The CommonHealth

Dr. Monica Gandhi has thought deeply about the complex transition we have entered, with many vaccinated, and many not. We need to behave differently in private versus public settings. Being polite and compassionate remain essential. Resistance to vaccines comes from different populations, each requiring a different approach: racial and ethnic minorities; youth; those who ask what will be the rewards for getting vaccinated; and the recalcitrant. There has to be far more “positive motivation,” a form of “proactive, vaccine optimism” based on a concrete blueprint for how our lives will improve through vaccines. CDC guidance during this transition, on travel and outdoor masks, has been confusing but will improve as more people are vaccinated. School closures in the United States have been excessive. “It is political.” We are “not looking at data cleanly.” Global vaccine inequity is the world’s biggest moral challenge: we need to do “whatever it takes” to expand manufacturing and access. The population living with HIV whom she serves in San Francisco suffers from extreme loneliness, “untold mental health effects.” Her advice: “Please go see a friend.”Dr. Monica Gandhi is Professor of Medicine at the University of California San Francisco, Director of UCSF AIDS Research, and Medical Director of the HIV Clinic at San Francisco General Hospital (“Ward 86.”)

Dr. Castrucci joined us to discuss his evolving collaborations with noted Republican pollster Frank Luntz, an expert who is a “master class in communications.” Through a series of surveys and focus groups, they have teamed up to understand how best to engage conservative Republican voters who refuse or are otherwise deeply resistant to getting vaccinated against Sars-CoV-2. “Covid has been politicized since day one” and the question now is how to “change the conversation.” “If this is a political debate, we all lose.” What is the solution? Every health provider has to make engagement with patients on the vaccine a routine part of every patient’s visit. “Good stories and good facts” is “our formula, ” which can educate versus indoctrinate. Give people the facts, and they will “change hearts and minds.” Dr. Brian Castrucci is the President and CEO of the de Beaumont Foundation, based in Bethesda, Maryland.

We sat down this week with the acclaimed survey expert, Mollyann Brodie who been exceptionally busy in recent months, engaging over 11,000 American adults. She finds it remarkable “how fast and dynamic vaccine confidence has moved” across all population groups, reaching acceptance among two-thirds of Americans. The “moveable middle,” of persons waiting to decide, has been cut by half to 17%. Black and Hispanic populations have moved towards higher acceptance but still account for a large share of those postponing a decision. As for “persistently reluctant” individuals, the 3 in 10 evangelicals and Republicans, particularly younger, male and rural citizens? “Nothing we have thrown at them… has caused them to tell us they are willing to move.” What to do? “At the margins, carrots seem to work for a sliver” of this population: i.e. if vaccines improve the ability to visit family, travel overseas, receive a bonus from an employer. “They have their own set of concerns” over personal liberty, disruption of economic life, distrust of government. Politics needs to be removed from discussions. The focus needs to shift to meeting these individuals where they are. “Hyperlocal efforts,” conversations among themselves, with their own physicians, with their own family members, hold promise.  What gives her hope? “ I have never seen a movement of this kind in my lifetime.. of so many individuals and organizations on the ground trying to help us get to herd immunity.”  Mollyann Brodie is Executive Vice President and Chief Operating Officer at the Kaiser Family Foundation, as well as Executive Director of the Public Opinion and Survey Research Program.

Dr. Deborah Birx, former Trump White House Coronavirus Response Coordinator and renowned global HIV/AIDS leader, spoke to us about a rich assortment of issues: the recent drama surrounding her statements about the Trump administration; her almost 7 months on the road across America, far from Washington, visiting with 44 governors; the corrosive divisions in our society; what might cure vaccine hesitancy; President Biden’s early achievements; DOD’s profound contributions; the secret power of millennials and retailers; the potential value of a 9/11 Commission, and more. “This virus does not recognize party. .. The more we make this pandemic partisan, the more it divides us.”  “I have worked in pandemics that were highly politicized… that creates vulnerabilities, we could not see it here.” In March, 2020, people were listening, responding to science and data, how to stop the spread, what it might do to our health system. Then the focus swiftly morphed to the economy. “For those of us who stayed.. we believed we could recapture how severe this pandemic is.” By the fall, “we were never able to move people to testing as a public health measure in itself.”    On vaccine hesitancy, her message to all mothers: “No matter what age your son, tell him for your peace of mind to get vaccinated.” “To daughters and sons, call your dads.” “Do it for your family.”  Dr. Deborah Birx is Senior Fellow at the George W. Bush Institute. 

Journalist, writer, editor Frances Stead Sellers returned to share new insights. Leaders like Henrietta Fore, UNICEF, struggle with “incredible added burdens” dealing with crises in childhood education and disrupted immunizations while “vaccinating the world” against Covid-19 with Gavi. “Imagine being Henrietta Fore. .. The strains on the organization are enormous.” Francis Collins, head of NIH, faces similar expansive responsibilities, and uses his own voice “as a person of faith” to address vaccine hesitancy. The Washington Post Live series, one-on-one conversations, creates a new “intimacy” where guests are more reflective. Over and over during the pandemic, journalists face the “We don’t know” quandary of scientific uncertainty. “We keep getting ahead of ourselves.” That requires laying out what different experts believe, a form of “service journalism”. Vaccine hesitancy among Republican men is a “new phenomenon,” very “distressing,” that reflects our immense national divisions. People want to hear from their friends, from trusted individuals. It is important for people’s “barber to be seen getting vaccinated.” Her personal hope for the future? “I desperately want to return to real-life meetings… Nothing beats face-to-face meetings.”Frances Stead Sellers is a Senior Writer and Reporter on the National Desk at the Washington Post.

Dr. Jennifer Kates and Josh Michaud, Kaiser Family Foundation, take us on a tour d’horizon. Rapidly accelerating vaccine coverage has resulted in “a huge, huge change.” By the end of June, we will have twice the volume of vaccines needed to inoculate America’s 260 million adults. Improvements in testing and surveillance lag – “We can’t just focus on one intervention.” At the same time, state leaders relax controls, and variants increase transmissibility, concentrated among youth. “We are definitely at risk.” The equity agenda? “It’s not going well yet…. Most states are not doing a good job on equity…. It is the key aspect of this rollout over the next few months.” Many southern states are weak performers on vaccines (AL, TN, TX, GA, AR, SC, MS) while many smaller states are strong performers (AK, ME, SD, ND, RI, WV, CT). 55% of Americans now “want to be vaccinated,” while those who prefer to wait-and-see has dropped from 30% to 22%. But 15% are refusing, and another 7% will take the vaccine only if required. The chief challenge: how to reach Republican voters – especially male, rural, younger – with what message and what messenger? Digital certification of vaccination is “going to happen” but “can be quite fraught” over privacy, discrimination, and civil liberty concerns. Dr. Jennifer Kates is Senior Vice President for Global Health and HIV Policy; Josh Michaud is Associate Director for Global Health Policy, at the Kaiser Family Foundation in Washington, D.C.  

Dr. LaQuandra Nesbitt, director of the Washington DC Department of Health, shares her insights into battling the pandemic. Washington is the opposite of self-contained. Protesters of many stripes transport their grievances to Washington, often stoking “strife and agitation” with little regard for the health of the community. Emergency preparations intensified beginning in 2015: “We were ready” in 2020 but had “still so much to learn” as the pandemic unfolded. Messaging in the fog of a pandemic is difficult, in need of constant refinement. Testing got off to a halting start. But as swabs, reagents, and skilled staff became available, the city quickly scaled its testing. It also raised a caution: testing is costly and long-term. How to sustain? Vaccine distribution, including to high numbers of non-residents who work in the Capitol, has been a challenge. Equity and accountability concerns continue to dominate. One reality persists: “We simply do not get enough vaccine here in the District.” And when doses move through retail pharmacies and hospitals with insufficient oversight and coordination, equity suffers. Luckily, ”demand is so high” for vaccines. Dr. LaQuandra Nesbitt is Director of the District of Columbia Department of Health in Washington, D.C., a position she has held since January 2015.

Helen last joined us on April 2, 2020, a dark moment. She returned to explore with us whether the joy, relief, and gratitude that millions are experiencing through Covid vaccines generate gains in other disease areas, where adult vaccination “is a hard field.” “These vaccines have been extraordinary” with “very few side effects.” Among Republicans, especially in rural areas, “a good chunk of people are not intending to be vaccinated.” It was a lost opportunity when President Trump did not go on camera when he was vaccinated. The search is now fully on for trusted influencers to reach Republicans. What lies ahead is a “bumpy period,” and progress is going to take time, but the rapid development of vaccines and today’s surge in production provide hope.   Helen Branswell is a Senior Writer, Infectious Diseases, at STAT. She is the winner of a George Polk Award in Journalism in 2020 for her remarkable coverage of SARS-CoV-2.

Peter Hotez joins us for a Texas-centered conversation. After 11 years in Washington DC, Peter migrated to Texas where over the past several years he has established himself as a leading research scientist, public voice on infectious disease, including SARS-CoV-2, vocal advocate of vaccines, and opponent of anti-science, anti-vaccine voices. How did this happen? How has this changed his life? In recent days, Governor Abbott made his sudden, unforeseen decision to lift the mask mandate and restrictions on businesses. How to make sense of that? Viral variants dominate the conversation, in Texas and beyond. What does that portend? Peter Hotez is Dean of the National School of Tropical Medicine at Baylor College of Medicine and Co-Director of the Texas Children’s Center for Vaccine Development.

Ashish Jha, a determined optimist, gives the Biden administration an A- for its first six weeks. The picture today is “dramatically better.” “A light switch went on after January 20,” when states could suddenly ask for – and receive – help. An “extraordinary bump-up” in vaccinations is underway: “We have more vaccines coming than we will know what to do with.” More needs to happen in building out testing, developing strategies for variants, and planning for when variants may escape vaccines. “The equity agenda is not going well.” While it may be “easy to look like a superstar compared with Trump,” the Biden administration “needs to lean in heavily” with its political and diplomatic power to shape the international environment to control outbreaks, bridge the dangerous vaccine gap, and increase manufacturing. Surplus vaccines will be key: “The problem is not money, it is vaccines.” Ahead of us lies “a really good summer and fall.” Ashish Jha is Dean of Brown University’s School of Public Health.