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Comment & Response
December 9, 2021

Overcoming Vaccine Hesitancy Around Bell Palsy in Otolaryngology–Head and Neck Surgery—Reply

Author Affiliations
  • 1Department of Otolaryngology–Head and Neck Surgery, University of Missouri, Columbia
  • 2Department of Otolaryngology–Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio
  • 3Case Western Reserve University School of Medicine, Cleveland, Ohio
  • 4Department of Ophthalmology, Shamir Medical Center (formerly Assaf-Harofeh), Tzrifin, Israel
  • 5Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
JAMA Otolaryngol Head Neck Surg. 2022;148(2):198-199. doi:10.1001/jamaoto.2021.3561

In Reply We thank the authors of the Letter to the Editor for stimulating further discussion. Tamaki et al1 explored the relationship between COVID-19 and the COVID-19 vaccine on Bell palsy (BP). Patients were counted as having Bell palsy if they received a diagnosis of International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) code G51.0. Granular patient-level data may be lacking in an analysis of this magnitude, and it was not possible to differentiate persistent or recurrent BP. Likewise, it is difficult to accurately quality check the accuracy of coding without the benefit of reviewing clinical data. We plan to expand on our work with further analysis. We agree that research using large databases may be at risk for misclassification. However, such databases can be an effective resource in studying rare pathologies, especially in specific populations such as those who have had COVID-19 or received the COVID-19 vaccination. Our propensity score matched analysis suggests that rates of BP are higher in patients who are positive for COVID-19 and this incidence exceeds the reported incidence of BP with the COVID-19 vaccine.

Social science suggests that there are more powerful persuasive forces other than facts and data.2,3 This is suggested by the Israeli experience4 and by the previous commentary.5 First, storytelling and the power of the anecdote is a well-known tactic in oratory that illustrates an issue using a concrete scenario that appeals to the audience’s sensitivities. Think of all the State of the Union speeches in which the President of the United States delivered a personal story—and even brought the affected person(s) to the House chambers during the speech for further punctuation. Second, individuals can be motivated by positive appeal to their values. Likewise, they also can be persuaded by fear; but using fear can be philosophically off-putting because it appeals to the darker side of human nature. Finally, science and medicine alone are not trusted enough institutions. Proper messaging needs to be distributed along other trusted social networks for it to resonate with individuals. These networks include peer networks, political networks, religious networks, and ethnic networks—whatever networks we identify as our “tribe.” Governmental systems can also provide encouragement. The Israeli government created a digital passport called the “Green Pass,” which allows holders to access various cultural venues. Green Pass eligibility is partially based on vaccination status. It is impossible for the typical individual to personally digest all the collective raw data to arrive at an understanding. Most people—physicians and scientists included—are reliant on networks to help interpret and act on the myriad of information before us. It will take not only data collection and analysis but also an appreciation for social psychology to navigate public health initiatives.

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Article Information

Corresponding Author: C.W. David Chang, MD, Department of Otolaryngology–Head and Neck Surgery, University of Missouri, One Hospital Dr, MA314, Columbia, MO 65212 (changda@health.missouri.edu).

Published Online: December 9, 2021. doi:10.1001/jamaoto.2021.3561

Conflict of Interest Disclosures: Dr Chang reported being a cochair of the Patient Safety Quality Improvement Committee, American Academy of Otolaryngology–Head and Neck Surgery. No other disclosures were reported.

Tamaki  A, Cabrera  CI, Li  S,  et al.  Incidence of Bell Palsy in Patients With COVID-19.   JAMA Otolaryngol Head Neck Surg. 2021;147(8):767-768. doi:10.1001/jamaoto.2021.1266PubMedGoogle ScholarCrossref
Kolbert  E. Why Facts Don't Change Our Minds. The New Yorker. Published February 20, 2017. Accessed October 10, 2021. https://www.newyorker.com/magazine/2017/02/27/why-facts-dont-change-our-minds.
Vedantam  S, Penman  M, Vargas-Restrepo  C,  et al Facts Aren't Enough: The Psychology Of False Beliefs. Hidden Brain Podcast. July 22, 2019. Accessed October 10, 2021. https://www.npr.org/2019/07/18/743195213/facts-arent-enough-the-psychology-of-false-beliefs
Shemer  A, Pras  E, Einan-Lifshitz  A, Dubinsky-Pertzov  B, Hecht  I.  Association of COVID-19 vaccination and facial nerve palsy: a case-control study.   JAMA Otolaryngol Head Neck Surg. 2021;147(8):739-743. doi:10.1001/jamaoto.2021.1259PubMedGoogle ScholarCrossref
Chang  CWD.  Bell palsy and COVID-19: overcoming the fear of “known unknowns”.   JAMA Otolaryngol Head Neck Surg. 2021;147(8):743-744. doi:10.1001/jamaoto.2021.1261PubMedGoogle ScholarCrossref