Validating Fear Before Facts: A Framework for COVID-19 Hesitancy

In "Validating Fear Before Facts: A Framework for COVID-19 Hesitancy," the panel explores how validating a patient's fear can open the door to an evidence-based conversation.

Dr. Jeff Goad asks Curlin how pharmacists should approach patients whose hesitancy centers on fear of the unknown, rather than a specific documented risk. He notes this dynamic echoes long-standing, unfounded fears linking vaccines to autism, where no amount of reassurance ever feels like quite enough.

Curlin emphasizes that the first step is never dismissing a patient's concern, no matter how unfounded it may seem to a clinician. Patients who raise these questions are intelligent people, he says, even if they lack specialized healthcare training. Their concerns typically stem from real information they encountered, Curlin notes, information that may come from high-quality or low-quality sources depending on where they looked. Dismissing those concerns outright can backfire badly, he warns. Patients may conclude that their pharmacist does not care, does not know the answer, or is simply trying to pressure them into compliance. Curlin recommends the opposite approach: listening first, validating the underlying concern, and building shared values with the patient before introducing data.

For a specific fear like autism, Curlin outlines a sequence. First, understand exactly what the patient fears and where that fear originated. Second, acknowledge the concern honestly, telling the patient that the same worry would trouble anyone in their position. Only then should the pharmacist introduce evidence, Curlin says, explaining that extensive research has found no relationship between vaccination and autism.

Goad illustrates the broader point with an analogy from pediatrician Dr. Paul Offit, who compares persistent unproven fears to a childhood belief that jumping off a table in a cape might result in flight. Repeated failed attempts eventually settle the question, Goad explains, even without a fully satisfying scientific mechanism. At some point, both physicians agree, the accumulated evidence allows clinicians to say confidently that a feared connection simply is not the cause.

In the final episode, "The Pharmacist's Expanding Role in COVID-19 Vaccine Confidence," the panel looks ahead at how the pharmacist's role in vaccine confidence will keep evolving.