By Alison Laurio
The World Health Organization (WHO) in December 2018 released Ten threats to global health in 2019. One is “vaccine hesitancy — the reluctance or refusal to vaccinate despite the availability of vaccines — threatens to reverse progress made in tackling vaccine-preventable diseases.”
WHO noted great success with measles, stating vaccines are not only a cost-effective way to avoid disease, but they also prevent 2 million to 3 million deaths annually. The reasons some people hesitate or decline vaccines are complex and can include complacency, inconvenience to access, and lack of confidence. “Health workers, especially those in communities, remain the most trusted advisor and influencer of vaccination decisions,” WHO stated, “and they must be supported to provide trusted, credible information on vaccines.”
One year later, on Dec. 31, 2019, Chinese authorities alerted WHO to pneumonia cases in Wuhan City, Hubei province, China, stating an unknown cause. The mystery disease was COVID-19. The first U.S. case was reported in Washington state on Jan. 21, 2020. On Oct. 8, 2021, the Centers for Disease Control and Prevention’s (CDC) Covid Data Tracker Weekly Review reported the United States had “reached a grim milestone: surpassing 700,000 total deaths from the virus.”
The 2018 WHO report remains true today, and is the reason the CDC is awarding $3 billion in grants to state and local health departments and community-based organizations “to expand COVID-19 vaccine programs.” NASW is among the organizations receiving CDC grant money, because social workers are among the best professionals to help inform others about the benefits of vaccines.
NASW is partnering with the University of Texas-Austin Health Behavior Research and Training Institute on a one-year, $3.3 million CDC grant to engage the nation’s more than 700,000 social workers in boosting COVID-19 vaccine confidence, uptake and access, particularly among populations with low vaccination rates and higher vulnerability to severe forms of infection. Overall, the goal is saving lives.
A June 29, 2021, Associated Press story reported, “Nearly all COVID-19 deaths in the U.S. now are in people who weren’t vaccinated, a staggering demonstration of how effective the shots have been and an indication that deaths per day... could be practically zero if everyone eligible got the vaccine.”
In a July advisory, U.S. Public Health Service Surgeon General Adm. Vivek H. Murthy, MD, MBA, stated seven in 10 adults — about 146 million people — use social media platforms where they are seeing “false and inaccurate information about vaccines and vaccine safety,” and “67 percent of unvaccinated adults had heard at least one COVID-19 vaccine myth and either believed it to be true or were not sure of its veracity.”
His advisory also stated that “false news stories were 70 percent more likely to be shared than true stories, health misinformation is a serious threat to public health, and limiting the spread of health misinformation is a moral and civic imperative that will require a whole-of-society effort.”
NASW is one of more than 42 groups that signed on to an August 11 request from the Alliance for Aging Research to the CEOs of Twitter, YouTube, Google and Facebook requesting they “remove the accounts of prominent anti-vaxxers and their organizing pages” from their platforms and “immediately begin issuing corrective posts to counter the misinformation and disinformation” in platform feeds.
The grant goal is to train social workers how to reach out, educate, and inform a client or someone who is vaccine reluctant about the benefits of becoming vaccinated.
Vaccinations are a core public health function, said NASW Deputy Director of Programs Anna Mangum, MSW, MPH.
“One of the aims of this initiative is to equip social workers with the information and skills they can deploy to talk with clients about the vaccines. Although NASW believes the science that vaccines are safe and effective, and encourages all people, including social workers, to become fully vaccinated, we are through this effort promoting informed decision making, not suggesting that social workers coerce clients to become vaccinated,” she said.
“The methods in which we will be training social workers include motivational interviewing (MI) and screening, brief intervention and referral to treatment (SBIRT), which are evidence-based models for supporting clients in making decisions about their health, and which recognize client self-determination and agency. They have been widely used and effective in substance use prevention and treatment. MI in particular is already a model being used in COVID-19 vaccination uptake efforts.”
Social workers who take the training will learn how to talk with clients about the vaccines and becoming vaccinated, Mangum said. They also will learn to promote vaccine confidence in their work settings and their own communities.
Social workers are well-positioned and well-trained to help with this effort, she said.
Robert Arnold, director of the NASW Foundation, said NASW will provide education, training and resources about COVID and the vaccines to all social workers, not just NASW members, using expert sources with the social work lens.
“We hope that social workers who are hesitant will learn more, have their questions or reservations addressed, and will become vaccinated, but we’re not taking the position of mandates or coercion," Arnold said.
He views the training as “what every social worker needs to know” to do their jobs better, work with clients who are across the spectrum, and be credible and trusted messengers and professionals. Social workers, because of their education, training and world views, have a unique and key role in being trusted messengers to all populations — and, importantly, with people who have multiple reasons for hesitancy.
Arnold said NASW will engage sister social work organizations, chapters and more to help identify barriers and help reach special populations. In addition, funding has been received to offer free CEs to the first 3,000 people who take the virtual/web trainings and to 400 people in smaller in-person 6-hours of trainings.
Trust, Reach, Counseling Style
Social workers are the largest force in health care, in terms of numbers, and are influential with patients, said Mary Marden Velasquez, PhD, professor in Leadership for Community, Professional and Corporate Excellence and director of the Health Behavior Research and Training Institute at the Steve Hicks School of Social Work at the University of Texas at Austin.
“They’re trusted, and they work in a variety of settings. Their reach really is tremendous, and that gives social workers the opportunity to reach a large number of people,” she said.
The goal of the grant is to educate social workers so they can work with a client who is reluctant to vaccinate and provide factual information, answer questions, and address their concerns. “They can utilize motivational interviewing — a counseling style that is a respectful and supporting discussion with a client — to help them make an informed decision.”
Motivational interviewing is used in health care, schools and other varied settings, and it’s used by a large number of social workers to talk with people about behavior change, she said. They can learn about how to increase their client’s confidence about vaccines.
Trainings include webinars and outreach strategies, and the skills learned will be applicable to any conversation they have with their clients about behavior change, Velasquez said. Social workers have the opportunity to work with clients in all kinds of settings, and they work with widely varied and diverse populations — people of all backgrounds and all socio-economic situations.
“I’m very excited about this partnership between the University of Texas, the CDC and NASW,” she said. “For me, it’s such a strong partnership of smart, well-informed and caring people.”
In the Field
Timothy MacGeorge, MDiv, LCSW, QS-CSW, Bonita Springs, Fla., works for a community behavioral health center and supervises a substance use treatment program at a local jail where there are programs for both men and women. He discusses vaccinations with many of his clients.
Because scientists tell us the vaccine is the way out of this pandemic and so many lives already have been lost, he believes everyone who can be vaccinated should be.
“As a member of society, it’s important, and for those of us who work in health care, it’s even more important because we provide services to people who are vulnerable,” said MacGeorge, an NASW-Florida member.
A substantial number of Americans, including health care professionals, are refusing the vaccine, which many others find frustrating or confusing — especially since everyone receives multiple vaccines that are required to go to school.
“Our profession respects the right of individual self-determination, but we do not live in isolation,” he said.
MacGeorge believes if a person is engaged on a personal level with someone they trust or the information on vaccines comes from a trusted authority, they might decide to take the vaccination. “I think some of us have shied away from having these challenging conversations with one another — the vaccinated with the unvaccinated — because of the great divisions we so regularly hear about in our country today.”
“First, I think we need to have good, solid information ourselves,” he said. “We must engage in these conversations with respect and a listening ear. Sometimes our role is to help others think through their reasons for thinking or acting in a certain way. Those clinical skills we use in motivational interviewing and other similar interventions can be very helpful in these conversations.”
MacGeorge has had those conversations in his work doing clinical assessments at the Naples County Jail for those voluntarily participating in a substance use treatment program. Most are recently arrested and most are not vaccinated. As part of his assessment role, that includes a brief medical history where he asks them about being vaccinated. Most have not, for “vaccination is not a top priority when you’re looking for your next fix,” MacGeorge said.
He asks if they have any questions about the vaccines and answers those he can, being “careful to remain within my scope of practice.” MacGeorge encourages them to do their own research, cautioning them to look to reputable and trusted sources — especially the CDC and FDA — and to be cautious about some of the misinformation or disinformation that’s out there. And he says to speak with a medical professional “if they have more specific questions about their own health.”
MacGeorge believes messages need to be tailored to the population to which they are directed, and encouraging others to become vaccinated is part of the social work obligation. In his work, he sometimes provides information about vaccines in general, how this virus spreads and is different from other viruses, and why “everyone should be vaccinated, both to protect ourselves and to protect others.”
Graphic: Coronavirus deaths in the U.S., per day - NBC News