The National Black Nurses Association (NBNA) has rolled out two major health campaigns for Black nurses under the auspices of their new wellness initiative, NBNA Resilient Nurse Resource™.
The first campaign, RETHINK, launched on December 7, urges Black nurses to trust the science behind vaccines and safeguard their health by getting annual flu/pneumococcal vaccinations. The site provides essential facts on the viruses that kill tens of thousands of Americans every year and seeks to counter vaccine hesitancy.
The RETHINK site also features a short video filled with evocative images of Black nurses vaccinating Black adults and children. (The video will be available to a variety of institutions, hospitals, schools of nursing, managed care organizations, and other places where nurses work). Anchored by strong, positive depictions of African American healthcare providers, the imagery shows Black nurses availing themselves of life-saving public health initiatives to stay healthy as they work toward a future that consigns America’s dark history of medical mistreatment of Black bodies to the past.
In fairness, that dark history casts a long shadow. The subjection of enslaved people to brutal experimental surgeries and treatments was followed by further inhumane practices after emancipation. And, although the notorious 1930-72 Tuskegee experiments might have been the last deliberate, organized program of medical abuse, numerous academic studies and countless patients attest to the present-day neglect, dismissal, ignorance, bias, and indifference displayed by many White HCPs. Renee Mahaffey Harris, president and CEO of the Center for Closing the Health Gap in Cincinnati, recently told CNN that people tend to place more trust in leaders who look like them than White officials from the CDC or FDA. Harris said, “It must be a Black person talking to a Black person. You’re not going to all of a sudden trust a group of people that you have [long] mistrusted just because the science says this.”
The NBNA RETHINK campaign calls upon Black nurses to get vaccinated to protect their health, and by looking after themselves, it is to be hoped that their example inspires other people of color to “rethink” their attitudes toward vaccination. In addition to the video, the site features an interactive “Test Your Flu IQ” quiz on the flu and flu vaccines, and a vaccination locator to find flu/pneumococcal vaccine providers throughout the US. To visit the site, click on www.nbnaRETHINK.com.
Mental wellbeing is the focus of the second Resilient Nurse Resource™ program, RE:SET, rolled out on December 15. RE:SET offers a wide range of free mental health services to support NBNA members as they navigate the stressful environment of the pandemic at work and at home. With support from the Pfizer Foundation, RE:SET provides members and their families with access to free HIPAA compliant therapy sessions (with the option to choose African American therapists), 24/7 telephone support, text-based therapy, behavioral health programs, and work-life services. Other complimentary resources include a special webinar series on mental health issues, and wellness podcasts featuring Joe Clair, MC Lyte, and others, to aid NBNA members in maintaining their mental wellness throughout the pandemic.
RE:SET is also designed to encourage Black nurses to combat the stigma in the Black community surrounding mental health. This, in addition to the lack of providers from diverse racial/ethnic backgrounds and culturally competent providers, contributes to only one-in-three African Americans receiving mental health treatment. RE:SET addresses members of an underserved population at a time when nurses are experiencing unprecedented levels of burnout, anxiety, and uncertainty. Dr. Martha A. Dawson, NBNA President, said, “It is crucial that we protect our nurses’ physical and mental wellbeing during such an unprecedented time in our country. With RE:SET we are able to provide them with the tools necessary to recover from the daily stresses of exhausting working conditions and challenges. It is essentially PPE for their mental and emotional health, which will help to impact their physical health.”
To learn more about the RE:SET free tools and other resources, visit, www.nbnaRESET.com.
To become a member of the National Black Nurses Association and learn more about the services NBNA provides, visit www.nbna.org.
Flu season is here, and the media is filled with news about the new Covid vaccines, so this is a good time to have a sort of primer explaining the profound importance of vaccination for communities as well as individuals. Nursing@Georgetown, the online MSN programfrom the School of Nursing and Health Studies at Georgetown University, has kindly allowed DailyNurse to share their guide to the essentials of herd immunity and tips for addressing vaccine-hesitant patients and loved ones.
What is Herd Immunity?
Also referred to as “community immunity,” herd immunity is a public health term used to describe a case in which the potential for person-to-person spread is significantly reduced due to the broader community’s resistance against a particular pathogen.
A Glossary of Important Vaccination-Related Terms
Active immunity: Immunity as a result of the body’s antibody creation after exposure to disease-causing pathogens, either through natural infection or vaccination.
Herd immunity threshold: Also called the “critical vaccination level,” this is the approximate percentage of a population that needs to be vaccinated in order to reach herd immunity status.
Immunity: Resistance to a particular pathogen, or disease-causing bacteria, through antibodies.
Inactivated vaccine: A vaccine using a killed form of the disease-causing germ. This vaccine usually requires multiple doses over time to form immunity. Examples include the DPT and Hepatitis A vaccines and the flu shot.
Live attenuated vaccine: A vaccine using a weakened form of a germ to produce an asymptomatic infection and generate an immune response similar to a natural infection, without sickness. Examples include the MMR and chickenpox vaccines.
Natural infection: Contraction of a disease through person-to-person transmission or interaction with disease-causing bacteria.
Passive immunity: Immunity after receiving disease-fighting antibodies from an external source.
R0 (Pronounced “r-naught” or “r-zero”): The reproductive number of a disease that describes the average number of additional cases a single infected person creates.
Subunit vaccine: A vaccine using a component of the germ (such as a specific protein) to produce an immune response. This vaccine does not contain a live germ. Examples include the shingles and HPV vaccines.
Vaccine: A controlled simulation of natural infection meant to trigger antibody creation that helps fight against the disease later, without sickness.
Why is Herd Immunity So Important?
When enough community members are immune to a virus so that it inhibits spread, even those who are not vaccinated will be protected. The “herd” collectively provides insulated safety to all members, which is important for those who are too high-risk for certain vaccinations.
For these individuals, it is important that their community has built an immune response to the yellow fever so they are not at risk of infection and transmission. Individuals who are too high-risk to get a vaccination are often more likely to contract the illness and experience serious symptoms.
Some other reasons why people cannot get certain vaccinations include:
Recent blood transfusion
Underlying medical conditions like lung or heart disease
“It’s like a little nuclear circle,” she said. “So that our babies that can’t get vaccinated yet, or our pregnant mothers, or our elderly with immune systems [that] are not as robust, or people who have certain kinds of conditions that they don’t have the correct immunity, will have protection from the active pathogen that could possibly harm or kill them.”
HITs and R0s: the Science Behind Herd Immunity
In a community where no one is immune to a virus, a disease can spread rapidly and lead to an outbreak. As individuals acquire immunity, either through infection or a vaccine, the disease spreads more slowly because fewer people can pass it on.
In a community where enough members are vaccinated, the disease will stop spreading because the virus will not be able to find susceptible hosts.
The herd immunity threshold (HIT) varies depending on a variety of epidemiological factors. The primary consideration is the infectiousness of a disease. Infectiousness is measured by the Basic Reproduction Number or reproductive ratio—often referred to as R0 (“r-zero”). R0 refers to the number of cases expected to occur on average in a susceptible population as a result of infection by a single individual at the start of an epidemic before widespread immunity starts to develop. So if one person develops the infection and passes it on to two others, the R0 is 2. Herd immunity helps R0 drop below 1.
Here are some examples of R0s for a few well-known infectious diseases:
The Role Clinicians Play in Herd Immunity and Vaccination
Zschaebitz and Thompson-Brazill have years of experience in various health care settings— from travel clinics and trauma units to international research. Some of the ways that clinicians increase herd immunity and vaccination include:
participating in global research to genotype communities and help produce viable vaccines.
administering vaccines so patients can stay up-to-date on immunization schedules and travel requirements.
educating patients on the importance of vaccination and specific information related to different vaccines.
How to Talk to Patients, Family, and Friends About Vaccination
Thompson-Brazill shared her experience speaking with patients who are vaccine-hesitant and said she has learned that one of the roles clinicians play in herd immunity is educating patients about why vaccines are safe and normative for society.
Zschaebitz also shares the importance of herd immunity with patients — often through the retelling of her own experiences genotyping Maasai tribal women for an HPV vaccine.
“We were interested in preventing deaths of cervical cancer because in certain countries women just die,” she said. “Declining a vaccination is sort of a first-world problem because people in other nations would walk for miles to get what we have and what we take advantage of.”
Thompson-Brazill and Zschaebitz’s tips for speaking to vaccine-hesitant friends and family:
Tip #1: Avoid pointed questions that could make someone defensive.
Instead of: “Why wouldn’t you get the shot?” Try: “What about the shot worries you?”
Tip #2: Use storytelling as a way to share your experience.
Instead of: “I can’t believe you are not going to vaccinate your children” Try: “I chose to vaccinate my kids because…”
Tip #3: Refer people to credible, reliable sources.
Instead of: “Why would you believe that? That’s just a hoax!” Try: “The CDC has a lot of useful information about vaccines and potential risks. Have you read what they have to say?”
Tip #4: If you do not know how to respond, recommend an expert who does.
Instead of: “I can’t talk to you about this; we will never agree.” Try: “Have you shared your concerns with your clinician? They will be able to answer your questions.”
A Herd Immunity FAQ
Is it possible to achieve herd immunity without a vaccine?
No, not all diseases can be overcome with herd immunity. For example, herd immunity cannot be achieved for Clostridium tetani, the bacteria that causes tetanus. Although infection is avoidable via individual vaccination, the “herd” cannot provide protection. For example, the immunity of others will not prevent an individual from contracting tetanus after stepping on a rusty nail.
Why do I need to get vaccinated for diseases we already have herd immunity for?
Some immune responses weaken over time, which is why booster shots are so important. Additionally, vaccine refusal can lead to waning community immunity. For example, in 2019, measles outbreaks in New York and Oregon threatened the United States’ 20-year measles elimination status, according to a press release from HHS on measles outbreaks in 2019.
Is immunity from a natural infection stronger than immunity from a vaccination?
Reliable Information Sources on Vaccines and Vaccination
Both Zschaebitz and Thompson-Brazill recommend using nationally recognized, expert-led sources to learn more about vaccines, like the CDC, FDA, and NIH. Some of the additional resources available include:
CDC Immunization Schedules External link : The CDC-recommended vaccination series and timing schedule for children, adolescents, and adults.
The CDC Yellow Book External link : A set of travel health guidelines, including country-specific vaccine recommendations and requirements.
When it seems hard to persuade people in the grip of a pandemic to wear masks, it is understandable if you sigh at the prospect of reminding them to get vaccinated for this year’s flu viruses. Amid all the changes in our world, flu remains a constant. We can expect it to arrive on schedule, and as usual, it will take thousands of lives between fall and spring.
To reduce the burden of flu cases during the pandemic, public health officials are emphasizing the importance of vaccinating this year. At an August 20 livestream with JAMA (the Journal of the American Medical Association), CDC Director Robert Redfield said, “This fall and winter could be one of the most complicated public health times we have… This is a critical year for us to try to take flu as much off the table as we can. Our hospital capacity could get strained.”
Manufacturers are preparing 194-198 million doses of flu vaccine for the 2020-21 season, and a nationwide media blitz is encouraging people to make use of those doses. According to the CDC, even the fairly mild 2019-2020 season led to over 410,000 hospitalizations and took at least 24,000 lives. While it is hoped that social distancing may reduce this year’s numbers, bypassing vaccination is a particularly dangerous gamble in a year when flu cases will be competing with COVID-19 for hospital beds. Sadly, it is an uphill battle to vaccinate even half of the population. In the 2018-2019 season, only 45.3% of American adults over age 18 got their shots, and a substantial majority were senior citizens.
Getting Vaccinated: Who Needs a Shot and When They Should Get One
It takes about two weeks for vaccine antibodies to become fully active and start protecting the body from the flu virus. The flu season usually peaks between December and February, but vaccines are already available. However, the CDC suggests that August is too early for vaccination as this can leave people with less protection later in the season. Seniors should get their shots in September or October, but even being vaccinated as late as January can prevent infections.
While everyone from the age of six months and upward should get vaccinated, many public officials agree with Redfield’s view that 2020-21 is “a critical year.” The state of Massachusetts has even taken the decisive step of making flu shots mandatory for all children attending child care, pre-school, kindergarten, K-12, and colleges and universities.
What if someone has COVID-19? The CDC recommends that patients with COVID-19 delay getting their influenza vaccine to ensure others in the healthcare setting are not exposed unnecessarily. All patients coming in for flu shots should be screened for COVID-19 symptoms before and during the visit.
The CDC also suggests that providers work to ensure certain adults at higher risk from COVID-19 get their flu shot, including:
Staff and residents of long-term care facilities
Adults with underlying illnesses
African Americans and Hispanics
Adults who are part of “critical infrastructure
Although no states have implemented a legal requirement for seniors to get flu shots, as members of the largest at-risk population most people over 65 should consider vaccination imperative. Because they are so vulnerable to serious complications, seniors constitute 70-85% of flu deaths and 50-70% of hospitalizations during an average flu season. Owing to the added dangers of contending with flu, most seniors receive special vaccine compounds. The most common form is the high-dose vaccine, which contains four times the amount of antigen as a standard flu shot. In a recent study, the incidence of flu among seniors receiving a high-dose shot was 24% lower than it was among those who had received a standard shot. A more recent compound for seniors is the adjuvanted flu vaccine, which creates a stronger immune response than the standard vaccine. Side effects are somewhat more likely to occur with the senior formulations, but reducing the danger of flu usually makes the risk of minor pain at the injection site, headache, muscle ache, and/or fatigue for one to three days seem negligible.
Where to Get Vaccinated
Locating a vaccine provider is easy. Those with internet access can go to VaccineFinder.org and enter their location and the type of vaccine they need (children, adults over age 18, and seniors receive different formulations, as do people with egg allergies as most vaccines are egg-based).
For the millions of newly unemployed whose jobs had provided their health insurance, getting vaccinated can pose a financial challenge. Public health departments in many larger cities offer free vaccinations, but in areas that lack this service, the price for vaccination varies. Non-seniors who live near a Costco can get a shot for less than $20.00, but most drug store chains charge around $40.00. See here for an overview of vaccination sources and prices.
But Will People Get Vaccinated?
While there are undeniable reasons to be concerned about vaccine hesitancy and past failures to vaccinate even 50% of the population, it is possible that more Americans will get their flu shots this season. Findings in the 2020 United Healthcare Wellness Checkup Survey indicated a heightened awareness of health concerns spurred by the pandemic and 30% of the surveyed respondents said they are more likely to receive a flu shot this fall.