Overcoming vaccine hesitancy and access issues has become even more critical because of the COVID-19 pandemic, public health experts argued at a recent webinar hosted by the National Academies of Sciences, Engineering, and Medicine.
“Strengthening vaccine access and confidence today is more important than ever because … all across the globe we are dealing with the [COVID-19] pandemic,” Nancy Messonnier, MD, director for the CDC’s National Center for Immunization and Respiratory Diseases, said at last week’s event.
The pandemic has interrupted and delayed routine vaccinations for many people, including children, Messonnier noted.
Robin Nandy, MPH, principal adviser and chief of immunizations for UNICEF, added that a “substantial setback” in immunizations is expected. He highlighted a study from UNICEF, the World Health Organization, and others estimating that 80 million children across 68 countries were at risk for preventable diseases due to disruptions in care resulting from the pandemic.
Discussing the prospect of a COVID-19 vaccine, Messonnier said she hopes some will be available this fall, with more arriving in the winter, but expressed concern that a large number of Americans won’t be willing to be immunized.
One in four U.S. adults said they were not interested in getting a coronavirus vaccine, a recent Reuters/Ipsos poll found. Ongoing research suggests that, at a minimum, 70% of the U.S. population would need vaccine-based immunization, or infection with the virus itself, to achieve herd immunity.
In addition, vaccine confidence levels vary across different ethnic and socioeconomic groups, Messonnier noted.
“It’s very concerning to us that overall confidence in vaccines is lower in Hispanic and black communities, lower in those [of] lower income, and lower in those with lower education,” she said, citing research from the Pew Research Center.
These are also some of the same groups that are disproportionately impacted by COVID-19.
“Vaccinating With Confidence“
Messonnier noted that even parents who report that they are less confident in vaccines are more likely to get their children vaccinated when they have “easy access.”
To that end, the CDC and other public health experts are working on plans for the distribution of a coronavirus vaccine, to monitor the impact of such a vaccine, and on gaining a better understanding of public perceptions of the coronavirus vaccine in order to develop effective messaging.
The anti-vaccination movement is powerful. According to recent research, anti-vaxxers have greater influence on social media than pro-vaccine activists.
However, experts know that the impact of fear as a motivator “doesn’t last very long,” Messonnier said.
As a result, the CDC is pivoting toward a strategy of “vaccinating with confidence,” which involves identifying pockets of low vaccination, working to improve vaccine access, and taking steps to try to stop misinformation.
A child’s doctor is still the “most trusted source of information” for most parents, Messonnier said, adding that, in some cases, the reassurance of those doctors has been enough to get vaccine-hesitant parents to change their minds. Strengthening the conversation between parents and providers will be a critical part of the plan to increase vaccine uptake.
Vaccine Uptake and Access
Immunization rates among U.S. children are strong overall, with more than 90% of those under 2 years of age having received their “primary series,” Messonnier said. High rates are due in part to the Vaccines for Children (VFC) program, which has also reduced disparities in coverage and reduced incidence of vaccine-preventable diseases.
The program provides vaccines for more than half of the children in the U.S., many of whom are uninsured or underinsured, she noted, adding that despite the availability of the VFC program, children without access to health insurance are nine times more likely not to have received a vaccine by the time they’re 2 years of age.
Vaccine uptake among adolescents is a “mixed picture,” said Messonnier, with 86% receiving their Tdap (tetanus, diphtheria, and pertussis) immunization, but only 52% receiving a flu shot, and only 68% receiving one or more doses of the HPV vaccine.
Only about 60-64% of adults receive their routinely recommended vaccines, and somewhere between 35-68% of adults receive the annual flu vaccine.
There are also vaccination disparities related to race, ethnicity, and location. American Indian and Alaska Native children have the lowest MMR (measles, mumps, and rubella) vaccination rates for children under 2 years. Urban-dwelling children are more likely to receive one or more MMR doses versus those in rural areas, according to a 2019 Morbidity and Mortality Weekly Report.
While school vaccination requirements have helped to protect students from vaccine-preventable illnesses, “grace periods” that allow parents to enroll their children in school, with a pledge to visit the doctor for an immunization at a later date, have proven challenging.
The number of kids who fall into these grace periods across different states is anywhere from 0.2-6.7%. Some of these children do eventually get vaccinated, while others may be children of vaccine-hesitant parents who are taking advantage of this loophole in schools’ policies. Most counties and schools lack the staff and resources to follow up with families and determine which children ultimately did receive a vaccine.
If all non-exempt children who fell into these grace periods went on to be vaccinated, most states would see a 95% MMR coverage rate, Messonnier said.
Vax “Drop Off“
Messonnier said she’s worried about the “dramatic drop off” seen in rates of healthcare providers ordering routine vaccinations after March 13, when the White House declared the novel coronavirus pandemic a national emergency. This was particularly true for routine measles vaccination across all ages, with kids under age 2 faring slightly better than other groups, she added.
Parents are worried about exposing their children to COVID-19, and haven’t been going to the doctor, which is an “appropriate concern,” Messonnier stated.
But the CDC and the American Academy of Pediatrics want parents to know that it’s safe to go back to the pediatrician’s office, and are urging healthcare providers to encourage “catch-up vaccinations” through outreach to parents.
Many practices are implementing special preventive measures to help reduce the risk of viral spread. For instance, some are having “well child” visits in the mornings and seeing sick children in the afternoon.
The CDC is also urging public health officials and clinicians to disseminate information regarding the VFC program as there may be more families who are eligible for the program given the increasing unemployment rates, Messonnier said.
Lt. Col. Joseph Henry Ward, M.D., Dr. John A. Kenney and his son, Dr. Howard W. Kenney, are not exactly household names.
But these VA trailblazers deserve to be remembered for the great strides they made toward equality in health care leading up to and during the Civil Rights Movement.
Since these beginnings, VA has continued its commitment to hiring a diverse workforce. To be able to truly serve our Veterans, VA must cultivate an inclusive and welcoming environment for employees from all backgrounds.
“We are all on the same team, and diversity makes us all better,” said Darren Sherrard, associate director of recruitment marketing at VA.
Fighting for Equal Care
In 1924, Ward became VA’s first African American hospital director at the nation’s only segregated Veteran hospital in Alabama. He served there until his retirement in 1936. A World War I Veteran, Ward lived long enough to see the end of racial segregation in VA hospitals in 1954.
John Kenney was one of the hospital’s first physicians. He fought to have it staffed with African American medical professionals. Later forced to move to New Jersey due to threats to his life and family, Kenney went on to use his own money to build a hospital for African American patients.
But his son, Howard, would return to Alabama and continue his father’s legacy. He served as medical director at the same VA hospital where his father worked. Later, he became the first African American to integrate a formerly all-white VA hospital and VA’s first African American regional director.
VA celebrates these heroes who not only served other American heroes at VA but worked to break down barriers.
Continuing a Culture of Community
VA embraces inclusion and empowers employees to perform to their highest potential. Maintaining this culture of support and community allows employees to feel appreciated and respected. Only then can they provide exceptional care for the nation’s Veterans.
“There is strength in diversity,” said Cathy Mattox, a VA utilization management review registered nurse. “Every nurse brings something to the table; each one of their skillsets and individual experiences are valuable.”
Through VA’s Office of Resolution Management, Diversity and Inclusion, several special-emphasis programs focus on recruiting specific populations, including black/African American, Hispanic, LGBT and individuals with disabilities. The Diversity and Inclusion in VA Council, an independent, executive-level body, advises the VA Secretary about issues related to diversity and inclusion.
Work at VA
If you’re interested in being part of a diverse organization that gives back to America’s Veterans, consider joining our team.
School may be closed, but nursing students have continued to learn while working on the COVID-19 frontlines. Most find that they are more dedicated than ever in the wake of the pandemic. Now in her third year at University of Virginia, Martha Peterson says, “It’s definitely made me want to become a nurse even more. All this has also given me a greater appreciation of nursing, too. If it’s for the greater good, and helps people survive, the risks are really worth it.” “I do think that I feel more needed than ever, more necessary,” says fourth-year UVA student, Tyler Gaedecke, who begins work on a pediatric ICU this month.
A major challenge for many has been learning to cope with fear. Gaedecke says, “There are some who’re asking, ‘Did we sign up for this?’ which will be a big debate for years in the particular generation of nurses I’m a part of, and that’s a complicated question, but I’m definitely ready to get out there.” Northeastern University grad Hannah Terry made herself available to work wherever she was needed at Massachusetts General Hospital, but she admits to having been deeply afraid: “Seeing that some of these patients were so young and there was nothing [else] wrong with them—this was at the time where everyone was saying that it was only the elderly and the immuno-compromised that were getting sick. A lot of people were—including myself—very fearful of what we couldn’t see.”
Third year Northeastern student Susan Dawson, reflecting on her 36 hours a week on the COVID-19 ICU at Massachusetts General, said, “I’m glad I had hospital experience before this all broke out. I think I would have been a lot more scared and tentative if I had not.” However, she cannot help feeling emotional when she thinks about the death toll. At the height of the outbreak, Dawson recalls, “The patients are not just in-and-out in a few days. We see these patients each day, we get attached to these patients, even though they can’t talk—we still are attached to them, we care for them. Seeing a patient not come out of this, knowing that the doctors and nurses are doing everything they can, it just isn’t good.”
Overall, though, students have focused on giving patients the best nursing care possible under such extreme conditions, helping facilitate Zoom meet-ups with family members and providing human contact amid the PPE. Columbia student Ashlynn Lawrence held patients’ hands and did her best to lift their spirits: “I always try to tell them that underneath all the personal protective equipment, I’m smiling, and I encourage them to do the same. The comfort of a friendly face goes a long way.”
Nurses are generating a host of innovations to resolve healthcare pain points during the age of COVID. At the Nurse Hack 4 Health virtual hackathon, a project to make telehealth more accessible to rural Americans and a “GPS” that helps hospital nurses quickly locate available equipment were just two of the five winning ideas that emerged from the May meeting of minds.
Some 30 teams of nursing innovators competed in the hackathon, and five winning proposals were chosen by a team of judges from Johnson & Johnson, SONSIEL (Society of Nurse Scientists, Innovators, Entrepreneurs, and Leaders), Microsoft, dev up, and prominent independent nurse-entrepreneurs and leaders. Over the summer, SONSIEL and Microsoft will have business and technical mentoring meetings with the winning teams. The teams presented the following stand-out projects:
Well Nurse (Resiliency and Self-Care category), a peer-to-peer app to help nurses cope with stress, connect with one another, and identify best practices to foster mental well-being. “The end goal is that the application will be not only functional, but a helpful resource for nurses facing mental health challenges,” says team member Charlene Platon. Team members: Chris Caulfield, Charlene Platon, Ahnyel Burkes, Jillian Littlefield, Kathy Shaffer, Kristy Peterson, Natale Burton, Xiaoyun Cong, Anil Punjabi, Laura Deschere.
HearNow (Acute Care Patient Monitoring category) is designed to connect patients and their loved ones at times of social distancing and also accommodates the usual communication issues in acute care. With this system, loved ones can transmit video and audio messages from home that nurses can share when patients are alert and in need of comfort. Team members: Molly Higgins, Kelly Ayala, Sabine Clasen, Rosemary Yetman.
Activate School Nurses (Data and Reporting category) connects short-staffed school system nurses with nursing students to manage school re-openings and maintain and monitor student health data to reduce the danger of further outbreaks. Team members: Joanna Seltzer Uribe, LeAnthony Mathewshttps, Blanca Badgett, Ramona Ramadas, Chris Young, Lacey Sprague, Brian Goldenberg, Pao-Chu Tseng, Pramila Thapa.
Nurse GPS (Patient Care Coordination category) is a technology that provides nurses with the floor and room location of urgently needed equipment. The aim of the project is to reduce delays in obtaining equipment and lessen the danger of infection by making it unnecessary for a nurse to leave and reenter a room multiple times. Team members: Subbu Venkat, Mary Kavalam, Ian Kerman, Julie Gerlinger.
Project Flourish (Remote Patient Monitoring category) seeks to broaden the reach of telemedicine in rural areas and among senior citizens by working around obstacles such as a lack of broadband access and smartphones. Primarily making use of Unstructured Supplementary Service Data (USSD) 1990s-era technology such as Nokia flip-phones, care providers can make contact and receive health data from patients who lack technical literacy and/or present-day devices. Team members: Joshua Littlejohn, Kim Bistrong, Lisa Rickers, Biemba Maliti.
For details about the hackathon, visit the Nurse Hack 4 Health Home page.
Nurse of the Week Ben Busey is no stranger to crises. In addition to working as an Urgent Care Nurse Manager at the Roseburg VA Medical Center in Oregon, Busey is also a part of the VA’s Disaster Emergency Medical Personnel System (DEMPS), which deployed him in Puerto Rico after Hurricane Maria struck. So, he was ready to serve when COVID-19 started to spread in beleaguered New Orleans.
The 34-year-old Busey spent two weeks at the VA in New Orleans at the height of the pandemic, and says, “The first day I walked in there, two people died within the first two hours of me arriving. They had just run out of body bags, the ICU.” In addition to coping with the strained hospital resources, like most frontline nurses he did all he could to maintain connections between isolated patients and their loved ones: “I would end up calling them in the middle of the night to give them updates on a small improvement on my patient, just because I knew that they couldn’t see their family member and they weren’t allowed to be on the unit with them, and they were probably just worrying all the time about how their family member was doing.”
Warned of the PPE shortage in advance, he packed N95 masks for his trip, and used his small supply sparingly, often wearing the same mask for as many as five shifts in a row. Upon his arrival, he quickly learned that it is unwise to make assumptions merely because your age and health place you in a fairly low-risk group. As Busey recalls, “The person who oriented me for a couple of hours that first day when I arrived, he had just come back from being ill with COVID and he was 31. The way he described it, he said every day he sat in his room and he wondered am I dying, because he felt so sick and short of breath…” Fortunately, Busey himself returned unscathed; his test results after his return to Oregon proved negative.
Busey worked night shifts, and provided strong, capable support during his two weeks in New Orleans. When he came back to the Roseburg VA Medical Center, the Center presented him with official recognition for his work during the crisis.
For more on Dan Busey’s experience in New Orleans, visit here.
“You have been one of the pillars of the whole country. To you here and to your colleagues throughout Italy go my esteem and my sincere thanks, and I know well that I interpret the feelings of everyone,” Pope Francis said in a June 20 address to healthcare workers from Lombardy, the hardest hit among the Italian hotspots during the COVID-19 outbreak. In his first large public audience at the Vatican since lockdown was imposed, the Pope lauded health workers’ efforts to comfort families as well as patients, remarking that the former “found in you almost other family members, capable of combining professional competence with those attentions that are concrete expressions of love..”
The pontiff expressed his gratitude for the service of the frontline workers, and observed, “Even if exhausted, you have continued to commit yourselves with professionalism and self-denial. And this generates hope. You have been one of the pillars of the whole country.”
Pope Francis has repeatedly praised the work of nurses and credits his recovery from a life-threatening illness during his twenties to the intervention of a nurse who treated him. The Pope referred to this experience in a 2018 speech to members of the Federation of Professional Nursing Colleges, Health Assistants, and Child Wardens, and added, “The role of nurses in assisting the patient is truly irreplaceable. Like no other, the nurse has a direct and continuous relationship with patients, takes care of them every day, listens to their needs and comes into contact with their very body…”
Although Italy has been emerging from lockdown, social distancing laws are still in effect. Those attending wore protective masks and Pope Francis told the healthcare workers that he would approach them himself at the end of the audience rather than have them follow the customary practice of lining up to greet him. For more details on the Pope’s speech, visit here.