How to talk about vaccines with loved ones

What can you do if you have a loved one who doesn’t want to get the vaccine? Farzana Hussain is a GP in London. In February, she made it her mission to personally call up as many eligible patients as she could who hadn’t yet signed up to get their covid vaccines, to talk them through it. Chris Smith spoke with Farzana about how she reached out to her patients...

Farzana - Yes, it was Chris. When the vaccine program rolled out, I found that within about two, three weeks, I could see that around the country, there was great uptake, but amongst my patients, only 50% of my over 65s, which was the open cohort at that time, were attending. And it was fascinating for me because I run quite a small practice. I've been there 18 years. I know my patients quite well, and I could see that the 50% that weren't attending Chris, were mainly from various BAME communities. And the 50% that did attend were all Caucasian. And I really found this fascinating, because Newham had the highest COVID death rates in the country in the first wave. So I took it upon myself to ring my patients, having been very fortunate, having that relationship with many of my elderly patients as well, to try and find out what it was, what was causing the lack of wanting to go.

Chris - And what did they say?

Farzana - In Newham we’re very diverse, ethnically, very rich little world, 74% BAME. If I was to put it into three categories, and which I know is huge generalization, my South Asian patients, particularly my Pakistanis and Bangladeshis, who have been shown to have lower uptake than the Indians, were mainly concerned, as Mohammad said, about animal products, is it safe? Is it halal Islamically? Is it okay, I'm a practicing Hindu. I don't want any animal products in my body. My black Africans and Caribbeans, it was exactly as Paula was talking about, it was a general mistrust of the state. You know, lots of examples of, well, if you're black, then you're more likely to be diagnosed with schizophrenia. Why should we have any faith in this vaccine now, when black people are generally more victimised? So it's a fascinating piece of work for me.

Chris - It does sound like it comes down to what we were hearing just previously with Mohammed, about education and information. There's also a study out. It's in yesterday's Telegraph, this was reported. A study out from Kings college and university of Bristol, 5,000 people quizzed. They showed that actually the number of people who were vaccine hesitant has dramatically changed in a year. Among white communities, 56% are saying they're supportive of vaccines and that's gone up this year to 87%, but as exactly as you're pointing to, 67% of Muslims questioned now express vaccine confidence. But that's up from 23% last year. So a big turnaround. That kind of says, these are not people with rigid ideas that they're just not going to do something. It appears to be a lack of information, or knowledge about a product that's making people sceptical. And it argues your approach of actually talking to people, and then putting them on the right path is the right one.

Farzana - Absolutely, Chris. We've seen a five fold increase in the Bangladeshi community, nationally, taking up their vaccines. A three-fold increase in the Pakistani community. The key to this for me as a GP, I'm a family doctor. I've been a GP for 20 years, and I very much consider myself a family doctor, part of the community. I live in Newham. I work in Newham, I'm a mum to two teenagers in Newham. And I really want to listen to my patients. We talk a lot about education. Education works both ways. It's not just about us telling our patients what to do. We've seen lots of messaging, public health messaging nationally, but the key for me has been to listen to what the concerns are, because every single family and every single individual will have a unique concern. And that's what we need to address with facts, medical facts in an appropriate language, asking people to give us their feedback on what they've heard.

Chris - Well, speaking of listening, let's have a listen to the family that we spoke of at the beginning of the program, they've tried to talk to their son about the vaccine. This is what they said.

Concerned Listener - We just sent him the details and said, look, you're wrong. And here are the reasons why, and that's it. I know we've addressed everything, all the facts, all the supposed facts that he sent us, we've addressed them. And we've tried to explain to them why they're wrong.

Chris - What would be your approach under those circumstances, Farzana?

Farzana - I'd really be going with, what is it? Because I've found that the common theme for whatever the reason people are giving is fear. Whether it's fear of lack of fertility, fear of the state, fear of putting something in that doesn't comply with my religion. That's the key in, that I would take through listening. What's his fear?

Chris - What about friends and family Farzana? Because you know, who we turn to when we want advice, isn't necessarily picking up the phone and talking to your GP. The first people we will almost certainly speak to, as in the family we've been hearing these clips from, are other family members. So is part and parcel of solving this problem about reaching, not just one individual, but reaching the whole network.

Farzana - Yes, definitely, Chris. I think you've hit the nail on the head, and certainly where I am, we see a lot of intergenerational families as well. And I always go back to the old thing: if your mum tells you to put your coat on, you generally put your coat on. So one of the things that I've found really useful is actually speaking to some of the women, and particularly the women who are perhaps mothers, as well as looking after their mother-in-laws and their own parents. Because if they are very pro-vaccine, they can actually influence an awful lot of people in their household, from their younger ones to their husbands, to their relatives.

Chris - It's a bit like sparks coming down and starting lots of little fires isn't it? So you have started the ball rolling. By getting to a few people, there were obviously some influences in there, that then helped to grab other people along the way.

Farzana - Yeah. And I think my biggest success was one of my ladies who I've known very, very well. Over 15 years, I've known her. In her eighties, an African lady. And she said to me; "Oh, but doctor, I'm worried about the long-term side effects." And I know her really well. So I could be a bit cheeky. And I said: "Listen, if you grow a second head because of your vaccine, when you're a hundred, I'll come and cut it off myself." And she was laughing. And I said: "You know, my mum's passed away. My mum died when I was 19." I said: "But my mum would have been exactly your age. She's in her early eighties." And I said: "If my mum was here, I would really want her to have the vaccine to protect her. And I want you to have it." Her son rang our reception three days later and said: "Can you just thank Dr Hussain because I wanted my mum to have it as well." So I did have him on my side, and she said but what Dr Hussain said about her mum, she went and had it.

Chris - A bit of a worry when your GP says I'll chop your second head off! But it can be really hard on families. Let's have a listen to a little bit more of what they told us.

Concerned Listener - I mean, we just don't talk about it, that's all. We talk about other things, but we won't get into that issue because you know, we've learned that every time we've tried, it just doesn't work. And his parting argument is always: "I want to protect you. I want what's best for you, because you're my parents. And obviously I love you. And I want to make sure that you're safe."

Chris - Have you got any advice for people or families that find themselves in this position, where it's almost become an unmentionable subject, like not bringing up politics at a dinner party?

Farzana - Yeah. It was quite sad to hear wasn't it, that they don't talk about it. And actually heart-wrenching to hear that actually, he just wanted to protect his parents and this is how he knew best how. I think in a situation like this, if we can encourage support, so does that family know anybody else in their wider family friend circle that has perhaps had the vaccine? Is there anybody else they can talk to? In Newham we've got what we call COVID Champions. So our council, our public health team, have trained up over a hundred people who are from the community, who have found out about the COVID vaccine, and COVID effects, and they help other members of the community, and come into practices as well with us. Sometimes it's really powerful to just have somebody else, when you've reached that loggerhead yourself, with your family, to have somebody else coming in.