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234 Complexity, confidence, and shifting context: an in-depth exploration of vaccine confidence during the covid-19 pandemic
  1. Catherine H Saunders1,2,
  2. Gabrielle Stevens2,
  3. Clarissa Hsu3,
  4. Lisa C Johnson2,
  5. Glyn Elwyn2,
  6. Marie-Anne Durand4
  1. 1Department of Medicine, Dartmouth Health, Lebanon, NH, US
  2. 2The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Dartmouth College, Lebanon, NH, US
  3. 3Kaiser Permanente Washington Health Research Institute, Seattle, WA, US
  4. 4Unisanté Center for Primary Care and Public Health Department of Occupational and Environmental Medicine, Lausanne, Switzerland


Long-term care workers (LTCW) served on the frontline of the COVID-19 pandemic, often without sufficient information or protection, to care for the most vulnerable members of society.

‘She’s already in a bag… I do not mind the’s the losing of life...I do not know how many…’1 - LTCW

Yet, when safe and effective vaccines became available, LTCW inoculation rates remained dangerously low, endangering the workers themselves, their communities and the vulnerable residents of nursing homes and other long-term care settings.

The COVID-19 pandemic revealed the depth, breadth and nuance of varying attitudes about vaccines. We will carefully weave together the complex vaccine confidence issues in the shifting public health environment during the symposium, including the tension between public health priorities and shared decision making among essential workers.

First, we will review the origins of apprehension about vaccines (sometimes called vaccine confidence), the labels we have attached to this phenomenon over time and how popular conceptions of it have evolved along with advances in measurement, all in the context of the shifting environment during the rollout of the vaccines during the COVID-19 pandemic.

Second, we will review vaccine confidence among LTCWs, emphasizing the critical role of feeling heard, included and respected, and the importance of conducting meaningfully participatory research with LTCWs.

Third, we will review the co-design and results of two randomized controlled trials to provide good information and support to LTCWs to improve COVID-19 vaccine behaviors and attitudes among LTCWs, both funded by the Patient-Centered Outcomes Research Institute (PCORI).

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