HJNO Mar/Apr 2021

VACCINE RESISTANCE 10 MAR / APR 2021 I  HEALTHCARE JOURNAL OF NEW ORLEANS   Dianne Hartley, Editor US Healthcare Journals’ research shows that these groups in the U.S. are most likely to resist taking the COVID- 19 vaccine: women of childbearing age, anti-vaxxers, radically right-wing religious groups, undereducated, African Americans, Hispanics/Latinos, American Indians and other unique groups, with unique objections. What are their objections? Charles Stoecker, PhD: “ Anti-vaxxers” exist on a continuum between outright refusal all the way to acceptance. There are some people in this group who have concerns that can be addressed by education from trusted messengers. Unfortunately for some in this group, the trusted messenger isn’t necessarily a healthcare professional. It’s helpful to think about people with de- grees of hesitancy rather than categorizing them as anti-vaxxers when interacting with individuals one-on-one. Recent research suggests political con- servatives in the U.S. place more weight on the opinions of people in their close net- work than in experts otherwise unknown to them. This presents a challenge for com- munication of medical information but also presents an opportunity if these networks can be leveraged. African Americans may have had experi- ences with individual or systemic racism in encounters with the medical establishment. The atrocities of the Tuskegee experiments cast a pall over even the best intentions. Trusted messengers may be a powerful force in coronavirus vaccine acceptance messaging (such as former president Bar- rack Obama being vaccinated live). Some data suggests that people living with HIVmay have concerns about interac- tions between the coronavirus and either HIV medications or HIV itself. This popula- tion may be amenable to messaging from trusted HIV medical professionals. M. “Tonette” Krousel-Wood, MD, MSPH: Our work with LA-CEAL is focusing on vulnerable populations in Louisiana — pri- marily African Americans and also includ- ing Hispanics/Latinos, American Indians, low income and rural populations. There are several concerns of individuals in these groups that are contributing to vac- cine hesitancy: concern about side effects and safety of the vaccine, concern that the development of the vaccines was rushed, concern that the vaccine might “give them COVID-19,” unsure about how well it works in people like them in their communities, sense of distrust in government and sci- ence because of historical failings of these groups to “do no harm,” and concern that the vaccine may change their DNA. There is also a lot of misinformation andmispercep- tions about the COVID-19 vaccine circling in social media and beyond; these must be addressed so that people have the accurate and relevant information in a timely man- ner to make informed decisions about the vaccine for themselves, their families and their communities. In our LA-CEAL work, there is also initial feedback from our com- munity that people are motivated to vacci- nate to ensure their safety and the safety of their family, friends and community. Editor How are you advising practitioners to address these concerns, and do you feel any have merit? Stoecker: It’s tough to take the time to delve into a patient’s vaccine concerns in an ap- pointment where a lot of things need to be done. Listening and engaging can be effec- tive but may take time from other pressing medical issues or from other patients. Un- fortunately, there is a trade-off here. Krousel-Wood: We are advising practitio- ners to get informed about how COVID-19 vaccines work, their safety and efficacy — overall and in different age, race and sex groups — so that they can address the concerns of their patients. There are mul- tiple resources to learn about COVID-19 and the vaccines: Louisiana Department of Health, Centers for Disease Control and Prevention, and the Louisiana CEAL https://haltcovidla.com/ to name a few. Some key facts are: the vaccines do not cause COVID-19; the two approved vac- cines for emergency use (with more on the horizon) work well in providing immunity with Moderna and Pfizer vaccines report- ing >94% effectiveness (after two shots) in women and men and across racial groups; the vaccines are safe with the majority of patients reporting only mild symptoms such as arm soreness and mild fatigue for 24-48 hours post vaccine (severe allergic reactions are rare and should be moni- tored); the vaccines were not rushed — they were accelerated with the availability of technology and large investments that al- lowed simultaneous assessments of phases of vaccine development — no steps were skipped! Editor Do you believe these approaches dis- cussed above will be successful to achieve herd immunity from COVID-19? And what, in your opinion, happens on a global, national, local and group scale if we do not achieve it? Stoecker: Herd immunity is a patchwork quilt as we have seen with outbreaks of measles in some schools but not others. Some modeling suggests a target of 70% for heard immunity. Recent surveys indicate approximately 80% acceptance of the vac- cine among Asian adults, 60% acceptance of the coronavirus vaccine among Hispanic and White Adults and 40% acceptance among Black adults. We do know from in- fluenza data that parents are more likely to immunize their children than themselves, so immunization rates among children may