With COVID-19 vaccines available to all Kansans age 16 or older, public health officials are battling a different pandemic problem: vaccine hesitancy.
Experts say the COVID-19 shots are as safe as any other routine vaccine, and they are highly effective at preventing severe illness, hospitalization and death from the disease. They offer an end to the year-long pandemic, but only if enough people are inoculated to reach herd immunity.
Estimates differ on how many people need to get COVID-19 shots, but public health officials agree that not enough people are choosing to get vaccinated. The hesitancy and rejection by about a quarter of the population may risk prolonging the pandemic with new coronavirus mutations and variants that threaten everyone.
New research shared last week during media briefings hosted by The University of Kansas Health System offers insight on how to improve acceptance among the vaccine-hesitant.
“When you (as a medical professional) have a patient hesitating on making a decision that you know is supported by the data and one that they should logically make to protect or improve their health, you’re often at a stage where because of the way we’re professionalized, we just throw more data at them,” said Dr. Gregory Poland, who researches vaccines at the Mayo Clinic. “That turns out to not be very helpful.”
“What we need to do as health care professionals is turn it around, understand the preferred (cognitive) style of the patient in front of us and adapt our style to their needs.”
Gregory Poland and his daughter Caroline Poland, a licensed mental health counselor, studied how to improve COVID-19 vaccine acceptance.
Caroline Poland said medical information is typically provided in an analytical cognitive style, based in facts and data. But some people in the general public process information, especially about vaccines, with a fear-based lens.
“When we listen to another person’s stories, their fears, their motivations, and we listen to understand those things instead of listening to reply to those things — kind of layering that understanding and that empathy together — then we are able to meet that individual where they are at in their decision-making journey,” Caroline said.
“When we can tailor our communication and our passion and our empathy to be in line with the current situation of the individual who is making that decision, then they don’t have to be defensive in their communication and we can just meet in a healthy and respectful and compassionate way with one another as we have conversations about the decisions that we make.”
Herd immunity and vaccine hesitancy
Vaccine hesitancy and rejection span wide swaths of the populace, but some groups are refusing at higher rates.
White evangelical Christians have among the highest rate of vaccine skepticism in the U.S., an Associated Press-NORC Center for Public Affairs Research poll found in late March. About 25% of all Americans say they likely won’t get vaccinated, but that figure jumps to 40% of white evangelicals, who comprise about 20% of the entire population.
The same AP poll found that 36% of Republicans say they likely won’t get vaccinated, compared to 12% of Democrats. Black and Hispanic Americans, at 24% and 22%, have a lower degree of vaccine hesitancy than white Americans, at 26%. There is an age divide between adults younger than 45, at 31%, and those older than 60, at 12%.
Latino leaders in southwest Kansas have targeted messages to immigrant and refugee communities. Last month, Gov. Laura Kelly launched a “Roll Up Your Sleeves” campaign with advertisements in English and Spanish.
In the Wichita area, the Sedgwick County Health Department may spend $125,000 on a vaccine campaign to combat hesitancy. The health department has also partnered with Black churches on vaccinations.
Nationwide, hesitancy has been dropping across the board since the first emergency use authorizations in December. In late January, AP-NORC polling found that 67% of adult Americans were willing to get vaccinated, and that number has since climbed to 75%.
Children are not currently approved for vaccinations, though children are included in the estimated 70% to 85% of the population that public health officials estimate must be vaccinated to reach herd immunity.
Gregory Poland leans toward the 85% mark. With 25% of the population hesitant or rejecting vaccines, “we can’t get to where we need to get to get out of this pandemic, under the current circumstances. So how do we do that?”
What happens if we don't reach herd immunity?
Dr. Steve Stites, the chief medical officer at The University of Kansas Health System, said there is evidence that many of the people who are vaccine hesitant are also in the group that does not wear face masks. Some may have had COVID already, offering some level of shorter-term immunity against the original coronavirus strain. There may eventually be enough people infected and vaccinated to reach the lower estimates for herd immunity.
“The problem will be that there will be a pool of people who will have not had it who can then continue to transmit it, the virus continues to mutate, and that is a danger to us all,” Stites said. “It is a danger to all of us ultimately if people refuse to be vaccinated.”
While the COVID vaccines do protect against the mutant viruses, they are believed to be less effective. Some variants seem to spread more easily and quickly, posing a risk for new spikes. Infection and hospitalization rates among children are increasing amid the new nationwide surge, which wasn’t the case with the original virus.
Kansas currently has one of the best COVID case rates in the country and among the lowest percentage of cases that are variants, Centers for Disease Control and Prevention data show. While the UK variant surges elsewhere in the country, Kansas has the smallest proportion of that variant of any state.
“The number of cases in much of the rest of the U.S. is now increasing, and it will come your way, too,” Gregory Poland said of the UK variant.
Safe and effective
More than 100 million doses have been administered in the U.S., and the only safety issues have been in a “very tiny fraction of people, often with risk factors,” Gregory Poland said. The risk of anaphylaxis, a severe allergic reaction, is equivalent to other routine vaccines.
"We are no longer in an environment where anybody can legitimately say, 'This was rushed and I want to wait and see if it’s safe,'" he said.
While patients have died after getting vaccinated, there is no evidence the vaccines contributed to their deaths, the CDC has said. Dr. David Wild, vice president of performance improvement at KU hospitals, said two facts can both be true — vaccination later followed by death — but unrelated.
Wild said if you were going to have a heart attack, the vaccine won’t cause it or prevent it. Gregory Poland said miscarriages among mothers who get the COVID vaccine occur at an identical rate to miscarriages in the general population.
Poland, who has been a vaccinologist for four decades, called the efficacy of the COVID-19 vaccines “stellar.”
“This is, if not the best, one of the best vaccines that we’ve ever seen,” Poland said, referring to the Moderna and Pfizer mRNA vaccines and the Johnson & Johnson inactivated virus vaccine.
"I do marvel that we could be in the midst of a pandemic that [has] taken about half a million American lives. One out of about every 590 Americans is now dead of a disease we know how to prevent: with a safe and effective vaccine."
Poland acknowledges neither decision — to get vaccinated or not — is without risk. But he says people need to weigh those risks.
“One thing I hear people say is 'I’m unlikely to die [if I get COVID-19],'" he said. “Well, first of all, you don’t get to choose that. We’ve seen people, probably because of various genetic variants, who do die or have very severe cases. Even with mild illness, we have seen people be left with end organ damage on so-called long-haul COVID symptoms that seriously impact the quality of their life."
"That does not happen with vaccine."
Questions about natural immunity compared to immunity from vaccination are “very fair,” Poland said. While vaccine-induced immunity is stronger and less risky than virus-induced immunity, the medical community does not yet know how long the immunity lasts. Researchers know it lasts at least six months because that’s how long data on the vaccines have been around.
“Many of us suspect the longer the pandemic goes on, the more likely the virus will become endemic, meaning that it would circulate annually, much like flu,” Poland said. “For that reason, a number of manufacturers have embarked on testing booster doses or doses against some of the new variants, and in one case combining coronavirus vaccine with flu vaccine.”
So if doctors don’t have data to know how long the protection lasts, how can they be certain the vaccine is safe and effective?
“Probably everybody ... uses a cellphone,” Poland said. “You can’t answer the question for me of what does 45 years of using a cellphone do to rates of brain cancer. You don’t know. But that doesn’t stop you, because of the benefit of it, and having data over about 20 years saying there’s no increased risk.”
Stites said public health officials have to convince people the vaccine works, is not political and is not a hoax.
“As we watch people who are vaccinated be protected and those who aren’t still get sick, I think it will add weight to the argument that we all need to be vaccinated,” he said.
Fears, conspiracy theories and misinformation
Poland said he thinks the vast majority of people who are vaccine hesitant are trying to make the best decision they can, but need help. Trauma-like fear may be holding them back, regardless of whether that fear is rational.
“With people who are very vaccine hesitant or even rejecting, there is no one thing that you’re going to do that will help them to see or think more clearly about the decision they have to make,” Poland said. “This is a trust-building relationship in many aspects, and that takes time to do.”
He said the vast majority of physicians have been vaccinated.
“Do you really think that they’re taking the vaccine and giving it to their families if they thought that this offered harm and not benefit?” he said “So you kind of take them step-wise through thinking, and what you often find is you can trace it back to fear.
Oftentimes it’s almost a post-secondary traumatic stress lens that they’re making their decision through, and helping them to see that and carefully step by step through that thinking process is often all it takes to get them to see differently.”
Caroline Poland says people who believe in conspiracy theories are using a denialist cognitive style.
“You’re just disbelieving of scientific facts,” she said.
Denialists may not care what the data show because they don’t trust the source. Conversations about vaccines should avoid pushing a “hard sell” and getting into arguments. It may be a long process to build trust and a relationship.
People want their voices to be heard and understood, Caroline Poland said. Belittling the fears and concerns of others will likely be perceived as a threat, pushing them to become defensive.
“What we want to do is provide very consistent messaging over and over. There’s repetition, and I would say as well to not get into arguments over that,” she said. “If you want to be a safer, trustworthy person, you’re going to have to sit back and listen to understand: ‘So what I’m hearing you say is this ... are you interested in hearing another perspective?’”
Gregory Poland said that for health care providers, a helpful technique for him has been to ask the patient for a topic they are an expert on or know a lot about. He then goes on the internet, looking for misinformation or conspiracy theories on that topic, then shows it to the patient.
“They’ll say well that’s ridiculous, that person doesn’t even know what they’re — and then the light bulb goes on for them, I’m not looking at credible sources of information,” he said.
“Get credible information,” he said. “You’re talking about your health, the health of your family and the health of your community. We have seen one tragedy after another due to misinformation and disinformation.”
Dr. Dana Hawkinson, medical director of infection prevention at KU hospitals, lamented the effects of inaccurate information.
“It is hard to discuss the facts when people are getting their facts from untrue sources,” he said.
The University of Kansas Health System addresses frequently asked questions about COVID vaccines in its online blog.
People should seek out original sources of information, not opinions on those sources, Caroline Poland said. They also should not let pandemic fatigue affect their decisions.
“Don’t shut down to the facts simply because you’re tired or you don’t feel like it anymore,” she said. “Facts don’t care about our feelings, so we really want to engage in those things mindfully and wisely.
"It takes a whole community and moving from a ‘me’ mindset to a ‘we’ mindset, understanding that my choices are going to impact my community and those around me as well.”
This story was produced by The Wichita Eagle as part of the Wichita Journalism Collaborative, a partnership of seven media companies, including KMUW, working together to bring timely and accurate news and information to Kansans.
