Vaccines won’t end this pandemic. Vaccination will.
Scrambling five letters at the end of a word is far more than semantics, say experts like Immunize Colorado’s Stephanie Wasserman. The seemingly magical public health power of a highly effective vaccine dissipates immediately if too many people refuse to actually take the vaccine.
Colorado needs to get to a 70% COVID-19 vaccination rate to achieve the herd immunity that protects those who are unable or refuse to get it, and should shoot for closer to 80%, medical experts said. That goal is up against poll responses where the idea of taking the vaccine is so far rejected by 44% of Colorado Hispanics, 48% of Blacks, 50% of those without a college degree and 58% who self-identify as Republican, far lower than Democrats, according to Healthier Colorado.
The state’s other beginning benchmarks are equally ominous: Colorado has the worst rates of school-age vaccinations for measles in the entire country, and has slipped far down the list of other age-appropriate childhood vaccinations.
Now, with tens of thousands of vaccine doses in transit to Colorado from Pfizer and Moderna, and hundreds of thousands more following quickly, state and local health leaders are turning to the increasingly hard work of convincing people steeped in skeptical and often caustic social media.
“Yes it’s as safe as we can get it,” is what Parker family physician Dr. Oswaldo Grenardo will tell his patients. Grenardo, who is biracial, co-chairs the Colorado Vaccine Equity Task Force and says he will tell all patients of color that he will take the vaccine and they should, too.
“For some,” he said, “that still won’t be enough. For some, there will need to be a leap of faith.”
Official budget to market the new vaccine: $1 million
The Colorado Department of Public Health and Environment has a $1 million federally-financed budget for official marketing of the coronavirus vaccine. The state did not have comparable marketing figures available for the annual flu vaccine campaigns.
Dr. Eric France, the state’s chief medical officer, said the money will be spent on social media campaigns, shareable graphics and messaging, and press events amplifying trusted voices. Authorities will also seek big-media donations of public service announcements to further leverage the budget.
France, though, said he is frustrated by the media focusing on worries about vaccine hesitancy, instead of the more than 60% of Americans overall who say they will seek vaccination. That alone will get public health most of the way to a level needed to beat back the pandemic, France said, and the very presence of new COVID-19 stories at the top of the media menu every day serves as the best advertising to any remaining skeptics.
“There’s been a lot of conversations around hesitancy, and to my dismay we focus a lot on this,” France said. “It misses the point. Six out of 10 or 7 out of 10 Coloradans are ready to receive it. Historically we find that when a doctor recommends a vaccination, close to 70% say yes, I want it.”
With nearly everyone personally knowing someone who has had coronavirus by now, those acceptance numbers should be even higher, France said.
Of the rest, France said, about 20% have more questions, but are open to a vaccine once they get answers directly from a medical provider. “And there’s always a small group, 5% to 7%, that are anti-vaccine, and they have loud voices.”
Groups like the equity task force likely have months more to perfect their rollout effort for the general public. The state last week released its priority list for the first batches of tens of thousands of coronavirus vaccine doses arriving now. First priority goes to direct health care providers and residents and staff of skilled nursing facilities. In the second wave of deliveries, as winter turns to spring, priority goes to first responders, health care workers not directly involved with COVID-19 cases, school personnel and people 65 or older.
In the final tier, currently predicted for late spring and early summer, vaccines would go to everyone else.
State health and local medical providers say their research and experience has shown that for many groups with good reason to be skeptical about new treatments, direct recommendations from providers, religious leaders and school officials are most persuasive.
Calling on congregations of the faithful
There’s more than one kind of authority that can boost confidence in medicine, Gov. Jared Polis said last week during a press conference. “We understand it’s not necessarily the governor who can do that, it’s faith leaders and community leaders who can do that.”
From the start, they will be facing literal and metaphorical congregations feeling let down by a long history of medical inequity and the more recent crush of the pandemic.
The portion of U.S. 2-year-olds with all recommended vaccines runs at 69.6% for white children, but 63.5% for Black children, and only 61% of Native American children, according to Immunize Colorado. In the 2015 flu season, 75.1% of whites 65 and older received the annual flu vaccine, but just 64.3% of Blacks.
Meanwhile, COVID-19 cases strike far harder at minority groups in Colorado. Black patients make up 14% of Coloradans hospitalized for the virus though they are only 4.6% of the overall population. Latino patients are 38% of those hospitalized, while their share of the population is 22%.
Distrust is deep, Colorado leaders said, stemming from past shocking revelations about withholding of treatment from Black patients, known as the Tuskegee Experiments, to present-day reality that it’s disproportionately lower income people of color who have to go to work and face virus exposure.
In the Black community alone, there’s a “deep and horrific history of experimentation and injustice,” said Jake Williams, executive director of the nonprofit advocacy group Healthier Colorado, which commissioned the poll on vaccine acceptance.
Ean Tafoya, an environmental field advocate and treasurer of Colorado Latino Forum, said he checked in last week with 10 acquaintances about their vaccine opinions.
“I called a friend who’s a paramedic for Denver Health, he’s Latino,” Tafoya said. “He said, ‘I’ll agree to it, but I’m scared about it because it was rushed through, and ultimately you feel like a guinea pig.’ But for me, if I see someone like that take it, that’s going to help us get there.”
The credibility of Polis and other state leaders has also been damaged, Tafoya said, by the fast-changing position of incarcerated and other confined residents on the vaccine priority list. Minority groups in Colorado are well aware they are hugely overrepresented in prison, for example, he said. Multiple outbreaks have hit Colorado prison and jail facilities.
The governor at first appeared to reject his own health department’s placing prisoners high on the priority list. When enough people protested, Polis said prisoners would be vaccinated in the same priority as their other demographic characteristics indicate, by age or underlying condition. “There is inherent distrust of doctors in incarceration,” Tafoya said.
“We’re seeing a government that says at times we should follow science, and other times telling us to not follow science,” Tafoya said. Then Mayor Michael Hancock is revealed to be sending “stay safe at home” messages while waiting to board a plane to go visit his family out of state.
“That kind of mixed message is difficult for us.”
Tafoya said many Latinos would be more willing after Polis’ assurances last week that the state would not share any personal data collected during vaccinations with federal authorities, like U.S. Immigration and Customs Enforcement.
Grenardo said that long before coronavirus came along, patients of color would periodically bring up discriminatory medical practices like the Tuskegee experiments or government-sponsored sterilization of the mentally ill. Patients of all backgrounds, meanwhile, have already asked how the COVID-19 vaccines can be safe if they’ve been developed so quickly, and some have echoed social media misinformation in asking whether the virus itself is even real.
While statewide task forces develop messages for broadcasting, Grenardo said, he and other medical providers will do what they’ve found most effective with other recent vaccines like shingles, pneumonia, hepatitis A or HPV: individual conversations.
“I hope they can then say, yes they’ve heard it from a trusted source, this is my doctor, I’ve trusted him before, so I’ll follow through,” Grenardo said. He acknowledged that can be taxing for any medical practice. “To have those conversations takes a while. It takes effort. It takes a lot of time, effort and energy,” he said.
What the state will tell providers, France said, is that experience has shown even the way those one-on-one conversations take place can make a big difference in acceptance. Public health researchers say it’s far more effective when a provider says, “Here’s what we’re going to do today, we’re going to give you the vaccine, do you have any questions?” rather than, “How are you feeling about vaccines today?” France said.
Presuming people will accept it goes a long way toward actual acceptance, he said. A common response among patients is to ask, “Is it safe?” France added. In that case, the best answers mention other vaccines they already presume to be safe, such as chicken pox or measles.
“We do it to protect ourselves and protect our loved ones,” France coaches other providers to say, “while using language about how it’s similar to others we know and understand.”
Vaccination isn’t a slam dunk among health care providers, either
The public may assume vaccination adoption is a slam-dunk in the health care settings where providers and staff will have first priority, said Dr. Sean O’Leary, a pediatrician and infectious disease specialist at Children’s Hospital Colorado and professor at the University of Colorado School of Medicine. But health center leaders are just as consciously planning internal vaccination campaigns, and will showcase persuasion tools they’ve found most effective.
“Within the hospital it can get down to personalities” being effective, O’Leary said. “Our CEO is very popular, our chief medical officer is very well known, some of us in infectious diseases and nurse leadership are well known in the hospital,” he said. He’s encouraged by how high the interest is already.
“I gave grand rounds on the vaccine last Friday, and I was told it was the most heavily attended grand rounds we’ve ever had,” he said.
So far, there has not been talk of requiring all health workers to get the new vaccine. Colorado was one of the first states to require all health facility workers to get the annual flu vaccine, in 2012, but such blanket decisions take a long time for consensus and need consensus on the state board of health. Health facilities and other employers have the right on their own to require vaccines for continued employment, with exceptions for disabilities or contraindications.
Nor does it appear yet there will be a renewed push to add the coronavirus vaccine to tighter restrictions on exemptions sought by families with school-age children. Some states will seek to make the new vaccine part of the required vaccinations list for school attendance — a New York legislator has already introduced a bill to mandate the vaccine for various groups if the inoculation rate falls short of public health goals.
New York and other states have also tightened up requirements to receive school vaccination exemptions in response to recent measles outbreaks.
The Colorado Legislature passed a bill requiring families who want an exemption to get a doctor’s signature on a form, or to complete an online vaccine education program currently being designed by state health officials. Asked last week about further restrictions, Polis did not call for new measures.
France said he believes there is “more to learn” about the efficacy of school vaccine requirements. It’s true, he said, that public health studies show with previous vaccines such as flu and the pneumococcal vaccine for pneumonia that when more children get shots, their elderly relatives and teachers catch fewer cases. Coronavirus appears different, though.
“What’s unique about COVID is kids don’t seem to catch it or spread it, so we don’t necessarily need to vaccinate all these kids to protect adults,” France said. Public agencies are still testing vaccine safety and efficacy on children under 16, and whether epidemiology shows younger children can spread the virus even if they don’t develop significant cases. “So there’s science to learn still about kids and vaccination value in children.”