A COVID-19 vaccine could be offered to some of California’s essential workers as early as next week. When it becomes more widely available, health care providers will be responsible for distributing it swiftly and safely to the general public.
Many physicians are already laying the groundwork for how to do that, but they’re expecting resistance from at least some of their patients.
“We can't really figure out human behavior very well, and we don't know what people will decide,” said Dr. Beatrice Tetteh, a Sacramento pediatrician. “I have heard from many people concerned about ‘well this happened so fast … this vaccine, can it be trusted? Will it be OK?’”
Between May and November, the percentage of Americans who said they would “probably” or “definitely” not get a vaccine climbed from 27% to 39%, according to the latest Pew Research Center survey.
In California, opposition to a potential COVID-19 vaccine has been brewing since the spring, driven largely by people arguing against government restrictions on personal freedom. At public demonstrations, people voiced their refusal to get immunized against the virus, while also arguing against masking mandates, physical distancing and stay-at-home orders.
“Most recently those anti-vaccine groups have led not only in opposition to vaccines, but opposition to any public health measure to limit the spread of the coronavirus,” said Sen. Dr. Richard Pan, a Democrat from Sacramento who has authored several laws to increase immunization in California.
He says there’s still a concerning amount of false information about immunization on social media.
“So that’s going to be a particular challenge for physicians and public health advocates and other people who are trying to get accurate information about vaccines out to the general population,” Pan said.
Professional organizations such as the California Medical Association are offering educational materials to help doctors up to speed on the current vaccine trials, and to prepare them to speak with patients who hold fears or misconceptions about immunization.
Vaccine Basics
The Immunization Action Coalition, a Minnesota-based group that partners with the U.S. Centers for Disease Control and Prevention to distribute accurate vaccine information to the public, recently worked with researchers at Georgetown University to prepare a list of questions that doctors should expect to get from patients regarding the COVID-19 vaccine.
“Clinicians are likely among the first to be offered COVID-19 vaccines and have a key role in helping patients make decisions about vaccination,” the authors wrote. “Providing evidence-based information will be particularly important in an environment of polarization and mistrust.”
Here are some of the topics that will likely pop up in doctors’ offices this winter and spring, and some brief responses suggested by the researchers.
Efficacy: The CDC expects the COVID-19 vaccine will prevent disease or increase its severity in at least 50% of people who are vaccinated. The U.S. Food and Drug Administration has confirmed it will only author temporary approval for a vaccine, also called an Emergency Use Authorization, with “substantial evidence of safety and efficacy”.
Safety: Doctors should prepare their patients for side effects. It is likely that vaccination will be associated with mild adverse events like soreness at the injection site, fever, fatigue, and muscle aches. Patients should understand that rare adverse events may only be detected as a vaccine is widely used, and that health officials are closely monitoring and evaluating the situation.
COVID-19 restrictions: A large portion of the population will need to be immunized before virus transmission is significantly reduced. The duration of immunity provided by the new vaccines are unknown, and may wane over time. Even after vaccines become widely available, public health measures such as masking and social distancing will still be needed for several months.
Children and pregnant women: Young children and pregnant women have not been included in COVID-19 trials, and will likely not receive the vaccine until it’s distributed to healthy adults.
Dr. Richard Pan says physicians need to clearly convey accurate information to patients, and not pass judgment on those who say they’d rather not get the shot.
“So the patient says, ‘well, I am not interested in getting this vaccine,’ I want to ask ‘why?’ What have they heard about the vaccine?” he said. “[Physicians] want to be sure that their patient actually is making the decision based on accurate information … Not to say, ‘well, you're wrong,’ but to listen to the patient and address their concerns or their fears about the vaccine.”
Making Preparations
In Orange County, Dr. Shannon Connolly says talking to patients about vaccines is part of her daily work.
“It's just a really important part of preventive health care,” she said. “And as far as how my patients are responding, it really runs the gamut. I have patients who make appointments specifically coming in for a vaccine, and I also have patients who are deeply distrustful of vaccines and unwilling to get them.”
But while she’s been discussing flu vaccination for years, she says COVID-19 presents new complications.
“Because the pandemic has become so deeply politicized in our country, patients are much more distrustful of, or will be much more distrustful of, the COVID-19 vaccine than they have been historically of other vaccines,” she said. “I think they're afraid that the politicization of the pandemic has resulted in the development of an unsafe product, or the development of a product that came out too quickly without sufficient safeguards in place.”
Connolly says she’s been doing research outside of her office hours to ensure she’s ready to reassure patients about the safety of whatever vaccine becomes available.
Dr. Pan says while vaccine education is a vital part of a physician’s job, it also pulls their attention away from other important public health issues.
“The spread of disinformation in the general public does have a cost to it,” he said. “And part of the cost is the time we have to spend to debunk that information that gets to people … You know, 20, 30 minutes on average doing that instead of talking about things like nutrition or the child's development or other safety concerns as well.”
Doctors also need to be ready to talk to patients about the logistics of getting immunized against coronavirus.
The COVID-19 vaccines the FDA is currently considering have to be administered in multiple doses. The American Medical Association recommends physicians start making a plan now for how they’ll communicate with patients to remind them to get a follow-up dose, and how they’ll document which patients have received which shots.
“It’s hard to remember to take medicine once a day, let alone, ‘oh, I need to make another appointment for another shot’,” said Tetteh, the Sacramento pediatrician. “That can take time because people have different schedules.”
Cultural Considerations
There are many reasons people might be hesitant to take the COVID-19 vaccine, especially if they are part of a racial or ethnic group that has been subject to unethical medical experimentation in the past.
“Really disgracefully, our country's medical establishments have a long history of abuses of vulnerable populations and particularly communities of color, and this has resulted in distrust,” Connolly said. “So it's my obligation to understand and acknowledge that, and begin these conversations from a position of working to establish trust with my patient before I can begin to even address vaccine hesitancy.”
The U.S. has a history of testing out treatments on people of color without their consent — a prime example being the Tuskegee Syphilis Study of 1932 involving 600 Black men.
Another issue is the lack of representation in clinical trials. African Americans make up 13% of the U.S. population but only 5% of clinical trial subjects, according to the Center for Information and Study On Clinical Research Participation. Latinx residents make up 17% of the U.S. population and only 1% of clinical trial subjects.
“It’s critical that there be diversity in the COVID-19 clinical trials,” said Dr. Arleen Brown, a professor of medicine at the University of California, Los Angeles, in a recent California Medical Association webinar. “In order to have people take up the vaccine, they have to have a sense that this is a vaccine that will work for them.”
Cultural groups are doing their part to educate people about vaccine safety — the NAACP is holding a virtual town hall on the topic next week.
And around the world, doctors and scientists are taking to social media to address concerns from patients who aren’t sure about getting their COVID-19 shots.
