Despite the rollout of COVID-19 vaccines, many communities are not over the hurdle
It is easy to blame individuals for their contribution to the current COVID-19 pandemic. There are anti-mask protesters, COVID-19 deniers, and people who gather in large groups with others outside their household. It is easy to dismiss these people as irresponsible or senseless. I admit that I fall prey to these thoughts at times, especially when I am walking through a supermarket and I see people who wear their face masks as chin straps, even though as a medical student, I have been taught not to dismiss my patients. Many of us in America have been indoctrinated with a strong sense of individualism, where our achievements are largely earned by ourselves. By that logic, failures on the part of others may be perceived as their own wrongdoing as well. Of course, in reality, people’s behaviors during the COVID-19 pandemic is explained by more than an exercise of one’s individualism. A key component of not following CDC guidelines is misinformation. Misinformation is increasingly prevalent in our digital era where we are constantly flooded with information. False news spreads six times faster on social media platforms such as Twitter, so it is no wonder that the COVID-19 pandemic is not immune to misinformation.
— Carolyn Fan, 2nd year Health Services PhD student at the University of Washington
People are complex, social creatures that have cognitive biases that tend to amplify in our minds the voices of those that we are familiar with. Similarly, our innate social behaviors make it difficult for people to be physically distant from one another. There are innumerous reasons why people do not follow CDC guidelines and understanding some of them may help us both end the pandemic more quickly and reduce the number of deaths until we can do so. Most people believe that everyone deserves health care. As I have touched upon before, this is a notion that I carried with me since the first time I mumbled the Hippocratic Oath. It is so tempting to continue to blame people for perpetuating both the COVID-19 pandemic and the misinformation pandemic, but if we remember that much of the negative impact that we all feel — whether it is financial, social, or health-related — can be addressed from a public health and public policy perspective, we can make the end of this pandemic go more smoothly than its beginning.
As my friend Carolyn Fan put it on our conversation about the future of public health, “there is so much we can do as a community, and from a structural and policy level than [when we] blame people for their ‘individual failings.’” Carolyn is a 2nd year Health Services Ph.D. student and in a conversation with her (full conversation here), we explore what the field of public health is and how understanding the social determinants of health — the conditions of the environments where people live or lived that impact their health — can help us improve the health of populations of people. Public health experts are also the people who help make important health decisions in your community. For example, Carolyn’s work with Health Impact Partners (HIP) creates guidelines on COVID-19 related topics such as where to place a major testing site. Organizations like HIP work with departments of health around the country and together, also impact decision making on the distribution and allocation of COVID-19 vaccines.
Timestamps:
- Carolyn’s path in pursuing public health as a career 1:45
- What are the social determinants of health? 6:35
- COVID-19 and the social determinants of health 8:36
- Equitable allocation of COVID-19 vaccines 15:52
- Mistrust and fears about COVID-19 vaccination 17:47
- What you can do to impact public health (spoiler: check in on your communities!) 23:21
On Friday, December 12th, Pfizer was granted an Emergency Use Authorization (EUA) from the United States Food and Drug Administration (FDA). Moderna is expected to receive a EUA from the FDA in the upcoming days. Millions of doses of the vaccine have begun to be distributed on Monday of this week and healthcare workers are receiving their first doses as we are entering the first phase of vaccine distribution in the United States.
This is reason to be optimistic. Millions of people across the United Kingdom, who started vaccination a week earlier, and the United States are getting the vaccine. The vaccine is safe and effective as the FDA has maintained since its approval, with very few people getting any adverse reactions (severe side effects). In the UK, there were two reported cases of significant allergic reactions to the Pfizer vaccine, which was swiftly treated by doctors. In the U.S. one woman in Alaska had an allergic reaction that required treatment and monitoring overnight, yet she was discharged on Wednesday morning after her symptoms resolved. The FDA released data that suggests that people who received a placebo vs. the vaccine had similar rates of allergic reactions (0.51% vs. 0.63%). Perhaps more importantly to note, a very small amount of people will inevitably have adverse reactions, like an allergic reaction, to any drug including any vaccine. Most administration sites have tools such as adrenaline rapid injectors (like the commonly found EpiPen) to quickly address any adverse reactions. Even the smallest of hospitals, like the Bartlett Regional Hospital in Alaska where the aforementioned woman worked, are well equipped to deal with adverse reactions.
I am eager to get any FDA authorized/approved COVID-19 vaccine.
While I am not currently seeing patients and therefore will have to wait a while for a vaccine, I am eager to get any FDA authorized/approved COVID-19 vaccine. Our society is taking its first steps into a post-COVID world, yet the pastures may not be as green as quickly as one might expect. There are still things we do not know about life after vaccination. We currently do not know whether or not vaccinated individuals can be asymptomatic spreaders of COVID-19, therefore all people should continue wearing masks and practice physical distancing. We also do not know how many individuals are going to get the vaccine even when they are available to the general population. If we look at this challenge from a public health lens, we must reach herd immunity — where enough of the population is immune (typically 70–90%), thereby making infections more difficult to be spread and protecting unvaccinated individuals. Herd immunity is essential for several reasons: it protects individuals who are unable to get the vaccine for any reason and it reduces the chance that another strain of the virus could develop.
Yet studies done the past several months suggest that only about 50% of people plan on getting a COVID-19 vaccine and overall, there has been a 21% drop in the willingness of the U.S. population to get a COVID-19 vaccine from May to September. Persons of color tend to have lower vaccination rates when compared to White people. According to the CDC, the estimated influenza vaccinated rates in the most recent 2019–2020 influenza season were lower in all persons of color compared to white adults. In a similar study, Black adults surveyed were the most hesitant to get the COVID-19 with only 32% of participants stating that they would get the vaccine compared to 52% of White adults, 56% of Hispanic/Latinx adults, and 72% of Asian adults (although only English-speaking Asian adults were interviewed). This data is unsurprising as persons of color, especially Black and Brown people were subjected to many atrocities from the medical profession. Socioeconomic factors have long disproportionally affected communities of color, including their access to new drugs. As always, the information gathered in polls is not perfect and it does not tell the complete story on what people believe or will do, but it provides insight into some of the differences between specific populations. In the same study, “concern about side effects” and uncertainty of the vaccines’ effectiveness were listed as the top two reasons why people would not get a COVID-19 vaccine. Even among the people who said they probably would or definitely get a COVID-19 vaccine, a majority of the participants still cited costs, side effects, and effectiveness as things that they were concerned about.
COVID-19 has revealed a lot of the fears that people have about healthcare that may have gone unnoticed in the past. Many factors, including negative contributions from social media and widespread misinformation, obscure the optimism that we are continually approaching. The Pfizer and Moderna COVID-19 vaccines mark an important advance in medicine. As a physician-scientist in training, I am particularly excited that we have this new technology that uses messenger RNA to create protective immune responses to pathogens. This technology not only represents a pathway out of this pandemic but also represents a new class of molecules that makes vaccine development more efficient (and potentially more effective) in the future.
There are, however, a lot of questions and fears that have yet to be addressed in our diverse communities across the country. While people in public health like Carolyn, clinicians, and even trainees like myself all are working to address some of peoples’ hesitations as a part of our careers, we can all do our part by quelling the fears that come with this pandemic. As Carolyn wisely suggested, we can all check in with our communities — whether it is our family, our friends, or local community centers and organizations, everyone can benefit from a more nuanced conversation about the pandemic that acutely affects us all. People tend to listen more to people who they trust, so our most effective way out of the pandemic is perhaps caring for one another by spreading facts by putting faces back onto the information we receive.
