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letter
. 2022 Sep 15;387(11):1050–1051. doi: 10.1056/NEJMc2210367

The Vaccine-Hesitant Moment

PMCID: PMC9511608  PMID: 36103424
letter N Engl J Med. 2022 Sep 15;387(11):1050.
Mark E Horowitz 1,✉

To the Editor: As a family physician providing Covid-19 vaccination to my patients and to others who have located me through city and national vaccine search portals, I read with interest the review article on vaccine hesitancy by Larson et al. (July 7 issue).1 Since early April 2021, I have had the privilege of engaging in open, nonjudgmental discussions with vaccine-hesitant persons. As of this writing, however, my unvaccinated patients are no longer “vaccine-hesitant” but are vaccine-avoidant or vaccine-refusing. They provide a number of justifications for their refusal and are highly resistant to accepting scientific evidence of the safety and efficacy of current vaccines. Their refusals fall into one or more of the following five categories: the newness of the vaccine, a belief that their immune systems are robust, a belief that previous SARS-CoV-2 infection confers resistance, a distrust of the government or of the health care system, or an adherence to misinformation from social media or internet influencers. Some put their faith in God, others in the flawed advice of others. New strategies will be needed to overcome these persons’ resistance to Covid-19 vaccination.

Footnotes

No potential conflict of interest relevant to this letter was reported.

Reference

N Engl J Med. 2022 Sep 15;387(11):1050–1051.
Heidi J Larson 1,✉

The author replies: Horowitz shares his experience of a hardening of vaccine hesitancy among his patients toward vaccine avoidance. My co-authors and I have learned of this trend from others, such as Danielle Ofri, whose article on emotional epidemiology1 we refer to in our review. In a recent article,2 Ofri echoes Horowitz’s concern: “The COVID vaccine engenders a unique obstinacy that seems to blot out conversation. We doctors and nurses are exhorted to listen to our hesitant patients and hear their concerns, but this is difficult to do when patients don’t even want to talk.” New research in France has shown that even among persons who were vaccinated, some felt resentment or anger that they had been coerced.3 Although our review article focuses on the vaccine-hesitant, we appreciate that we need new approaches to address the worrisome trend of outright refusal.

Footnotes

Since publication of her article, the author reports no further potential conflict of interest.

References

Articles from The New England Journal of Medicine are provided here courtesy of Massachusetts Medical Society

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