President Biden suggested that, by the end of May, all Americans who want a COVID-19 vaccine will be able to get it. There is only one crease in the plan: not everyone wants one. Recent research suggests that about a third of adults in the United States are skeptical about the effectiveness and safety of the new vaccines. Hesitation is understandable; there is a lot of misinformation circulating. And, as with all things related to your personal health, it is okay (even) to ask questions. But when it comes to infectious diseases, a collective response is needed to prevent it from spreading.
So we decided to ask some common questions about coronavirus vaccines for Uché Blackstock, MD – Harvard Medical graduate, emergency physician, former associate professor at NYU, medical contributor to Yahoo News and founder of Advancing Health Equity, a consultancy that has partnered with organizations to address issues of prejudice and racism in healthcare. Dr. Blackstock is one of many medical professionals in the country tasked with combating false news with facts. Your opinion: people should feel confident to get the vaccine. Here’s what else she has to say.
At the beginning of the pandemic, we learned that the vaccine developed most quickly took four years. How can we explain how quickly COVID-19 sockets were developed and approved? Were any corners cut with the tests?
This is a concern that many people have, and it is understandable why the public health message surrounding the vaccine was not what it should be. Research on mRNA vaccines – and also other types of vaccines that are being approved now – has been going on for years, so these vaccines were not developed overnight in terms of the technology used. Due to the urgent nature of the pandemic, the government has invested billions of dollars in vaccine research and development, partnering with private manufacturers in a way that has provided resources to develop vaccines in this fast-paced schedule. No steps have been cut. Typically, vaccine development takes 10 years because all steps are carried out sequentially. But, because of all the resources invested in this effort, these steps took place in parallel, significantly reducing the time, without saving on shortcuts. These vaccines have been tested on more than 100,000 people and have been given to millions of people so far. All of them have proven to be safe and effective. People must have confidence in them.
It seems that what you are saying is that the way the timeline has been accelerated has been cutting red tape, not cutting science.
Exactly. This is a nice and succinct way of putting things.
You mentioned mRNA vaccines. How are these vaccines, developed by Moderna and Pfizer, different from the vaccines I may have received in the past?
The goal with these vaccines is to show the body something that looks like the coronavirus, but it is not the coronavirus, so that the body can develop antibodies. With these new vaccines, the genetic material called messenger RNA, or mRNA, is injected into the body and instructs our cells on how to make a portion of the coronavirus spike protein. This peak protein is responsible for clinging to human cells and infecting them. As soon as the immune system sees the manufactured spike protein – which is not the actual spike protein in the virus, but looks like it – the body develops antibodies. In the case of a future infection, these antibodies bind to the virus’s spike protein and neutralize it.
So it appears that these vaccines train the immune system through simulation so that, if your body needs to confront the real coronavirus, it knows what to do.
Right. One of the things I have heard people expressing concern about is that cells can somehow incorporate this genetic mRNA material, and that it will remain there permanently. What is really important to know is that the injected messenger RNA disintegrates. It does not become part of your genes; it is transitory.
We received so many reasons to be suspicious of the previous government, especially with regard to the management of the pandemic. And in addition, there are many marginalized communities – black Americans and other people of color, the LGBTQ + community, incarcerated people – who have been ignored or actively harmed by the “medical establishment” in the past. How can people trust the information they hear about vaccines?
Much damage was done. Before January 20, we didn’t get many accurate and responsible messages about the federal government’s coronavirus, and I think that has become embedded in people’s ideas about the vaccine. We saw an unprecedented level of political interference in the work of the FDA and CDC, and we had leaders who did not follow science or act in a way that was rooted in evidence. For this reason, a significant part of the country still does not think the pandemic is so serious or that the masks work. There is an abundance of misinformation and it is extremely important that my medical colleagues and I know around and that our voices are amplified so that the public can hear reliable science-based messages.
This idea of hesitation of the vaccine, I like to reformulate it more as an idea of institutional reliability. Institutions have a history of exploiting and abusing marginalized communities. Because of the urgency of that moment, there is an impulse to tell people, “Just get the vaccine,” and you really can’t do that. We need to make sure that we are transmitting information to people in a culturally responsive and deeply digestible way, so that they can have their questions answered by people they trust. Some people may not trust the health care “institution”, but they trust their individual health care providers, their nurses and their doctors. Trusted messengers in the community – religious leaders, barbers, community organizers – also do a great deal of health advocacy, especially in black communities and other communities of color.
This is what systemic racism does. It exploits and abuses, and then, when the time comes for communities that have been disproportionately affected by racism to seek care, people become suspicious. In this story that you mention – Tuskegee, Henrietta Lacks, “Mississippi appendectomies” – there is a certain percentage of the population, especially older black Americans who remember that. But I also think that we cannot forget the continuous discrimination that blacks face when they interface with the health system today. It is not just what happened in the past, it is the present as well.
Another institution that many consider untrustworthy is the pharmaceutical industry, which has paid billions of dollars in deals for fraudulent marketing and tuition fees to health care providers. Modern may not be considered Great Pharmaceuticals –they have only been around for 10 years, and this vaccine is the first drug to hit the market – but Pfizer certainly is. Why should we trust private companies when it comes to public health?
I understand the concerns and I will say that I am extremely convinced by the data that we have seen. The flu vaccine has an effectiveness between 40 and 60% and, to obtain emergency authorization, a vaccine needs 50% effectiveness. Moderna and Pfizer photos are 94 to 95% effective. This is almost a miracle. I continually assess the risks and benefits and, although institutions have been untrustworthy in the past, we are in a situation where we cannot say no to the vaccine. The only way for people to be able to see their loved ones again, to travel, to see a newborn cousin is to actually get this vaccine.
My perspective is of someone who was on the front lines here in New York City in March and April, when we were the epicenter of this pandemic. I work in an urgent care clinic and saw people – even young people in their 20s and 30s – who were sick enough that I had to send them to the emergency department. I was incredibly humbled by this virus. I was afraid of what would happen to my patients. I was afraid to go to work, worried about bringing it to my family. So my perspective is that I saw the worst of it, and here we have these vaccines where the data is incredibly convincing. They are not only safe, but also effective. So even if these pharmaceutical companies have a history of being unreliable, weighing the risks and benefits of being vaccinated versus being infected with this virus, it is safer to get the vaccine than to be infected.
And if someone is thinking: it’s my body, and if I decide not to get the vaccine, it’s a choice I’m making to take that risk. Is this just a personal decision?
It is almost a privilege to say that you do not need to be vaccinated. This pandemic exposed profound systemic inequalities in our country. Black, Latin and indigenous communities are disproportionately affected by the virus. Blacks are dying at the same rate as a white person 10 years older than them. At the same time, here in NYC, there is also a disparity in terms of who is being vaccinated. In the Black and Latinx neighborhoods, you have people from outside these communities, non-residents, who come to be vaccinated.
Therefore, communities of color are more likely to die from COVID-19 and are also having trouble accessing the vaccine.
Yes, and people are thinking: I don’t need to wear a mask if I don’t want to or Nobody can tell me to get a vaccine instead of thinking about the community. Ultimately, we cannot keep everyone safe unless everyone is vaccinated. Especially with infectious diseases, we need a collective response to mitigate the spread. While individual behavior is important, we need everyone on board to see any positive changes. When you are infected with COVID, you put other people’s lives at risk. That’s how the virus works. We are interconnected. What I do affects other people and I have to worry about what happens to my neighbors because it affects me directly.
How do you talk to patients who may be concerned or who may be skeptical about the vaccine? And how do we talk to friends?
A conversation is not going to change your minds. Often, people just want to share their concerns and I try to answer their questions in an incredibly non-judgmental way. My goal is not necessarily to convince them to get the vaccine, but to make sure they have the information they need to make an informed decision. This is really all we can do.
Originally appeared on Bon Appétit