According to the Centers for Disease Control and Prevention (CDC), initial COVID-19 vaccine roll out and distribution is planned to start before the end of 2020. While challenges exist around the distribution itself, another hurdle is emerging around COVID-19 vaccine attitudes. A Dec. 3 report from the Pew Research Center showed that 39% of U.S. adults would not want to get a vaccine once approved.
University of Minnesota Medical School Vice Dean for Diversity, Equity and Inclusion Ana Núñez, MD, FACP, talks about why these attitudes exist and how they could limit access to certain communities, particularly people of color.
Q: Why is there so much uncertainty surrounding COVID-19 vaccines?
Dr. Núñez: It is complicated. We are trailblazing as we move forward, and we are discovering and learning in a new and rapid fashion. Instead of different groups — national, academic, and industry — all working separately, it’s as if we all got into a race car on a fast track, mobilizing, leveraging, and using the brain trust of scientists and the ‘can-do’ attitude of those in the U.S. We went from going 40 mph (and having the usual three years to develop a vaccine) to going 100 mph and having it within the next few weeks and months. We’re all flooded every day with new information, and it’s hard on some days to know what and who to believe. We, as scientists, work in a way to constantly seek to improve on the knowledge that we have by discarding what turns out to be wrong and build on what is right. To an outsider, that can sometimes look like we don’t know what we’re talking about and that we keep changing our minds. For this reason, people are right to feel hesitant, but they also need to feel open to making informed choices. All of us want a safe way to move forward, but different people have different ideas of how to do that safely.
Every 20-30 seconds (at this writing), someone is dying from COVID-19. We need to equitably figure out how to balance preventing deaths and the spread of disease with protecting healthcare systems, so that we can work on keeping people well. Achieving equity means we need to first agree on the end goal. To move forward, we need to come together in agreement that a) we are better together fighting this pandemic; b) we value fighting the virus to protect lives; c) we need to achieve and keep safe healthcare systems so people can be and stay well.
Q. How can we achieve this equitable balance — of who is at highest risk to receive the vaccine?
Dr. Núñez: There are several factors:
- Geography — How likely someone is to come into contact with someone with the virus varies greatly. Do they live somewhere where it’s likely that even going to the grocery store will lead to an exposure? Compare that to someone else who would have to be in a crowded bar to be exposed.
- Personal risk factors — Do they have medical issues that make them higher risk for severe disease? For example, compare someone in relatively good health with someone with diabetes and hypertension.
- Occupational exposures — A paramedic has a much higher risk than a stay-at-home worker.
A lot of other factors are going to be harder to define. For example, should someone who has already had COVID-19 be vaccinated? Probably, yes. Is the answer still ‘yes,’ though, when there’s an early shortage of vaccines? All of these factors will have to be weighed together and then policies formulated to guide who gets the vaccine first.
We need to make sure that we — and I’m speaking about us as part of a larger system that includes health care workers, large institutions, and governmental agencies — get it right. We need to make it easy for people to get information, have accessible places to be immunized without cost, ideally without having to take off from work and lose pay, and be able to help them keep track of which vaccine they get and when and if they need a second one.
Q: What part of our communities could be most affected by this hesitancy in receiving a vaccine?
Dr. Núñez: Unfortunately, the communities of people who are most affected by the pandemic are also more likely to be the most hesitant about a vaccine. Communities of color have disproportionately been affected by higher rates of COVID-19 and more deaths. Historic issues involving the lack of access and discrimination have led to worse health outcomes in general for those populations, which has been multiplied with COVID-19. Now, that same community has to believe on faith that this vaccine that was developed in record time is a good idea for them.
Q: Why should the public be confident in receiving one of the vaccines when they are available?
Dr. Núñez: Take people who are working as hard as they can to keep their families together and food on the table, who maybe even lost someone they know and love to COVID-19. They’re going to be asked to put their faith in scientists, even when there’s a lot of noise out there right now. It’s up to us to counter the misinformation by listening to people’s concerns and by leading by example. I have to be willing to get the same vaccine that I’m asking them and their families to take.
And, with the rising deaths, we need this as soon as possible. Why I am confident and I think others should be as well is we now have results from this focused work and there are safety steps along the way. One of those steps include the Advisory Committee on Immunization Practices (ACIP). This is a group of serious scientists, who have all been cleared for any conflict of interests. Their incredibly important job is to look at the data and evidence and provide a recommendation. This data doesn’t just come from the company making the vaccine. It is redone and rerun from the FDA. The ACIP then looks at the FDA’s information and makes their recommendation. Once the ACIP greenlights the vaccine, we can be comfortable and confident that they rigorously made sure that it is safe and ready for us.
Q: What else is the University of Minnesota doing to further public understanding of COVID-19 vaccines?
Dr. Núñez: The University of Minnesota, as well as the U of M Medical School, has many initiatives underway to help further the understanding of COVID-19 vaccines. These include the tireless engagement of health care professionals in our clinics, like the Community-University Health Care Center; the Medical School’s Rapid Response Grants to Reduce Racial/Ethnic Disparities in Healthcare; our focus in the new Office of Diversity, Equity and inclusion on vaccine acceptance; our new centers, like NRCRIM in collaboration with our university and public health colleagues to help state and local health departments create culturally appropriate material for refugees, immigrant and migrant communities; and CIDRAP to generate a one-stop resource for the general public to get comprehensive and usable information about the vaccine.
Dr. Ana Núñez is the vice dean for diversity, equity and inclusion and a professor of medicine at the Medical School. She is nationally recognized as a medical education and health services researcher, having developed novel curricula in the areas of sex and gender medicine, primary care, trauma/violence prevention and cultural competence. Dr. Núñez is experienced at speaking to the issues of vaccine and/or inoculation distribution in equitable and fair ways to communities that most need access.
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