Covid Vaccine Confidence

Dr. Derek Robinson (00:01):

Hello, and welcome to this webinar on how we will beat COVID-19. This is a joint presentation by Blue Cross and Blue Shield of Illinois and the Illinois Department of Public Health. My name is Dr. Derek Robinson. I'm Vice President and Chief Medical Officer at Blue Cross and Blue Shield of Illinois. And I'm pleased to have with me as a guest presenter Dr. Garth Walker from the Illinois Department of Public Health, where he serves as Deputy Director. Dr. Walker, how are you today?

Dr. Garth Walker (00:24):
I'm doing well. Thanks for having me Derek.

Dr. Derek Robinson (00:27):

It's a pleasure to have you as well. We're both emergency medicine physicians, but today we're outside of the emergency department, speaking to the public, speaking to our audience about how they can keep themselves their family members, coworkers, and friends safe from COVID 19, ways to prevent transmission, and also to answer some of their questions regarding the COVID-19 vaccines that are being deployed across the country today. Let us start by acknowledging the many individuals across the United States who have both been infected by COVID-19, affected by it, as well as those individuals who have lost their lives. Undoubtedly, there are many of you in the audience who have been affected by this pandemic personally. I know that Garth and I have, as well. So we certainly want to acknowledge the loss and the pain that we've experienced across our society. As we look at one of those slots on your screen, you'll see that it has some graphs that really illustrate some of the dark periods that we have seen over the last year with COVID-19, where we've seen dramatic rises and falls in the infection rate. Several of those occurring across 2020 in particular, a very large surge at the end of the year in November, December and extending into January.

Dr. Derek Robinson (01:40):

And so far, the early part of 2021 we've seen cases decline and as we've seen more vaccines roll out and you know, more optimism in society, we've also seen individuals begin to let their guard down. And so certainly there was a concern about, will we have another surge in COVID-19. Dr. Walker, I know that you're on the front lines in the state of Illinois, also communicating with public health leaders across the country. Some areas that we're hearing about a slight increase in COVID-19 cases, what demographics are we beginning to see that in, and what guidance would you have?

Dr. Garth Walker (02:16):

Thanks Derek, and thanks for highlighting that special point. When we look across the demographics, we do see that certain populations are affected more than others particularly Black and Latino populations. Part of that, those reasons and why we think that they may be more susceptible to COVID compared to other groups is just — for a multitude of reasons — but one of them is the social determinants of health, which we'll get to in a little bit later. But when we look at the numbers, Latinos have the highest positive positivity rate throughout our state followed by African American communities. And then when you look at nationwide indigenous communities and that rate has been relatively consistent throughout the pandemic. But when we look at it from not just positivity, but who is dying from it. So a lot of our communication has been very focused on partnering with community based organizations that have a rapport, that have trust with those communities and that we can help communicate some of those effective measures to help combat this virus.

Dr. Derek Robinson (03:26):

You know that's great information and certainly we've seen those communities that you noticed significantly affected throughout the pandemic, but we're also beginning to see young people be a major driver of cases here recently. Tell us a little bit about how we're seeing the numbers between the age groups change, you know, in this early part of the year. The cases overall they've come down, but we're starting to see some cases tick up.

Dr. Garth Walker (03:50):

Got it. So one thing that we've made sure of when we first started getting communication to different groups, as well as the vaccines to different groups, is prioritizing who's most at risk. And those who are most at risk are also typically more vigilant. And that tends to be people who are elderly. When we looked at the numbers, people who are 50 and older account for up to 98% of the deaths. Positivity rates, we see tend to increase among younger groups partially because they tend to have that kind of universal feel, invincible. They don't necessarily see their friends close to them getting sick, or just may not have that intimate experience as frequently as we see with nursing homes and people who may be more interactive with the elderly. But what we're really trying to communicate is that everybody's actions mean something that everybody is part of the solution in terms of fighting this virus. So talking to younger people who could serve as sources to transmit the virus, because we know that there's still people out there that are eligible that are not vaccinated yet and so we really need to make sure that we're disciplined as we move forward.

Dr. Derek Robinson (05:14):

Yeah, definitely means that the household discussions have to be candid and honest, right? Because the decisions and the actions of individuals across different age groups can impact the health of the entire household. So I think the big message we have here is we don't want individuals to let their guards down. We've seen a huge wave in terms of infection rates at the end of last year, beginning of this year, as well as hospitalization rates. And we have to be humble with this virus, right? Because we're still not sure what could happen around the corner. So we want people to remain vigilant. So along those lines, we've talked about this kind of three-pronged strategy in terms of our approach to COVID-19 that individuals first need to ensure that they do the three W's, right? So to watch their distance. So keeping at least six feet distance in public places, if they're wearing their mask and the current CDC recommendations are to wear two masks, two multi-layer masks. And the third is be sure we get good hand hygiene and that folks are washing their hands. Secondary is really ensuring that we try to improve treatment, right? And so, you know, you are on the frontlines treating patients in the emergency department. I'll just ask you a very quick question, because I think it's important for folks to hear this. Do we currently have a cure for COVID-19?

Dr. Garth Walker (06:32):

We don't necessarily have a cure, but we have some very, very effective tools. And when we talk about the vaccine and why everybody's so excited about the vaccine is because it serves as three potential benefits. One is that it reduces your risk of getting COVID. Two, it reduces your risk of transmitting the virus throughout your house, your viral load within your body is very low. And then lastly is that it improves your course. So for high-risk individuals, for example, people with end stage renal disease,
who we see have up to 11 times likelihood of death compared to a healthy individual, say they get the vaccine, say they give them a Moderna say they're that unlucky 5%, right? Because 95% efficacy in terms of protecting you against COVID 19 say that that unlucky 5%. So they get COVID instead of maybe having

a very, very difficult hospital course where they need to be intubated, maybe they just might have some fevers and chills. And then if you are, you just may have a couple of cold remedies instead of being admitted to the hospital, maybe you just might take the day off. So these vaccines are extremely important to us fighting this virus. It's not a cure, so we still need to make sure that we've masked physically distance and wash our hands. But it's very exciting news. But we still can't be invincible. We have to be able to stay disciplined throughout the course.

Dr. Derek Robinson (08:03):

That's absolutely right and I'm sure our viewers see some of the headlines on the slides in front of them right now that really, I think the salient reminder here is that we don't have enough hospital capacity to care for everyone if everyone gets sick. Right. So we definitely got to continue that effort to flatten the curve and ensure that we prevent transmission, that we keep individuals healthy and hopefully out of the hospital. So we don't want to let our guards down as we move forward with the pandemic. So, Dr. Walker, as we've moved through the last year, we've heard a lot of terms come up different come up regarding COVID-19 and health disparities and health equity. And I want to take a few minutes just to kind of ground our audience, because you began to talk about some of those earlier, and I think we'll take a few minutes to dive in.

Dr. Derek Robinson (08:49):

So, you all may have heard the term health equity and equity means ensuring that everyone has a fair and just opportunity to be as healthy as possible. It means that you are removing obstacles and barriers that may prevent individuals from having that opportunity to be as healthy as possible. And you're working continuously to try to ensure that you're measuring where differences in health outcomes may exist. And we commonly refer to some of those differences in health outcomes as health disparities, where you have certain populations that have a different health outcome relative to other populations. You also may hear the term health care disparities, and we talk about health care disparities you're talking about differences in how care might be provided to different populations relative to others. There's this other term called social determinants of health. We've got a nice illustration on the slide right now that has an individual there and it has all these things next to it. Dr. Walker, could you take just a couple of minutes to walk us through what are the social determinants of health? We're both doctors we're heavily engaged in providing care. We're ER doctors. So we know what it means to get in there and make a difference, but it sounds like these social determinants of health have a big impact on the health of individuals.

Dr. Garth Walker (10:02):

You're exactly right. Dr. Robinson, I think you hit it best with defining health care disparities and what those disparities do is provide an opportunity to investigate why those differences exist. And I feel like that's a great segue to social determinants of health. What are some of the issues that interfere with people's ability to achieve great health? Where they live the jobs that they do, the culture that they may have, the geography of where they may be in terms of with respect to access to healthy foods. But what this graph demonstrates is that 80% of your health profile is determined by those social determinants of health. And roughly only 20% is by just your general health intrinsic health. So when we think about people's ability to protect themselves against the virus, their ability to get their medications or how they get medications, that could be potential explanations for why these disparities exist and why we need to look a little bit further into what these issues are. And unfortunately they typically lie along racial and economic lines, which presents another opportunity to understand why those things exist as well, and also what type of issues to orient resources towards, and then as a health care provider, as you

mentioned just having a good understanding of our patients' lived experiences, which we probably agree that that can be the most difficult part of the job rather than some of the treating patients, treating heart attacks and things of that nature, try to make sure that they don't come back to our ER.

Dr. Derek Robinson (11:48):

No, you're absolutely right. And let's build on that because our next slide shows some of the graphs of different infection rates by race and ethnicity, for example, and death rates. And you talked about that a little bit earlier. To the lay person you may look at this and wonder what does that mean? That there is some sort of a genetic predisposition that leads to these differences in infection rate and death rate, but the research shows that that's not the case, right? Can you talk to us just briefly about, you know, what are some of the differences that we see in our minoritized populations in African-American, Hispanic, Native American populations in terms of the number of generations living in a household or the use of public transportation? What do we understand about that? And then connect the dots to us regarding one of the articles that you wrote that was published last year that talked about your experience in helping counsel a friend and their family.

Dr. Garth Walker (12:44):

Sure. One of the things that we are coming to understand more and more and it's dynamic as we go, because we can't necessarily anticipate everything but certain populations just have to adjust differently. And at times it's unfair. So you brought up the article that I mentioned. I was with my wife and one of our friends called us and said that their mother was sick — not sick, sorry. She had a roommate that was sick, that had COVID-19 and his grandmother had multiple medical conditions and they didn't have an alternative for where their grandmother should go. This was a two bedroom, roughly about 1,500-square-foot apartment with about six individuals in there. They had nowhere to put their grandmother. So I said that they needed to physically distance wash their hands and wear a mask. But the more we talk, the more unreasonable it seemed for that situation to be. And when we think about transmission and we think about COVID-19 and how it spreads, it's those environments where people don't necessarily have a choice. People don't necessarily have a choice to be able to stay home and not work, or maybe work virtually predominantly as we can, or be able to physically distance into another home or maybe move somebody that may be sick to another home. So we have to think about those issues and think about populations that just may have high proportion of groups that live that day to day. So we have to be a lot more intentional with our actions, as well as our solutions, as well as creative with how we address those solutions.

Dr. Derek Robinson (14:42):

It's very interesting how the pandemic has illuminated these differences that have existed in long terms in terms of how communities live, how they play, how they work and really having a virus that's contagious and also deadly that we haven't seen in our human population before how it's played out, and it's really made those differences pretty stark. In fact, Dr. Walker, if we began to look at changes in life expectancy, we know that a recent study looked at the deaths overall in the United States in 2020. And just looking at the first six months of the year, we lost one full year of life expectancy in the United States. And we actually saw that play out even differently as we looked into different subpopulations. African-American men, for example, like you and I, have lost three years of life expectancy in just the first six months of last year. So that doesn't account for that third wave that we saw at the end of the year. Hispanic and Latino men, I believe last two and a half years of life expectancy. So this certainly has very real impacts in our communities. And we know that nationally, in addition to the very strong work of public health departments, that retail pharmacies are going to be a major distribution method for the

vaccine. But we know that in some communities they've experienced a term described as pharmacy deserts, you know, where maybe in some minority communities or rural communities, pharmacies have left. As a public health professional, you've been on the front lines of trying to bridge some of those gaps in terms of getting vaccines supplied to communities that might not have those resources. Can you tell us, give us maybe two examples of some of the things that public health professionals across the country are deploying to help overcome some of those barriers?

Dr. Garth Walker (16:34):

Thanks. Dr. Robinson. Yeah. One of the major initiatives is building relationships with local health departments, as well as community-based organizations throughout the state, throughout the nation, so that we can communicate with different local health departments, what their specific challenges are. And then when we, when you talk about the topic of pharmacy deserts — populations that may not have equitable access to vaccines based on just not having many pharmacies — around how can we set up sites or partner with different community-based organizations that may be more local? They're doing that in the city in terms of their most high density COVID cases and partnering with organizations to be able to distribute vaccine accordingly to those groups and try to reduce those positivity rates. But oftentimes it takes a lot of intentionality, but also a lot of surveillance, making sure that we're getting the right data, making sure we're aware and able to anticipate where those gaps are so that we can make sure that we can control outbreaks, but ultimately save lives because being able to get the vaccine to these communities saves lives effectively.

Dr. Derek Robinson (17:58):

One of the things that you touched on was building trust, leveraging community based organizations. And I want to spend just a few minutes talking about distrust because we know that our health care system is not perfect. It definitely has some historical and contemporary challenges. And we know that certain communities, whether you're talking about the Native American community, the African American community and others have experienced health care differently than the majority of our nation. On a slide here, you see a couple of images that refer to some of the well-known breaches of trust that we see in health care — you know, the Tuskegee syphilis experiment, the story of Henrietta Lacks, which I'm sure many people have either read the book or seen a movie about that. There are some legitimate reasons why some communities may be distrustful of our health care system,
distrustful of our government, especially around this effort to improve vaccinations. And so I think part of what we're discussing today is trying to sort of distinguish the difference between those things that have happened in the past, or even recently, and the effort around getting America vaccinated against COVID-19 and really help and prevent transmission of the virus so that we can save all communities, which is really important. There was a survey done that was published last year in 2020, that looked at how adult Americans experience health care. And 1 in 5 adult Americans say they have experienced some form of discrimination in the health care system, whether it was based on their gender, weight, income, insurance status. And one of the highest ranking areas was the experience of discrimination by race and ethnicity. So we know that there are some structural challenges that we have in our health care system both that can impede access to health care people's ability to get services. There are the social determinants of health, whether individuals have access to transportation and can get to a mass vaccination site, for example. And then also challenges with trust. So all those things come together to present some unique challenges for us. Even as we get outside of the experiences of minoritized communities, even just generally our political discourse over the last year has made it challenging for folks to trust our institutions. And so we saw a high level of concern about or hesitancy and individuals' plans to get vaccinated, but we were beginning to see that trend move in the right direction. You've

been out having a lot of conversations. What is your sense right now in terms of individuals or communities' likeliness to get vaccinated?

Dr. Garth Walker (20:44):

I'm optimistic, I think the more that we partner and the more that we communicate — and it's not just IDPH, it's been so many groups throughout the state and city — we have seen a shift. Initially vaccination hesitancy was upwards around 60% among the Black population, so roughly around 40% were gonna take the vaccine. We've seen that number significantly reduce. And to your point, there's a lot of distrust, but in that communication, in that partnership with different organizations, we're highlighting a lot of the issues and concerns that communities may have. And one of the things that communities want to know is who's vouching for them. How has it being validated, not necessarily the nitty gritty science. So for example, the National Medical Association — the Black physicians association — independently looks to see if this vaccine affects Black populations more than one group or not, or if there's more adverse reactions for Black populations compared to others. And at the end, they recommended that we need to take the vaccine. And then we also highlight how there are Black physicians taking the vaccine and more Black physicians on social media, posting their vaccine. Or could there be other time in our lifetime. And those actions matter, because we need to know that it's safe and that it's different from prior history. But also, explaining the context of just how much this is affecting our community, not just from a medical standpoint, but socially and economically and the leaders that we've lost throughout this trajectory. And through that discussion, we've been able to see some improvement within minority communities. But like you said,, we still have work to do. And there are groups that have mistrust.

Dr. Derek Robinson (22:49):

Yeah, that's great to hear. And I know that we have some data that's shown at least early in the vaccination efforts that we saw lower rates of African Americans getting vaccinated in certain states that are collecting that demographic data. But I think as I listened to your comments reminds us of why it's important to collect a number of different demographic data points as we provide care, right? Because we may see differences in how an uptake in vaccination between men and women or by racial and ethnic groups. We've also seen data regarding political affiliations and how we might see differences in vaccine uptake there. The reason those things are important is because it allows us, allows public health professionals, to curtail their message, curtail their tactics in terms of how you engage different groups to help them where they are in terms of what might be a driver of hesitancy or concern for them. So let's shift gears here because we want to move folks from distrust and concern and really get towards convincing individuals to get vaccinated. So there are a couple of pictures up on the slide there. I see myself, I think I see you as well. So I got my two doses of the vaccine first in December of last year. And second in January of this year. What about yourself?

Dr. Garth Walker (24:09):
Yes. I got my, I've been vaccinated for about two months now. So fully vaccinated. I got my second dose

around January 21st.

Dr. Derek Robinson (24:19):

Great. So I think it's important for us to be credible messengers around this. It's one thing to tell folks to go and do something you haven't done it yourself. People get a little concerned about that, right?

Dr. Garth Walker (24:30):
Of course. So you can't go around talking about this type of discussion and not be vaccinated or not plan

to get vaccinated.

Dr. Derek Robinson (24:39):

So we've got a chart up on the screen right now that lists three of the FDA authorized vaccines that are in distribution in the United States. Two of those vaccines are two-dose vaccines. One is a single dose vaccine. There's some data there regarding the number of vaccines that have been administered as of the date that that chart was put forth. Can you talk to us a little bit about this next slide that addresses some very specific concerns regarding if an individual is pregnant, what should they think about in terms of getting vaccinated. Or if they have an autoimmune disorder or if they've been infected with COVID before, should they get vaccinated? How long should they wait before they get vaccinated?

Dr. Garth Walker (25:22):

Sure. So with respect to — I usually say the special populations, but it could also include people who just have a very unique medical condition — talk to their physician on a regular regular basis. But I'll include pregnant women. If you're pregnant and you have some concerns about the vaccine, talk to your OBGYN, because they will be the person that can give you the best advice. They know your health profile, they know your history. But in general, American College of Obstetrics and Gynecology recommends that people take the vaccine because when they compare the risk of actually getting COVID versus adverse effects of the vaccine they think that it's safer to get the vaccine. If you have allergies, and when I say allergies like can list four or five allergies, talk to your physician. One of the most severe side effects is anaphylaxis and Dr. Robinson has treated this a million times as well, but just think of a really bad allergic reaction where your body swells up your voice changes. You have to take that shot. You'll see people have an Epi pen. Just talk to your provider. It's likely that they will still tell you to take the vaccine, but you'll likely be observed a little bit longer compared to others — instead of 15 minutes, probably be observed for 30 minutes.

Dr. Derek Robinson (26:42):

One thing, I'll just jump in and add there, Garth, you know, the likelihood of having an allergic reaction we believe is fairly low, right? But we do know how to treat allergic reactions, right? With COVID, we're learning how to treat it better, but we can't cure the infection, end the infection, that kind of thing. Allergic reaction, we've got a whole algorithm that we know how to take care of that, right?

Dr. Garth Walker (27:05):

Right, exactly. So, and just with some numbers real quick, of the first 1.2 million, 10 people had anaphylactic reactions. So it's less risky compared to getting into a car accident just in your day-to-day activities. But to the last part, if you've had COVID before, it's still recommended that you get the vaccine. And I think this is a very important point to talk about really quickly. The recommendation is to wait 90 days, because we think that people have some form of natural immunity, meaning some protection that your body built. But we have seen cases of reinfection. But the reason why we say that everybody should get vaccinated even if you've had COVID is because when you examine the world, we see an increase in variants — meaning, increase in COVID-19 that is a little bit different from the original, which could make it harder for the vaccine to be effective against. Right now, the vaccine is effective against all the variants, but if the longer it takes for us to vaccinate everyone, the higher, the possibility we have of another variant that is completely unique being exposed to our community.

Dr. Garth Walker (28:18):

And that's when you'll see the outbreak start picking up, that's when you'll start seeing our hospitals that Dr. Robinson said that we would get really nervous about in terms of our ICUs building up and making it very, very difficult for us to treat some of the most mundane emergencies that we see on a regular basis. So I just wanted to make sure that we talked about that because that's a question that comes up quite often, and I think it also explains the urgency around making sure that we beat the rate of new variants.

Dr. Derek Robinson (28:52):

Absolutely. So we're in this race against the variants. And so we've definitely got to get to that herd immunity, get up to 80, 85% of our population vaccinated in the near future. So we're around in the last corner in this webinar, we're going to do a little bit of rapid fire back and forth. So we've gotta be the myth busters, right? Because there are a lot of myths out there that are standing between some individuals and getting vaccinated. So let's run through some of those myths. So myth number one is that the vaccine is not safe. It's been rushed, we've violated — they've not gone through all the safety protocols and it's not safe. Is that true or false?

Dr. Garth Walker (29:27):

False. This is by far the most scrutinized vaccine of all time. You've had so many scientists looking at it. Part of the reason why it was more efficient is because they moved a lot of the tape but the science behind it is the same science that's been applied to all the vaccines that your children have gotten at their pediatric appointments and that women have gotten during their pregnancy visits.

Dr. Derek Robinson (29:52):
All right. Great. Second myth. The vaccine doesn't work in individuals who live with obesity

Dr. Garth Walker (29:59):

Myth. In fact, we want people who are obese, who have co-morbidities to definitely get the vaccine. We see that people who have co-morbidities have more challenging outcomes and more challenging courses when they have COVID. So they're one of the groups that we want to make sure are getting it.

Dr. Derek Robinson (30:17):
All right. Next myth is the virus is actually in the vaccine. And so if I get the vaccine, then I can come

down with COVID from getting vaccinated.

Dr. Garth Walker (30:32):

False. So when we think about the three vaccines available, there's a viral vector and then there's two MRNA vaccines, and I'll do a quick analogy real quick. Both of them do what they're supposed to do, which is prepare your immune system to fight against the virus. So if I'm a boxer and I go into a ring with somebody that has a very unique form, I didn't prepare against, I'm either going to get knocked out really early or die. But if I have a time to prepare for that person, I mean, get into Rocky mode, watch tape and get in shape. I'm either going to last longer or I'm going to beat them. And that's what these vaccines do. They expose your immune system, prepare your immune system to fight against something that was novel, but no longer novel, because they showed a portion of the virus to our immune system.

Dr. Derek Robinson (31:26):

Great, great. So there are a bunch of additional myths on our next slide and I'll just hit the highlights. So there's no microchip in the virus. If you go get the flu vaccine, the flu vaccine does not help with COVID. So you need to get the COVID vaccine to provide you with protection from the COVID virus. So definitely, you know, we want to ensure that we are providing good information as trusted resources to all of our audience participants so that they can go and get vaccinated and encourage individuals and their families to get vaccinated as well. As we wrap up today's discussion, I do just want to remind us that we still see significant differences in infection rate and death rate across some different populations. So it's really important that we're all aware of what are the things that we can do to keep ourselves safe.

Dr. Derek Robinson (32:16):

And so we know that wearing masks works. We know that it's important to wash our hands, to watch our distance. There've been improvements in treatment for COVID, but no cure for COVID. So it was very important that we get individuals vaccinated. And as Dr. Walker has noted, we are currently in a race against the variants. And so we've got to ensure that we get our communities vaccinated, allow us to move our way of life back towards normal at sometime in the future. But we also want to ensure that we don't let our guard down. We've got to protect the ground that we've gained and we have to be humble. So this virus has thrown us some curveballs over the course of the last year. We certainly, again, want to ensure that we're doing everything that we can to protect ourselves and allow us to thrive and have a healthy economy as well.

Dr. Derek Robinson (33:05):

If you're looking for more information on COVID-19, ways to stay safe, as well as the vaccine, we encourage you to visit your local public health department. We certainly encourage you, if you're in the state of Illinois, to visit the Illinois Department of Public Health's website. They have a lot of great information there. Also a lot of useful information available at the website of the Centers for Disease Control and Prevention or CDC. Again, Garth, thank you so much for joining us today. It's good to see you. We're not in the ER but we're making a difference impacting the lives of many individuals. And so we're happy to have you help bring this message.

Dr. Garth Walker (33:43):
Thank you, Derek, and thank you Blue Cross Blue Shield for having us.

Dr. Derek Robinson (33:46):

It's been our pleasure. So thank you all very much. Have a great day. And thank you for joining today's webinar.