The Vaccine Project Newsletter: We’re going to need friendly persuasion, more hands on deck — and a bigger boat

This week’s Vaccine Project Newsletter is 3,174 words long and will take you 10 minutes to read.

Right now the COVID-19 vaccine conversation is focused on the fretful disconnect between supply and demand. People who want it can’t get it. Appointments are made and then canceled. Frustration simmers.

That’s today’s reality. There will come a time, educated observers say, when the scenario flips and the rollout, after finally hitting a nice cruising speed, will run into a residual wall of vaccine hesitancy and resistance, the Heartbreak Hill at mile 20 of this marathon.

“Political leaders and public health experts need to recognize that what appears to be considerable public demand for the COVID-19 vaccine right now may be more modest in the coming months,” professors Matt Motta and Timothy Callaghan predict. “In its place, experts will be faced with the new challenge of convincing hesitant groups to get vaccinated in order to reach herd immunity… Developing these communications and identifying appropriate messengers to deliver this information will be vital to stopping the pandemic.”

The biggest problem, Bryan Walsh offers in Axios, may not be glitches in distribution or the threat posed by a growing horde of virus variants but “how to talk about vaccines to those who think the shots aren't worth it.” We’re selling the vaccine short, he suggests, because somewhere in the conversation a core reality is getting lost: Vaccines will save your life and the lives of those you love. “Americans need a clear message about the public and personal benefit of vaccination, lest we miss our best chance to stop this catastrophe,” Walsh says.

That message needs to be communicated in a thoughtful and empathetic way in order to vaccinate as many people as quickly as we can—and help the unvaccinated stay safe and healthy.

This week’s Vaccine Project Newsletter is 3,174 words long and will take you 10 minutes to read.

The communications effort
With the vaccine-hesitant, -reluctant or just plain worried, shaming and coercion won’t work. We stand a much better chance of success with a dose of friendly persuasion.

  • Recommended reading for everyone in the communications business: A report on “Covid-19 Vaccination Communication” put together by a team of behavioral and social scientists for the National Institutes of Health. This “rapid working group” of experts lays out the fundamentals of creating and disseminating targeted and tailored messages for specific audiences, all in the interest of making vaccination not only an acceptable but an embraceable social norm. It’s not a tome—just 20 pages.
  • The Association of American Medical Colleges shares examples of local reaching and teaching: In Wisconsin, doctors at UW Health go on Spanish-language radio stations to field questions about the vaccine, including, “Is proof of citizenship needed?” In Los Angeles, a med school professor explains vaccines to a support group for gay Black men. Ohio State’s Wexner Medical Center addresses vaccine hesitancy in minority communities at an online roundtable featuring a pastor sitting (virtually) next to scientists.
  • New Orleans’ “Sleeves up, NOLA” campaign says the vaccine “is your shot to relieve healthcare workers, protect high-risk individuals, keep your family safe, support local businesses and help us get back to the New Orleans we love.” In a 30-second video, citizens in their finest Nawlins regalia share why they are getting vaccinated: “So that I can dance another day… So that I don’t have to lose another brother.”
  • Peer influence is a “huge factor” in gaining vaccine acceptance, says Harvard public health researcher Julia Wu in an interview with the Human Vaccines Project. “The goal is to engage community members, but not impose on them.”
  • With community solidarity in mind, Missouri’s COVID-19 vaccination website is sending the message that we are “Stronger Together… You have the choice to help our society shape our new path forward beyond COVID-19. Here, we put the facts in front of you so you can make an informed choice.”
  • Maryland just kicked off its GoVax campaign. The announcement included a two-minute video with a greeting from Governor Larry Hogan segueing into messages from Black, Hispanic and Asian pastors, educators and politicians. The video features brief sections in Spanish and Korean.
  • Be Wise, Immunize is a new educational website for three million home health care workers, launched by the Partnership for Medicaid Home-Based Care. Joe Jancsurak has details in McKnight’s Senior Living. PMHC officials note that the home care labor force—primarily older women of color—is disproportionately exposed to, and affected by, COVID-19.
  • What would convince people over 65 to get the vaccine? In McKnight’s Senior Living, Lois A. Bowers parses a variety of surveys and finds that the message resonating the most is this: “The quickest way for life to return to normal is for most people to get vaccinated.”
  • Any number of polls tell us that your own doctor or other provider is the most trusted and credible source of health information. Yet fewer than one in four (24%) of unvaccinated people surveyed by Kaiser Family Foundation said they had asked a doctor or health professional about the vaccine. 
  • Friendly and familiar voices matter. An advisory board of the Alzheimer’s Foundation of America is urging patients, caregivers and “all families affected by Alzheimer’s disease to get vaccinated as soon as they are able to do so” and to continue following masking and distancing safety protocols.
  • 109-year-old Elzora Costello received her COVID-19 vaccine at Luther Village in Arlington Heights, IL. “We told her, 'There is a virus and you should get this shot,'" her granddaughter explained to the Daily Herald of suburban Chicago. "And she was like, 'Oh, OK.’"

The takeaway: It’s important to emphasize what the vaccines can do and not what they can’t. Let’s not allow the perfect to be the enemy of the good.

The rollout
We need to be able to say, “We’ve got this.”

  • The rocky road of administering vaccine dose number one doesn’t bode well for dose number two, Caitlin Owens writes in Axios. We’re lacking a strong infrastructure to deliver those critical second doses to millions within the needed time frame (three to six weeks). “At this point in the pandemic, we can little afford to figure it out the hard way,” she notes.
  • Figuring it out will include achieving a healthy balance between first and second doses. Just in time for the Super Bowl, we’re debating whether to “call an audible” in favor of more first doses for more people. Biden COVID advisers are telling providers not to worry and not to stockpile second doses because ample supply will be forthcoming--retail pharmacies will be rolled into the rollout next week..
  • To turn vaccines into vaccinations, you need vaccinators. Ay, there’s the (alcohol) rub. To meet an urgent need, the Department of Health and Human Services has authorized retired or inactive doctors and nurses to prescribe, dispense or administer COVID-19 vaccine anywhere in the U.S., not just in the state where they are (or were) licensed.
  • A number of states are going further, turning veterinarians, dentists, dental hygienists and podiatrists into vaccinators, along with medical school and nursing students, paramedics and EMTs. I absolutely trust my vet to give me my shot—in the deltoid, please.
  • It does take a village: Staffing the vaccination mega-site at Petco Park, home of the San Diego Padres, requires 300 people a day—120 clinical workers and 180 in administrative support. Sites are assembling a mix of paid staff and local volunteers.
  • This week’s nor’easter didn’t stop 2,000 people from getting their vaccinations at Fenway Park and Gillette Field. Fewer than 400 appointments had to be rescheduled. That’s wicked good.
  • A dozen organizations in the live event industry are offering their venues, staff and expertise to the COVID-19 vaccination effort. An industry that has “stood still” since March 2020 is now “committed to doing everything in our power to bring people together again—not just for events, but for every aspect of community that we have been missing.”
  • In the arched majesty of an 800-year-old cathedral, and to an echoing organ accompaniment of Bach, Handel and Pachelbel, folks in England are queuing up for their vaccines. Salisbury Cathedral—I was once there at Evensong, and found it glorious and breathtaking—is one of three venerable church sites creating “an environment that is welcoming, reassuring and soothing.” Music requests are welcome, though nothing “too spiky.”
  • Officials in Johnson County, Kansas, apologized for making people wait in the cold to be vaccinated, including some recently eligible folks over 80 pushing their walkers. Next day, the clinic opened a half hour early, and warming buses, tents and shuttles from the parking lot were in use.
  • Cancer patients, including those undergoing active treatment, should be vaccinated against COVID-19, the National Comprehensive Cancer Network recommends. Caregivers, household members, and close contacts should be vaccinated when possible, the NCCN adds.
  • Can employees be forced to have a COVID vaccination? In People Management, Lisa Gallagher navigates the legal questions arising in the U.K., balancing the employer’s need to provide a safe workplace with the individual’s right to personal choice.
  • The law firm Davis Wright Tremaine, employing more than 500 lawyers in its Seattle headquarters and seven other cities on the West and East coasts, has implemented a policy encouraging staff to be vaccinated against COVID-19—but requiring it of those who want to come in to the office or attend firm-sponsored events.
  • Detroit’s Big Three automakers, GM, Ford and Fiat Chrysler, are among major US employers promising not to require but to encourage and facilitate vaccination. Corporate advocacy is important: In Human Resource Executive, Justin Holland, CEO of Chicago-based benefits company HealthJoy declares, “Companies have to make a stand. They have to decide what side of history they want to be on.”
  • A nearly 50% drop in COVID-19 cases and deaths at U.S. nursing homes over the past 4 weeks is one sign that vaccines are working and that achieving herd immunity and returning to normal operations are within sight, Danielle Brown notes in McKnight’s Long-Term Care News.
  • Access to vaccination is seen as one reason for a recent increase in senior living move-ins after a big dip in occupancy in 2020, Amy Novotney reports in McKnight’s Senior Living.
  • Getting on board with vaccines: Saga Cruises, a two-ship cruise line in the U.K. that caters to the over-50 crowd, will require passengers to be fully vaccinated against COVID-19 at least 14 days ahead of their sailing date.

The takeaway: More hands on deck mean more shots in arms.

The challenges
Who’s getting vaccinated, and when, is a crazy salad. Or maybe it’s a tossed salad, or a chopped salad. Take your pick.

  • The current distribution plan only reinforces existing inequities, say Muriel Jean-Jacques and JAMA editor-in-chief Howard Bauchner in a commentary. They recommend prioritizing zip codes hardest hit by COVID-19 as well as neighborhoods in economic hardship; offering registration options that don’t require the Internet and are accessible to people with limited literacy or English proficiency; and promoting vaccine awareness and uptake via partnerships with trusted local sources.
  • Putting those words into action: A walk-in vaccination site for seniors and healthcare workers is now open at the Mexican Heritage Plaza in East San Jose, CA, courtesy of the Santa Clara County Public Health Department in partnership with Gardner Health Services and The School of Arts and Culture.
  • The vaccination megasite in development at Yankee Stadium will be reserved for residents of the Bronx only, as the borough has a “concerning” COVID positivity rate of 7.6%.
  • On the other hand, a plan to prioritize hard-hit zip codes in Dallas was rescinded when the state threatened to cut the city’s vaccine supply because the plan was “out of compliance with the previously agreed-upon guidelines.”
  • There’s a growing and disturbing gap among older adults when it comes to getting vaccinated, Kaiser Health News reports. The “haves” are those with friends and family to help snag appointments, people with internet access and those with ready transportation to vaccination sites. The “have nots,” unfortunately, tend to be those already at a disadvantage in our healthcare system: Black and Hispanic elders, non-native English speakers, older folks in low-income neighborhoods and the frail, seriously ill or homebound.
  • A tale of two states: In Georgia, a rural medical center was suspended from the state’s vaccination program for moving teachers up the line ahead of the elderly. In Oregon, on the other hand, the Governor has approved giving teachers priority. There’s a “moral calculus” in the classroom of coronavirus that absolutely defies easy solution.
  • A Medical Group Management Association survey reveals that a “staggering” 85% of independent practices and 45% of practices owned by hospitals or health systems and actively seeking COVID-19 vaccine have received zero, zip, nada to date. Most practices with vaccine in hand only have enough to vaccinate 1% or less of their patients. In a letter to President Biden, MGMA says the rollout has been “haphazard at best” and calls for including medical offices in the vaccine distribution and education plan. 
  • Add librarians to those who want a seat at the table, or rather a place on the vaccine waiting line. Librarians were deemed essential workers in early recommendations of the federal working group but are missing from the latest definitions. Librarians are not being quiet about this, and they ssssshhhouldn’t be.
  • Seniors without seniority: Older folks living independently within “life plan communities” are on the outside looking in at their neighbors getting vaccinated in nursing homes and assisted living, Kimberly Bonvissuto notes in McKnight’s Senior Living. She also reports that more than 90 long-term care facilities in rural Colorado, tired of waiting for vaccine, have opted out of the federal pharmacy partnership program and are turning to county health departments for help.
  • Immigrant workers are reluctant to register for the vaccine, says this report from New Mexico. The state health department has said it will not require proof of residency or immigration documentation in determining vaccination eligibility—nor will they share immigration status information with the federal government. The challenge is to convey that message clearly and convincingly.

The takeaway: Moral calculus in math class is followed by ethical calisthenics in gym. We need to find a way that is fair as fair can be. Anyone who is gaming the system is shaming the system.

The resources
Here are this week’s additions to our ever-growing lending library of information and insight, experience and expertise.

  • Helpful and comprehensive guidance on countering the COVID-19 “infodemic” is available in The Vaccine Misinformation Management Guide, a collaborative effort of UNICEF, the Yale Institute for Global Health, First Draft and The Public Good Projects.
  • Recognizing that nearly a third of healthcare workers are hesitant about the vaccine, the Institute for Healthcare Improvement has compiled a Q&A guide to conversations with healthcare workers about COVID-19 vaccine. Though written for nursing home staff, it can readily be adapted to other audiences of health professionals.
  • You can keep a close eye on the vaccine odometer by following the CDC’s COVID Data Tracker (52.7 million doses distributed, 32.8 million administered as of February 2, including 6.1 million second doses). There’s a separate tab for vaccines administered through the federal Pharmacy Partnership in Long-Term Care.
  • States with the highest rate of vaccine doses administered per 100,000 population: Alaska, Vermont, West Virginia, Connecticut, North Dakota, Oklahoma, South Dakota, New Mexico, and the District of Columbia (11,000 to almost 17,000 per 100,000). This is a good kind of arms race. And several U.S. territories are outshining the states. Put your hands together for Guam, American Samoa, the Republic of Palau and the Northern Mariana Islands, with rates from 15,000 to 19,000 per 100,000. Now find them on the map!
  • Leaders from the Centers for Disease Control and Prevention and the Ad Council, including CDC deputy director Anne Schuchat, will appear in a webinar February 24, designed to “share information and resources to help inform your local COVID-19 response messaging.” The session is sponsored by the Public Health Communications Collaborative.

The takeaway: COVID-19 is its very own Continuing Medical Education course.

The vaccine dashboard
We’re just a couple of months away from having not two COVID-19 vaccines in hand (and in arms) but three, four or even five. There are more horses for the cavalry.

  • The Johnson & Johnson single-dose vaccine had 85% efficacy against severe to critical COVID-19 and 66% against moderate to severe disease, Brian Park notes in MPR—and complete protection against hospitalizations or deaths 28 days after vaccination. The company expects to file for Emergency Use Authorization in the U.S. this week and to ship immediately upon approval.
  • Park is on top of this story as well: Novavax reported 89% overall efficacy for its COVID-19 vaccine in early Phase 3 results in the U.K., including 95.6% efficacy against the original virus strain and 85.6% vs the U.K. variant. The vaccine is showing 60% efficacy in a Phase 2b trial in South Africa; the company is already at work on booster and/or combination vaccines targeting the upstart variant.
  • The European Medicines Agency has approved the AstraZeneca/Oxford COVID-19 vaccine for use in the 27 member countries of the European Union. The vaccine was 60% effective in clinical trials in the U.K., Brazil and South Africa. Alicia Lasek offers further insights on the J&J, Novavax and AstraZeneca candidates in McKnight’s Long-Term Care News.
  • UNICEF, the world’s largest buyer of vaccines, is now tasked with fulfillment — international shipping and in-country distribution of up to two billion doses to 92 middle- and low-income countries.
  • The Infectious Diseases Society of America held a media briefing to share expert insights on the emergence of coronavirus variants and the countermeasures that will be needed. Chen Fang has the story in Infectious Disease Advisor. 
  • The bottom line, Dr. Anthony Fauci and others say, is that COVID-19 vaccines will need to be fine-tuned, upgraded and diversified on a regular basis to keep pace with the elusive variants. “If we give the virus a chance to do its worst, it will,” said Michael Nussenzweig, an immunologist at Rockefeller University.

The takeaway: John Grabenstein, an epidemiologist with the Immunization Action Coalition, put it this way: “We’re going to need a bigger boat.”

… and some songs

Captain Sir Tom Moore, who raised nearly $45 million for National Health Service Charities Together last spring by doing laps with his walker around his garden, has died of pneumonia and COVID-19 at the age of 100. You must see his rendition of You’ll Never Walk Alone, which became a #1 hit in the U.K. 

Good as Hell, Lizzo. Healthcare workers in Boston Medical Center danced to this when they received their first shipment of vaccine.

Hugging You, Tom Rosenthal featuring Billie Marten

I’ve Gotta Get a Message to You, BeeGees

Reach Out (I’ll Be There), Four Tops

At Last, Etta James

And that’s the way it is, as Walter Cronkite used to say on the evening news. We’ll be back tomorrow with your weekly Haymarket Media Coronavirus Briefing. Happy belated Groundhog Day. (“Well, what if there is no tomorrow? There wasn't one today.”)

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