The Vaccine Project Newsletter: Moving the needle on vaccine confidence — and healthcare equity

This edition of the Vaccine Project newsletter is 3,024 words long and will take you nine minutes to read.

Source: Getty Images

In Black History Month, we face the uncomfortable — and unacceptable — truth that Black Americans and other people of color are disproportionately more likely to be hospitalized and die from COVID-19.

In the greater landscape of American healthcare this, unfortunately, is not a novel phenomenon. Blacks are more likely than whites to die at early ages from all causes. We’ve all heard the shocking news that, in the first half of 2020, life expectancy in the U.S. actually declined by one year overall. Less noted was that it dropped by three years for Black men and more than two years for Black women. 

As the vaccine rollout marches on, we face another sobering truth: that Black Americans are among those with the highest levels of vaccine hesitancy. They are also glaringly underrepresented in the ranks of the vaccinated. It’s not just hesitancy or resistance; it’s also lack of information and access.

There is no shortage of nationally prominent Black voices speaking out on behalf of COVID-19 vaccination: 60 Black members of the National Academy of Medicine, basketball legend Kareem Abdul-Jabbar, the Black Coalition Against COVID-19 and Kizzmekia Corbett, a brilliant young scientist at the National Institutes of Health who helped develop the Moderna COVID-19 vaccine.

Those national voices need to be reinforced by voices within the community — trusted local messengers like the Black Doctors COVID-19 Consortium, which last weekend vaccinated 4,000 Philadelphians in a 24-hour marathon clinic. Lack of trust in government and healthcare runs deep for many reasons, prominent among them the notorious Tuskegee study. Run by federal government health agencies, the study saw hundreds of Black men with syphilis go untreated for decades, even after penicillin became available in the 1940s. This outrage remained under wraps until the 1970s.

We’re not going to solve all these problems tomorrow, but we need to make progress today. It starts with an effort to build a shared understanding across all racial, social, religious, ethnic and political divides that vaccination is life-saving. Long after the coronavirus pandemic is under control — and it will be under control — the pandemic of injustice, which came and never went away, will demand our ongoing attention and response.

This edition of the Vaccine Project newsletter is 3,024 words long and will take you nine minutes to read.

Source: Getty Images

The communications effort

Mom was right. It’s not just what you say but how you say it. And it’s not just the message. It’s the messenger as well.

  • Lisa Sherman, president and CEO of the Ad Council, has provided the blueprint of what will be “the largest public education campaign in our history.” Sherman spoke Monday during a National Forum on COVID-19 Vaccine, convened by the Centers for Disease Control and Prevention. It drew more than 12,000 online attendees. The key strategies are to:

– Acknowledge concerns about vaccines; it’s okay to have questions and important to provide unbiased answers

– Talk about how the pandemic has disrupted our lives and how vaccination can help restore our lost connections and those “missed moments”

– Describe the protection that vaccines will provide for the individual and loved ones, as well as the most vulnerable among us

– Engage with an inviting, positive and respectful tone. Appreciate that vaccination is a choice and resist “guilting” your audience or suggesting that vaccination is the only right thing to do 

Messaging will be aimed at the 40% who are either skeptical about COVID-19 vaccination (18%) or open to the possibility but have questions (22%).

  • In the CDC’s National Forum, Cameron Webb, a physician in Virginia and an advisor to the White House COVID-19 Health Equity Task Force, said that it’s not just a matter of building confidence in vaccines, but also in the system that delivers the vaccines and in the motivation of policy makers.
  • Commercial broadcasters in the U.K. are uniting in an effort to encourage ethnic minorities to #TakeTheVaccine, Brittaney Kiefer reports in Campaign. In a short video, celebrities debunk myths and clarify that the vaccine will not cause infertility, does not contain animal products and is, in fact, halal. Comedian Romesh Ranganathan adds that there’s no chip in the vaccine tracking you: “Your mobile phone actually does a much better job of that.”
  • An expert panel convened by the nonprofit United States of Care explores how to move the needle, literally, on vaccine hesitancy. Lecia Bushak has details in MM+M. A key takeaway: to reach specific populations you need “microtargeted messages” laser-focused on the underlying reasons for hesitancy — whether it’s lack of information and access, skepticism about government and healthcare or political, social and/or religious beliefs.
  • Aloha! Long-term care facilities in Hawaii proudly report that 78% of staff have received COVID-19 vaccine, double the national rate. In McKnight’s Long-Term Care News, Danielle Brown notes what’s working: Having leadership vaccinated first to inspire confidence; frequent written and oral communication, including one-on-ones, Q&As with public health experts and conversations with local cultural leaders; raffles for the vaccinated; and swag, in the form of apparel celebrating a staffer’s vaccination status.
  • As far east as Hawaii is west, a home and hospice facility in Maine transformed itself into a freestanding COVID-19 vaccine provider, working directly with the state’s Center for Disease Control and Prevention (ayuh, Maine has its own CDC). In McKnight’s Home Care Daily, Joe Jancsurak describes the atmosphere on the first vaccination day as “celebratory” and “upbeat.” With good reason: When surveyed last October, nearly half of direct care workers at the facility said no to vaccine. Today, 68% have been vaccinated, with the goal of 85% not too far off.
  • Only one in three home care workers plans to get vaccinated, Liza Berger notes in McKnight’s Home Care Daily. With that in mind, home care associations have begun campaigns to win hearts, minds and arms. They include Be Wise, Immunize, an initiative of the Partnership for Medicaid Home-Based Care.
  • It’s heartening to see the medical community step up to face down the assault on science. Shots Heard Round the World, the creation of Pittsburgh pediatrician Todd Wolynn, has been there and done that since 2017. After producing a 90-second video on the benefits of HPV vaccine, his practice was attacked by anti-vaxxers on Facebook, Twitter, Yelp and Google. He fought back and now offers a “rapid response digital cavalry” to help fellow healthcare providers protect their social media pages.
  • #ThisIsOurShot is a grassroots social media campaign started by health professionals in California to put out misinformation wildfires.
  • Katie Hisert, a pulmonologist in Denver, is a freshly minted social media activist pushing back on anti-vax influence. “The general public is seeing science happen in real time, and it’s really hard for [them] to understand the process,” Hisert tells Medical Bag’s Rachel Nuwer. “I try to help people differentiate between ‘This is not a true statement’ and ‘We don’t have that data yet.’”
  • In Becker’s Healthcare, communications pros for seven health systems share how they are countering vaccine misinformation. Ashley O’Brien of Intermountain Health Care in Salt Lake City remarks that “stories from local, real people drive relatability, trust and interest in vaccines, which motivates our audiences to seek out information from reliable sources rather than believe or perpetuate misinformation.” At Renown Health in Reno, CEO Tony Slonim, a physician with a PhD in public health, holds virtual town halls for employees, the media and the public.

The takeaway: Communicating effectively requires listening as much as talking, earning trust and not just asking for it, and accentuating the positive (vaccine confidence) rather than dwelling on the negative (vaccine hesitancy).

Source: Getty Images

The rollout

Odometer check: As of Tuesday, 44.5 million first doses and nearly 20 million second doses have been administered in the U.S. We think we can, we think we can, we know we can…

  • Seniors 75+ in Massachusetts are finding out who their newest BFF is: A younger person who’ll transport them to a vaccination site, where both passenger and driver will receive their shots. This buddy system has potential for abuse, but Governor Charlie Baker, in his own avuncular way, advises traveling only with someone you know and trust — as opposed, say, to answering the Craigslist ad that offers a clean Toyota and your choice of radio music. The Governor is simply echoing an adult version of the message drummed into my dear little ear as a child: Never accept a ride from a stranger.
  • For the homebound, that BFF may in fact be a doctor or nurse who comes to your residence, vaccine in hand. Medical centers and health organizations in several states are sending vaccinators out on those missions, Joe Jancsurak reports in McKnight’s Home Care Daily. The Department of Veterans Affairs has also provided vaccination to more than 11,000 veterans who receive their primary medical care at home.
  • Starting March 1 (that’s next week, folks), California will set aside 10% of vaccines for teachers. Tithing for teachers? It could catch on.
  • The American Association for Cancer Research and more than 130 other cancer organizations have written to President Biden asking that cancer survivors and patients with active cancer be prioritized for COVID-19 vaccination. The letter points to a COVID fatality rate among cancer patients that is double the rate for COVID patients without cancer.
  • Also on the President’s desk is a letter from the National Governors Association making two urgent requests: One, to help quell the public’s anxiety over vaccine demand and supply by helping us understand the distribution process; and two, to get states involved in coordinating what are now strictly federal efforts to provide vaccine through pharmacies and federally qualified health centers. Alicia Lasek has more in McKnight’s LTC News.

The takeaway: The logjam will dwindle, eventually, and those who have been patient will be rewarded. The arm wants what the arm wants.

Source: Getty Images

The challenges

The snow and ice storms that walloped the middle of the country, freezing pipes as well as vaccine delivery, lead to one inescapable question: Where are the Iditarod sled dogs when we need them?

  • There’s vaccine hesitancy and then there’s vaccine likelihood, gradually gaining momentum as more people join the ranks of the inoculated. According to the latest Harris Poll, 70% are likely to get the vaccine as soon as it becomes available, up from a low of 54% last October. Skepticism is highest among Gen Z (39%), Gen X (35%) and Millennials (32%), and much lower among Boomers (23%). That’s more than okay, Boomer.
  • Lots of questions surround COVID-19 vaccination of pregnant women. The thinking right now: There is no compelling reason not to get it, but talk to your doctor first. The problem is that pregnant women are at high risk for severe COVID-19 but were not included in the original vaccine trials. The solution, as always, is to gather data. Pfizer and BioNTech are now doing just that, Brian Park notes in MPR. Researchers will also follow infants born to these women and determine whether protective antibodies pass from mother to child.
  • “When you make the move to New Perspective, you and your loved one can both get the COVID-19 vaccine.” That marketing ploy by a Minnesota assisted living center got the attention of the state attorney general, Amy Novotney reports in McKnight’s Senior Living. In Virginia, an assisted living facility touted a “vaccination staycation” for those who book a studio apartment for $5,000 a month. These tactics are withering under the glare of public scrutiny while giving business ethics professors rich fodder for future case studies.
  • Is it safe? Apparently so, per CDC reports on the first month of vaccine safety monitoring – from mid-December to mid-January, when 13.8 million doses went into arms. The safety profiles of both the Pfizer and Moderna vaccines were “reassuring,” with local and systemic reactions common and anaphylaxis rare.
  • The CDC also notes that deaths that occurred following vaccination, most of them in long-term care, did not point to “any unexpected pattern that might suggest a causal relationship with vaccination.” Danielle Brown shares details in McKnight’s LTC News.
  • In France, where rates of vaccine confidence are among the world’s lowest, a 35-member citizens panel will have a tete-a-tete (if not a toe-to-toe) with policy makers. The government has made “a significant effort in communication, but needs to focus more on the listening side of the dialogue,” said Heidi Larson, director of the Vaccine Confidence Project in London.
  • Mistrust of vaccines is also rampant in Pakistan, where beliefs persist that vaccines are a Western conspiracy against Muslims. The courts just tossed out a suit claiming that vaccine vials were filled with animal DNA and nanobots. This doesn’t help either: the CIA ran a fake hepatitis B vaccination campaign in an effort to track down Osama bin Laden, and the Taliban issued a fatwa against vaccination drives.
  • While waiting for a vaccination is stressful, other issues of day-to-day survival, like putting food on the table, reflect the ongoing ripple effect of the pandemic. In Psychiatry Advisor, Mary Beth Maslowski interviews researchers who explore how food insecurity — let’s just call it hunger — undermines mental health.

The takeaway: Science is messy, and that’s OK. We’ll know more tomorrow than we do today. Early real-world evidence that the vaccine protects against disease and reduces hospitalizations of people at highest risk is another beacon of light.

Source: Getty Images

The vaccine dashboard

A little birdie told us that spring is coming — and that vaccine supply will blossom.

  • The J&J/Janssen Biotech single-dose COVID-19 vaccine is up to bat on Friday before an FDA Advisory Committee, seeking to get to first base: emergency use authorization. With Pfizer and Moderna already having swung and connected, the bases would then be loaded.
  • South Africa has become the first country to use the J&J vaccine in a population-wide vaccination effort. The country’s president and health minister both rolled up their sleeves. Meanwhile, J&J has applied to the World Health Organization for Emergency Use Listing.
  • While working on two of its own COVID-19 vaccine candidates, Sanofi will offer manufacturing support to J&J. Sanofi Pasteur’s vision “of a world in which no one suffers or dies from a vaccine-preventable disease” pretty much says it all.
  • Vaccine news is fast and furious these days — you can’t tell the players without a program. In Infectious Disease Advisor, Jessica Nye offers a helpful summary of what’s up with the AstraZeneca/Oxford vaccine, focusing on clinical trial results and the implications for public health decision-makers.
  • The U.S. has pledged $4 billion to the global COVAX initiative, designed to help spread the vaccine wealth around the planet. As far as U.N. Secretary-General Antonio Guterres is concerned, it can’t happen soon enough. He blasted the status quo as “wildly unfair and uneven,” noting that 10 countries account for 75% of all vaccinations to date.
  • Ten leading airlines are making room — and time — for precious cargo, signing agreements with UNICEF to prioritize shipment of COVID-19 vaccines, essential medicines, medical devices and critical supplies to more than 100 countries. The Humanitarian Airfreight Initiative, launched last week, will get airborne right away, delivering 2.5 million doses of COVAX-acquired vaccine to Nepal.
  • Let’s not forget the Novavax vaccine. It’s not approved anywhere just yet, but the company has already committed more than a billion doses to COVAX and negotiated purchase agreements with several countries. The company has also completed enrollment of its Phase 3 trial in the U.S. and Mexico.
  • Booster shots against SARS-CoV-2 variants are already in the works. The Food and Drug Administration issued guidance on Monday outlining steps for streamlining and expediting the review of boosters.
  • The European Union has struggled mightily with vaccine deployment, immunizing just 5% of its population in the same time the Brexited U.K. vaccinated more than 20%. Supply Management’s Charlie Hart explains how the 27-nation E.U.’s plan for joint procurement fell out of joint.
  • Why have new COVID-19 cases plummeted in the past five weeks? Harvard infectious disease expert Paul Sax ponders the question, including the possibility that we have achieved more herd immunity than we think via natural infection and vaccination. The most plausible answer, he adds, is that we don’t really know and that H.L. Mencken was right: “Every complex problem has a solution which is simple, direct, plausible — and wrong.”

The takeaway: We join our friends, neighbors and fellow citizens in remembering and honoring the 500,000 American lives — and the 2.5 million worldwide — claimed by this pestilence.

Source: Getty Images

The resources

Let’s keep on keeping up.

  • An hour-long webinar on communication strategies to build confidence and trust in COVID-19 vaccines is available from the Association of Schools and Programs of Public Health. Partners in the effort include the American Public Health Association and the de Beaumont Foundation.
  • Johns Hopkins has created a vaccine dashboard for people with disabilities to help them figure out where they are, state by state, in vaccine triage and to bring the attention of policy makers to the needs of this community.
  • The Covid-19 Vaccine: Facts for Direct Care Workers is a concise Q&A to help home care workers make informed decisions about vaccination. It’s provided by CareAcademy, an online training platform for home health aides, non-medical caregivers and personal care aides.
  • Although it’s been said many times and in many ways, the myths about COVID-19 vaccines bear repeated correction. Here’s a nice summary of fact versus fake in The Conversation.

The takeaway: There’s no substitute for factual, actual information. As Mark Twain once said, “Be careful about reading health books. You could die of a misprint.”

…and some songs (and a poem) in honor of Black History Month

Lift Every Voice and Sing, Alicia Keys

My Country Tis of Thee, Marian Anderson (at the Lincoln Memorial in 1939)

This Little Light of Mine, Odetta and the Boys Choir of Harlem (from the first Late Show with David Letterman after 9/11)

Someday We’ll All Be Free, Donny Hathaway

The Hill We Climb, Amanda Gorman (at the Presidential Inauguration last month)

In recognition of Black History Month, Haymarket Media is committing to an annual donation to the Association of Black Cardiologists.

Thanks for being here, and we’ll see you back again tomorrow with a concise, cutting-edge Haymarket Coronavirus Briefing newsletter. Stay safe.

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