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COVID-19: Healthcare Workers vs The Vaccine

Dapo Iluyomade, MD

The mid-December rollout of two FDA-approved COVID-19 vaccines coincided with a surge in US infections, as we surpassed 21 million cases and 300k deaths. Amidst the hope for a recovery from the virus, that has captivated the world for the past 10 months, the vaccine rollout was met with stiff resistance from many Americans. Of these, healthcare workers comprise the largest group of those refusing vaccination (albeit, healthcare workers also comprised the majority of people offered the early doses). This theme has persisted over the past few weeks. I will review some of the ideas behind the refusal of vaccine acceptance.

First, the headlines (taken from Forbes):

  • Last week, Ohio Gov. Mike DeWine said he was “troubled” by the relatively low numbers of nursing home workers who have elected to take the vaccine, with DeWine stating that approximately 60% of nursing home staff declined the shot.
  • Joseph Varon, chief of critical care at Houston’s United Memorial Medical Center, told NPR in December more than half of the nurses in his unit informed him they would not get the vaccine.
  • Roughly 55 percent of surveyed New York Fire Department firefighters said they would not get the coronavirus vaccine, the Firefighters Association president said last month.
  • The Los Angeles Times reported that hospital and public officials in Riverside, Calif., have been forced to figure out how best to allocate unused doses after an estimated 50% of frontline workers in the county refused the vaccine.
  • Fewer than half of the hospital workers at St. Elizabeth Community Hospital in Tehama County, Calif., were willing to be vaccinated, and around 20% to 40% of L.A. County’s frontline workers have reportedly declined an opportunity to take the vaccine.
  • Nikhila Juvvadi, the chief clinical officer at Chicago’s Loretto Hospital, said that a survey was administered in December, and 40% of the hospital staff said they would not get vaccinated.

Distrust For The Government Among Black/LatinX

Frontline workers in the United States are disproportionately Black and Hispanic. It is no surprise to my readers, as mentioned briefly in my AHA recap article(s), that structural racism is (and has been) a pervasive force within healthcare. “I’ve heard Tuskegee more times than I can count in the past month — and, you know, it’s a valid, valid concern,” said Dr. Juvvadi. This forms the crux of the argument made by minority frontline workers against receiving the vaccine. A recent survey by the Kaiser Family Foundation found that 29% of healthcare workers were hesitant to receive the vaccine, citing concerns related to potential side effects and a lack of faith in the government to ensure the vaccines were safe. Furthermore, dissenters question the involvement of Black/LatinX participants in the clinical trials that led to the development and deployment of at least two FDA-approved vaccines at the time of this article. Dr. Juvvadi told NPR that “there’s no transparency between pharmaceutical companies or research companies — or the government sometimes — on how many people from.” In an op-ed published in the New York Times last week, emergency physicians Benjamin Thomas and Monique Smith wrote that “vaccine reluctance is a direct consequence of the medical system’s mistreatment of Black people,” exemplified by the unethical surgeries performed by J. Marion Sims and the Tuskegee Syphilis Study, that highlight “the culture of medical exploitation, abuse, and neglect of Black Americans.”

Altruism and Others More Deserving

Medicine is an inherently altruistic field, one that requires a dedication to the service and betterment of others. This theme has largely affected the sentiment concerning the acceptance of the COVID-19 vaccines. In an op-ed published earlier this week by Marty Makary MD MPH, a professor of surgery and health policy at the Johns Hopkins University School of Medicine, the case for delaying vaccination is made. Dr. Makary states:

“After a summer of corporate statements pledging that Black Lives Matter, America’s vaccine rollout is creating inequities stemming from a ruling class making rules to favor themselves. In the first two weeks after the FDA authorized the life-saving vaccine, hospital board members, spouses of physicians, cosmetic surgery receptionists, and young firefighters have been getting the vaccine ahead of our society’s most vulnerable. Low-risk Americans with access and power are cutting in the vaccine line and, by doing so, are essentially telling our society’s most vulnerable members ‘your life matters less.’”

Dr. Makary shares his experience as a physician who performs surgeries on COVID-negative patients in a sterile environment with the highest infection control precautions accounted for. Furthermore, he weighs his personal risk of having a complicated course of COVID-19 infection versus that of his elderly patients, many of whom have multiple comorbid medical conditions. He argues that low-risk healthcare workers, including those who have already been infected, defer their vaccination in order to allow for higher-risk individuals to receive a potentially life-saving intervention. This highlights the chasm in Medicine between altruism and self-preservation. Is it possible to do both?

I end with a quote from Dr. Makary, expressing his views on the matter:

“I’m not criticizing clinicians who get the vaccine — my personal decision might be different if I spent more time in the ICU, took more ER calls, or was at high risk of being a silent carrier of the virus, putting my patients at risk. But that’s not me. Given my very low personal risk of mortality and my very low risk of getting the virus in my clinical work, I have joined a growing chorus of healthcare workers who have taken a pledge to not get the vaccine until every high-risk American has been offered it first.”

Thank you for reading, and please feel free to reach out to me with comments or questions on Twitter @DrDapo.

 

“The views, opinions and positions expressed within this blog are those of the author(s) alone and do not represent those of the American Heart Association. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them. The Early Career Voice blog is not intended to provide medical advice or treatment. Only your healthcare provider can provide that. The American Heart Association recommends that you consult your healthcare provider regarding your personal health matters. If you think you are having a heart attack, stroke or another emergency, please call 911 immediately.”
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Virtual Meeting Preparation and Reflection of Scientific Sessions 2020

Patrick Tomko

As I complete my first virtual meeting of 2020 as a graduate student in science, there was two things I decided to take away from Scientific Sessions 2020. First, there is a specific agenda you could create to help yourself at professional conference meetings. I have some tips on getting involved with the content at the meetings. Second, I want to provide a reminder about the few advantages of virtual meetings.  

An Agenda for Professional Conference Meetings: 

First you need determine your priorities for attendance. This could be looking at the science specific to your interest that compliments your current work, or engaging in a way where you will communicate with someone outside your current network. Professional meetings have loads of information and dynamics that could create an overwhelming feeling, especially if it is your first meeting as a student. This is the “adulting” component of being a graduate student. 

 To help with attendance cost, a student should apply for everything. That means any student travel grants, waivers for registration fees, of even finding other agencies that offer to fund “professional development” in students. As frustrating as it can be, plan to be a “penny-pinching patty.”  This is part of the goal in prioritizing what you hope to get out of a conference; you need to have the stamina to handle all the sessions you hope to see. This means making sure you eat throughout your entire experience, even if it is virtual.  

 Second you need to develop general outline for the time frames of the sessions you plan to attend. This is almost like brainstorming what you hope to experience in the scientific sessions you attend at a conference. For me, this year I used the app associated with the American Heart Association meetings. The “AHA” conferences app helped provide reminders and take notes, it’s a virtual planner for your brainstorm session. I found myself on three different occasions changing the sessions I planned to attend virtually. These changes were more related to sessions I was asking others to attend for me, where then I  attended a session they could not see in return.  

 So that brings me to my third point for creating an agenda. Third, a buddy system, which seem obnoxious for scientific conferences. However, if there is an overload of content you want to see and engage with, like I did for this year’s Scientific Sessions, then creating a system to get coverage for all sessions is ideal. Furthermore, this buddy system can lead to an expansion of networks due to attendance of sessions you may not always find yourself becoming involved with. 

 A Research Tool Box and Advantages of Virtual Meetings: 

 The main point of research conferences is the presentation of new research in a format that catches attendee interest. Presentations at conferences are typically followed by questions and discussion between presenters and their audience. All of which is was still the framework for virtual scientific conference. 

 One advantage is no travel and lodging expenses. Most students have to pay out of pocket for travel and lodging at conferences (1). Although, there is nothing that can replace human interaction, there is some light from reduce burden of costs for students in virtual meetings. The stress of affording the expected costs of scientific meetings becomes slightly more manageable. I highlight this because depression and anxiety continue to grow with graduate students. Almost 40% students showed anxiety and depression scores in the moderate to severe range (2). Virtual conferences still allow you connect with others in a different manner. This point is especially important considering the how the pandemic is eroding graduate student mental health. From a  current survey of about 4000 U.S. STEM doctoral students , 40% reported symptoms aligning with generalized anxiety disorder and 37% with depression (3). 

 In addition to the reduced conference expenses, two are three helpful tools for your research conference tool box. 

  1. Take breaks and or watch conferences sessions in different environments. Do not be afraid to go outside with the laptop and listen to a session while being in the sun. This can help create a comfortable environment for you to fully immerse yourself in the session.
  2. Get involved on social media for these virtual conferences, it allows for continuing conversation and to expand networks. You can take notes from posts on social media reported by others that you may have missed. 

 2020 carefully reminds us about the value of human interaction for our lives. We will continue to learn and grow as students, adding to our toolbox.  Have a safe, socially distanced, and peaceful holiday. 

  1. Malloy J. Stop making graduate students pay up front for conferences. Nature. 2020;13:2020.
  2. Evans TM, Bira L, Gastelum JB, Weiss LT, Vanderford NL. Evidence for a mental health crisis in graduate education. Nature biotechnology. 2018 Mar 6;36(3):282.
  3. Chirikov I, Soria KM, Horgos B, Jones-White D. Undergraduate and Graduate Students’ Mental Health During the COVID-19 Pandemic.

“The views, opinions and positions expressed within this blog are those of the author(s) alone and do not represent those of the American Heart Association. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them. The Early Career Voice blog is not intended to provide medical advice or treatment. Only your healthcare provider can provide that. The American Heart Association recommends that you consult your healthcare provider regarding your personal health matters. If you think you are having a heart attack, stroke or another emergency, please call 911 immediately.”