, you can’t have a meaningful conversation about the importance of vaccination.

Other people have become convinced that the news they hear about the pandemic is “fake.” They believe COVID-19 is a hoax, or that it’s not as dangerous as its alleged to be, or that the vaccine is unsafe.

Some are even worried that the vaccine will actually make them sick with COVID-19. And the fact that many people briefly experience flu-like symptoms after receiving the vaccine may reinforce this anxiety. (In reality, these symptoms just prove that the vaccine is creating an immune response against infection, which is what it’s designed to do.)

And some people feel they don’t need the vaccine because they’ve already recovered from COVID-19. They believe that this makes them immune, so vaccination is not necessary.

You have to sincerely acknowledge the validity of these feelings and beliefs so your friend will feel heard and understood, and find common ground around shared values. Once you’ve achieved that, it may actually be possible to have a meaningful conversation.

Believe me, as a health professional I’ve learned this lesson the hard way. I’ve seen again and again that unless I gain my patients’ trust, I can’t expect them to listen to my medical advice.

3. Come from a place of caring

Make sure your friend knows you’re genuinely concerned for their welfare. That you’re worried about what this disease could do to them, or to the people they care about — like their parents, grandparents, aunts and uncles, etc.

Make sure your friend knows you sympathize with the way this pandemic has affected their life — whether through loss of income or inability to do the things they love to do.

Show them you understand how they feel…and that you, too, would like to see things get back to normal as soon as possible. And that you believe the fastest way to regain more normalcy is by stopping the spread of the coronavirus — through masking, social distancing, hand washing…and mass vaccination.

4. (Gently) counter misinformation with facts

There are a lot of ways to refute misinformation about the COVID-9 vaccine. For instance,

1. While it’s true that Black people were underrepresented in the clinical trials, the vaccines showed very similar safety and efficacy for Black participants and white participants. And communities of color are really being devastated by this pandemic. Precisely because of persistent racial inequities in access to quality health care, it’s essential that minority populations do everything they can to protect themselves — including getting vaccinated — as Dr. Ala Stanford (of Philadelphia’s Black Doctors COVID-19 Consortium) argues so eloquently.
2. If your friend thinks this pandemic is “fake,” ask them if they know anyone who has gotten seriously ill from COVID-19. (Chances are they do.) Talk to them about the people you know who have experienced this illness, and what their experience was like. If you personally know any front-line health care workers, share what they are experiencing day after day in trying to care for patients critically ill with COVID-19.
3. If your friend mistrusts the vaccine because “it was developed so quickly,” you can let them know that the speed of delivery was primarily due to years of previous research on similar viruses; regulators prioritizing COVID-19 vaccine research so that it moved through their processes faster; and unprecedented funding that allowed researchers to run multiple, parallel studies and enabled manufacture of vaccine candidates prior to their approval.
4. If your friend is afraid of getting COVID-19 from the vaccine, help them understand how the vaccine works. It contains no actual coronavirus. Instead, it contains mRNA that teaches your body’s cells to recognize and defend themselves against the virus’s spike proteins. You can also explain that it was tested on tens of thousands of people around the world in placebo-controlled clinical trials; that negative reactions were extremely rare; and that the vaccines were found to very effective in preventing illness from COVID-19.
5. If your friend doesn’t think vaccination is necessary because they’ve already had and recovered from COVID-19, it may help to point out that there have been documented cases of people becoming reinfected — and may start happening more frequently now that there are newer strains of the virus circulating in the U.S. It appears that immunity lasts for several months after someone is exposed to COVID-19, but the CDC still recommends vaccination for these individuals.

The key is to come from a place of empathy and patience. You’ve made the effort to understand how your friend feels about getting vaccinated; this has created an opening for sharing why you feel vaccination is so important. However, if you’re coming across like you think they’re being “ridiculous” or “selfish” for not wanting to get vaccinated, you’ll almost certainly get nowhere.

5. Create a sense of possibility

What’s the potential result if your friend gets vaccinated? Make it real for them. What would make vaccination worthwhile? If it could save even just one life, would that be worth it?

Also, conjure a picture of what life will be like by the end of 2021 if we can achieve herd immunity through vaccination. Hopefully mask wearing and distancing won’t be necessary anymore. We’ll all be able to go back to doing all the things we miss so much — like visiting stores and restaurants, taking vacations, and celebrating holidays with our families.

There really is a brighter future ahead if we can get this pandemic under control. You believe it and I believe it. Our job is to help our friends and loved ones believe in that future, too, so they will take the actions necessary to make it a reality.

This article was originally published on IBX Insights.

About Stephen Higgins, MD, FAAP

Dr. Higgins graduated from Hahnemann Medical School (now Drexel University College of Medicine) in 1989 and went on to train as a Pediatrician and Neonatologist at DuPont Hospital for Children/Thomas Jefferson University Hospital. He spent most of his career as a Neonatologist at Crozer Chester Medical Center where he worked clinically in neonatal intensive care. He was actively involved in medical education rising to the level of Associate Dean at Crozer for Temple Medical School and more recently as the Associate Dean for Drexel’s Clinical Campus at Crozer. In addition to his role as Associate Dean, was the Chief Academic Officer and Pediatric Residency Director at Crozer before joining the Independence Blue Cross family in April of 2019.