Building Confidence to Build Immunity: Vaccine Hesitancy and COVID-19

(This is an unedited transcript. For accurate quotes and presentations, please refer to the full-event video.)

0:04
Hello, everyone. And thank you for joining our first public webinar of 2021, Building Confidence to Build Immunity: Vaccine Hesitancy and COVID-19.

0:15
I’m Kathryn Martucci, director of Policy and programs at the Alliance for Health Policy.

0:21
For those of you who are not familiar with the Alliance, Welcome.

0:24
We are a non partisan resource for the policy community, dedicate, dedicated to advancing knowledge, and understanding of health policy issues.

0:34
And I want to remind everyone that you can join today’s conversation on Twitter using the hashtag all Health live and please follow us at all Health Policy as well as on Facebook and LinkedIn.

0:47
I want to take a moment to thank the Commonwealth Fund for sponsoring this event and for moderating as well which I’ll introduce our moderator in a moment.

0:57
Then we know that you are all webinar Super users at this point at the pandemic, but want to make sure that you cannot be active participants in the conversation and submit your questions. So, here’s how you can do it.

1:10
You should see a dashboard on the right side of your web browser that has a speech bubble icon and a question mark. And you can use that speech bubble icon to submit questions you have for the panelists at anytime. Will be collecting these and addressing them throughout the broadcast.

1:26
You can also chat any technical issues that you may be experiencing.

1:31
And then, finally, also want to note that we have materials accompanying this webinar on our website, and that these slides will also be available there afterwards, as well.

1:43
And now, I am so pleased to introduce Rachel Nuzum to moderate today’s discussion. Rachel is the Vice President of Federal and State Policy at the Commonwealth Fund.

1:53
She’s also on faculty at Georgetown’s Graduate School of Nursing and Health Professions, and on the Board of the Winston Health Policy Fellowship.

2:02
Rachel, I’m very pleased to be leading this discussion in your extra hands. So, thank you. I’ll turn it over to you.
2:10
Thank you so much, Kathryn.

2:12
It’s a real pleasure to moderate this panel and be with all of you today.

2:15
For those of you who don’t know, the Commonwealth funds a private foundation dedicated to achieving a high performance health system, guaranteeing access to equitable, affordable, high quality care and outcomes.

2:27
Over the course of the last year, the fund is explored how the Covid-19 pandemic has exposed weaknesses in our Fragile Health Care System from inequities in case and death rate, variation and access to care, testing, and treatment, to state variation in mitigation and response strategies. To supply and provider shortage issues, and difficulty in messaging to the public in a rapidly changing environment.

2:51
Coven 19 provides a critical opportunity to identify cracks in the system, to develop policies for meeting the needs of Americans trying to navigate it.

3:01
To date, over 420,000 Americans have died from the Covid-19 pandemic.

3:06
It’s unfathomable. as those numbers are, they fail to represent lives, lost to related substance abuse, and mental health conditions, or the millions of Americans out of work out of school, isolated, or suffering, and countless other ways.

3:20
The scientific advances made over the course of the pandemic have been heroic with vaccines entering the market and unseen speeds.

3:28
The vaccination process, however, the art and science of getting the vaccines to those who most need it in the safest.

3:34
most expedient and equitable way has been anything but easy to be fair. This is the largest mass vaccination campaign the US has ever undertaken.

3:43
In the first few weeks of a new administration, that’s made mass vaccination a top priority, Many challenges remain.

3:50
Our experts that have agreed to join us today are exactly the right wants to help us talk through challenges and potential next steps.

3:57
What will the states need to be able to do to successfully meet the vaccination needs and targets of their communities. How have other countries handled the vaccine rollout and what can we learn?

4:07
How might the new strains of covert 19 complicate the ability to instill confidence to get the vaccine when they’re eligible?

4:14
How do we ensure that the communities bearing the brunt of covert 19 are not left to be last centered in the planning and strategizing?

4:22
We only have an hour to tackle all of these issues and more, so let’s get right to it.

4:27
First, we have Hemi Tewarson, a visiting Senior Policy Fellow at the Duke Margolis Center for Health Policy. Hemi strengthens the Center’s Engagement and State Level coven 19 response, including involving new Models of Care and Effective Strategies for Coping 19, testing and containment. She was previously serving as a director for the Health Division of the National Governors Association, Center for Best Practices. Next, we’ll turn to doctor Heidi Larson, a Professor of Anthropology, Risk and Decision Science and the Founding Director of the Vaccine Confidence Project at the London School of Hygiene and Tropical Medicine. She is a clinical Professor of Health Metrics Sciences at the University of Washington, Seattle and a guest professor at the University of Antwerp, Belgium. Doctor Larsen previously headed the global immunization communications at UNICEF and served on the WHO Sage Working Group on vaccine hesitancy.

5:20
And finally, we’ll hear from Dr. Reed Tuckson the founder and managing director of Tuckson Health Connection. Doctor Tuckson, also a member of the National Academies of Medicine for a Framework for Equitable Allocation and Vaccines for the Nobel Coronavirus, as well as a founding member of the Black Coalition Against Covert. Once again, thank you all for being here with us today. Hemi, I’m going to turn it over to you.

5:44
Great. Thank you, Rachel, and really good to be here with all of you today. So, in the next couple of minutes, I’m going to talk next slide, please, a little bit about how are we really doing at the state level with vaccine distribution?

5:59
So, you can go into the next slide, please.

6:01
So, I wanted to just take a snapshot because I think we’re going to have a really rich conversation about vaccine hesitancy and all the different considerations we have facing us in order to make this campaign successful as Rachel talk so eloquently about. But let’s just take a look at where we’ve been.

6:16
So December 20th, we kicked off with the states trying to get vaccines into the arms of millions of Americans across the country.

6:24
And what you see here on this slide is the picture of where we are today.

6:27
And I say really today, because I do believe that the data will continue to shift and change.

6:34
So you know, we had a goal of a very laudable goal of getting as many people vaccinated as possible in the first couple of weeks of the rollout. And there were challenges.

6:44
And so what I thought I would do today is just talk a little bit about where we are, what those challenges continue to show themselves and how states are thinking about really dressing them before I turn it over to my colleague, doctor Larson and doctor Tuckson.

6:58
So where we are in the campaign, so doses administered, you can see over 25 million we really are looking at first doses.

7:06
And the second dose challenge continues to be persisting for state leaders. Because right now, the population given the second dose is only at 1.2%.

7:16
The daily rate of doses administered is around one point two million. And that is actually improve, this is last week data.

7:22
So it’s really improved from previous weeks, which I think shows progress in, you know, states and local governments, and their partners getting systems ready.

7:31
There is, though, a high variability in the percentage of doses administered across the state. And that’s what this picture shows.

7:38
Supply use nationally is around 54.3%.

7:41
North Dakota, for now, gets that, gets the number one slot, as the highest performing, and then the lowest performing is around 45% of doses administered.

7:52
And states have reported discrepancies between CDC reported data and internal data.

7:56
And just, you know, before we, we keep talking about, kind of why that is just a reflection on where we’ve been.

8:02
So, you know, the first phase really focused on health care workers, long term care staff and residents, and there have different in different challenges in both of those venues of really trying to get the newest into the arms of those people that we’re targeting, OK, next slide, please.

8:20
Next slide, please.

8:22
So, you know, why, why are there differences? And, you know, why aren’t we at 100% of getting everyone vaccinated? Well, there’s a lot of things to consider.

8:30
one is vaccine supply and transparency. So, states, when they first rolled out the vaccine their vaccine plans on december 20th, they didn’t even have certainty that they were going to get federal funding, which is, you know, since happened. And now, they’re going to have funding to do some of the things they need to do. But, at the time, back, on December 20th, they didn’t even know if they were going to have funding to pay for staff and set up new sites, et cetera.

8:53
So, they were really planning in a vacuum. The other piece, which can thing, continues to challenge them, is they only know week to week how many doses they’re going to get.

9:01
So, it’s really hard to think about the longer term planning when you’re on such a short schedule of knowing what’s going to come next.

9:09
I know that the Biden Harris Administration is making it a priority to focus on Supply first. So, I know it’s our sincere hope that, you know, in the weeks to come, there’ll be more progress, or States will be able to get a longer term.

9:21
You know, 3 to 4 weeks, even would be ideal of how many vaccines are actually going to get, which will allow them to get people scheduled and in the door, the slow rollout of the Federal long-term care facility partnership.

9:34
So Walgreens and CVS were tasked with vaccinating people in nursing homes, skilled nursing, skilled nursing facilities, and other, you know, long term care facilities across the country.

9:47
And they were vaccinating both staff and residents.

9:50
I think there were a couple of challenges in the rollout of that.

9:52
In some states, there wasn’t the staffing at CVS and Walgreens levels in those initial weeks to meet the need.

9:59
So, there were State that that really didn’t have enough people, at the pharmacy, to be able to be, to reach all of those populations. I think there are challenges getting all of those facilities to sign up. Some states are now at 100%, Some States are not.

10:13
And there was there was hesitancy as well, which I think we’re going to talk about during this webinar, especially with the long term care workers. They didn’t want to be the first in the door. And there hadn’t been the time to really do the education and build the trust that was really needed to get there.

10:28
So, you know, you’ll see some states, like West Virginia, who is also, you know, really high in the rankings, they decided to go it alone and partner with their community, pharmacies and other community leaders, and they are, you know, pretty close to finishing their second round of dosage facilities.

10:43
While other states are far behind variable public health structure, So, states are organized differently.

10:49
Some states have very strong county systems, some states don’t.

10:53
Some states relied on their health systems to really be, you know, the primary immunized … for those initial populations.

11:00
And, you know, you can see in the data there has been different uptake, depending on the health systems, and, you know, the willingness of the workers to get vaccinated, but also the effectiveness of getting them scheduled in the door.

11:12
So, you know, I think, hopefully, that will continue to improve.

11:15
We have talked to a couple of states, who, in, to the extent, they’ve been able to centralize some of the processing of figuring out like, where the supply is. And, you know, seeing if there’s a health system that hadn’t used all their supply to re-allocate it, that has been some some effective things to do, to try to really get the vaccine out.

11:33
Communication hesitancy. I mentioned this a little bit about the long-term care workers, but it’s even more broad. It was also with, with healthcare workers themselves where you saw health systems with 30% you know, rates of vaccinating their healthcare workers. So, I think a lot more work needs to be done to talk about the safety and efficacy of the vaccine.

11:51
But also, I’m going to the next piece, as well, managing public perception and media pressure.

12:00
So, on the one hand, we have people who really are not sure they want to get the vaccine, and it may be their turn. But, on the other hand, we have a whole host of people who really want it and are frustrated that they can’t get it. You know, a number of folks over 65, for example, which in some states, they’ve opened up other states, they haven’t.

12:16
Any of those folks are clear where to go, when they’re going to be in line, how to register. So, I do think there’s a lot of communication challenges that’s really going to have to be addressed at the federal, state, local, and beyond level, You know, with trusted messengers, having a, more of a uniform message to explain to people, here’s the safety and efficacy of all these vaccines. There’s new vaccines coming online. There’s new variants.

12:39
There’s a lot of information that people feel like they need to understand along with setting expectations of when they may be able to actually get it.

12:47
Um, technology for scheduling, I’ll just talk about this briefly. So, you know, the registration itself to get the vaccine has been very challenging across the state.

12:56
And it’s been hard. Number one, because the state don’t know how much supply they have that you know. And then when it flows down to the actual vaccinating providers, they can only schedule so far out because they don’t know how much slipped by they’re going to have week to week.

13:07
And that has been a source of frustration. And, you know, on the data side, there’s been IT challenges about data flow, and, and, you know, people using different systems, and, you know, we’re making progress, but more progress needs to be made to really make that flow. The way it needs to be for the millions of people that need to get the vaccine OK, next slide, please.

13:27
And, I just wanted to talk just briefly about the speed versus equity. So, right now, you know, it’s a race against time. You know the vaccine has been an incredible development and really will help us.

13:39
And this pandemic, but, at the same time, you know, folks are really wanted to get as many people as vaccines possible so we can re-open. We can, you know, protect against new variants, think about how to get the public back to where everyone wants to be.

13:53
But, at the same time, you think about, What does that impact on equity?

13:56
And I say that equity, meaning, in a broad sense, there are different populations that are just harder to reach.

14:03
And, in some of the states, they wanted to focus on those populations within the big, big categories of, you know, long term care and health care workers and some other groups.

14:12
And they report, it slowed them down, because, you know, it’s easier to set up a mass site where the people who want to come will come, and they’ll get themselves back the needed. And you’ll get the numbers in, which I think is really critical to do right now. And you’ll see, you’ll see, you see that happening across the state.

14:27
At the same time balancing, How do we continue to reach out to those vulnerable population who are going to be more hesitant, who aren’t going to necessarily have the means to be able to get to the vaccination site easily. You know, do we have to go into the community? The answer to that is yes.

14:41
How do we do that, and how do we do that, all of these things.

14:45
I think the early data shows, unfortunately, that significant disparities really are showing themselves by race, and that is a concerning trend, right now, there are 17 states that are reporting that publicly. I assume there will be more that will start to do that.

15:00
And so my worry is: How do we really address the hesitancy, combining with providing them with access?

15:09
So, you know, making sure people understand that the vaccine is safe and effective, but also making it accessible and easy to get in their neighborhoods.

15:17
States have started to talk about various strategies, you know, percentage of set aside for vulnerable communities, making sure you’re reserving certain schedules and appointments for those who are most vulnerable.

15:26
Make sure they’re getting in the door, locating sites and easily accessible locations, and education and communication.

15:33
But, you know, on this piece, there has to be some really strong partnerships built at the local community level. And we talked to a couple of states who built those for testing, and really feel like they have a robust structure, and really hope to leverage that in the vaccine context.

15:49
And then, finally, I just wanted to leave on this point that we can discuss as a group. I look forward to it.

15:54
There really could be a potential crisis point if we get to a place where we’re getting those who want to get vaccinated in the door through all of the different ways that states are working on with their partners.

16:04
But what happens then when we haven’t reached the populations that needed perhaps the most? And we haven’t built those structures to make sure that, that that’s going to be possible. So, with that, I think I will turn it back to you, Rachel.

16:19
Thanks so much. Thank you so much, Amy, that that was terrific. And, I think, a really good qualification, that, when we’re talking about equity today, we really mean two things. We mean, absolutely, the racial equity and disparity that has been documented all throughout Cove. In 19, prior to 19, in, our, in our healthcare system, and in our outcomes. But, also equity, in the sense that matching the ability to match the vaccines to where the cases are. So, I’m having both of those kinda frames of reference for equity in our minds as, as we make our way through this conversation. With that, I’ll turn it over to you. Doctor Larsen. Go ahead.

17:10
Great. Thanks very much. And, thanks, Henry. That was really excellent over here here.

17:19
I’m gonna pull the lens back a little bit, and just I just have next slide, two slides, because understood to do be brief, and just want to put that more state level picture into a global context, and see where the US Is.

17:43
And at the Vaccine Competence Project, I lead the Vaccine Confidence Project out of London, which I founded 11 years ago, to try to get some metrics on.

17:56
I saw a growing trend of refusals and questioning when I was leading immunization communication at UNICEF Globally, but the question always was, How much and is it getting worse?

18:10
And at the same time, being based in New York at UN headquarters was hearing more and more on the ground in the US. So, basically, I founded this group research group to start to measure and monitor over time and place on and some countries as nationally as we’re starting to do in the US.

18:32
Also, um, again, confidence in the importance and the effectiveness and safety of vaccines as well as compatibility with religious beliefs. We found those four domains.

18:49
Importance, safety, and effectiveness, doesn’t work. Doesn’t matter.

18:55
Is it safe, and is it compatible with my belief’s, religious or otherwise?

19:01
Interestingly, when you really look globally, data and comparing it to actual vaccine uptake, importance as the stronger perception of the importance of the vaccine is actually the strongest predictor of vaccine acceptance.

19:19
So, that’s a signal to what, what we should be putting into our communications.

19:26
Not just, I mean, interestingly, of those different domains, safety is the most, we see the least confidence and the most skepticism or anxiety. I should say. At the same time, if people believe in the importance of a vaccine, they’re much more willing to tolerate a bit of risk.

19:46
So, I think that that’s something that we need to remember.

19:53
The other thing that’s important, and I just wanted to point out on this particular slide, this was actually, we published a five year analysis of our vaccine confidence index across 149 countries and about 350,000 respondents. And the Financial times, and covered the publication a few months ago. and made this map based on some of that data.

20:22
But I think the most important point here, there’s two things.

20:27
Why is Japan the lowest?

20:30
And what it does is speak to, and we’re seeing a similar issue in the Philippines, which is been occurring since this 19, 2019, it’s slipping down to the bottom because historic events of anxiety concern, or what we call vaccine confidence crises, do have long term impacts on the historic memory.

20:55
Whether it’s within a minority community, or whether it’s population wide and Japan for all of its, you know, positivism in a sense about vaccines.

21:05
They’ve had a couple confidence crises, and one in particular, around the HPV vaccine, which has been suspended proactively for a while. Because the government is concerned about public anxiety. But, I say that, because in the context of the … vaccine, this year is going to be one of the most important years in the history of vaccine and vaccine confidence.

21:34
If we get this right, it can only be an asset to building confidence moving forward.

21:41
If we get it wrong, it will not be forgotten.

21:44
So, I think, every little effort we make, from a local conversation to an national one, or globally, but in this case, if it matters, next slide, please.

22:03
In addition to our routine, Vaccine confidence, more broadly monitoring, and we do a mix of survey work, 24 7, Social Media Monitoring, and focus groups in depth, Deep dives, where we are seeing a shift in, in, sent in sentiment, to trying to understand what’s driving that.

22:25
But we’ve also, since last, last spring, been monitoring closely confidence, in, more broadly, in the covert response, in government management of it, in public sentiments, feelings and emotions around the various measures and their experience of coven.

22:45
But within that, also about the culvert vaccine intent.

22:50
Why did we do all that?

22:52
Because what we’ve learned is that people’s willingness to accept a vaccine is highly embedded in their experience with health authorities, with government more broadly. And if they’re managing and receptive of masks and social distancing, if they feel like that’s being handled well.

23:14
And they’re, they feel like their concerns are being taken care of, they’re going to be much more likely to accept a vaccine.

23:23
This was again, a global study on. But this was specific to a willingness to take a cobalt vaccine.

23:30
The US, Actually, Just to put in context, there are countries who are far more negative, and quite a few more positive. The dark red is definitely will not take a vaccine. Again, this is a sampling of 32 countries. It’s not the whole world. But it just does give you a sense.

23:53
France, Which it is, on vaccines, more broadly, France, Serbia, and Pakistan, Lebanon are quite high, but the US is just under Germany in terms of it was saying they were, you know?

24:10
This is, by the way, December Last month.

24:14
Um, not, not as bad as some of the others, but is, is.

24:21
You’ve got a lot of countries below that are more positive. In addition to these core questions about, Will I take the vaccine? Is it important? Is it safe, is that effective? We’re also asking a lot about demographics and as well as government handling of the covert response. And what we see on the right is that anything to the right of that long line there is a strong correlation with willingness to take vaccine covert vaccine.

24:51
So, if your mail, If you’re over 65, and if you believe that the government is handling things well, you’re the most, That that’s the strongest. The positive sense of the government handling of the response is strongest.

25:11
These points, in terms of its correlation with willingness to take a vaccine, along with the number of covert deaths per 100,000, and that’s another motivator. What is the importance of the vaccine? Do I need it? We’ve seen the ups and downs in public willingness to take vaccines. Very much a reflection of the state of the, the epidemic, the state of the pandemic, whether it feels like it’s a threat or not.

25:41
And, and then, just what everyone’s heard on the news, or in their social media, or whatever’s, and it’s also, and how they’re being treated. But the government handling is, is a much stronger correlate than we had anticipated.

26:02
I mean, we knew it, it, it was, but that’s both at state and and government level. I think a number of the points I was going to make, actually, Henry’s covered well, in terms of the challenges and community level and certainly some of the the issues of the hesitancy, not only being in in communities. But, even being among healthcare professionals, we’re seeing this in a number of countries. And I also agree about the potential crisis point. We need to get the balance, right.

26:38
The in a way, you know, you almost want to start with the worst-case rather than the most and make sure if we can get the most difficult to reach onboard and build out the rest, but we have to do on all fronts at all times. But really keeping our, our eye out for making sure, as.

27:01
We’re all here and together in this, wanting to make sure that the access is equitable, but also that it’s with empathy. It’s with understanding, and we’re not just about getting the numbers of vaccine.

27:17
It’s, I think, we should see our journey as getting past koven together, not getting the most people vaccinated. I think people want to know.

27:29
I mean, I think the end of our journey, which will need to include masking and social distancing, until there are enough people vaccinated.

27:37
So, are, we want to get past this together? And I think, we have to understand that a lot of these questions around … vaccines are absolutely legitimate. We should never judge anyone for asking questions about these vaccines because they’re new. They’re brand-new.

27:55
And I think even the scientists are still learning. We can see there’s changing issues every day, including variance, here in the UK, based, the government was talking about changing doses and that confuse people.

28:10
So, I’ll wrap up, I know I had only a few, two minutes here, I was supposed to talk.

28:16
So, just to give another perspective on, on the excellent review of the state’s situation. Thank you.

28:25
Thank you so much, doctor Larsen. Maybe you would stand just for one second. We’ve we’ve had a few questions come on while you were doing your presentation that really connects with the point that he made as well. Just monitoring and meant mentioning some of the difficulties in the rollout.

28:44
But how, how do some of the limitations and supply that are happening in the US, and that, we’ve had a lot of policy changes around who should be vaccinated first and where to start?

28:55
How would you anticipate that feeding into, you know, this calculation around, you know, confidence and in government to get this right?

29:04
And do we have, do we have a risk, you know, what, as as we rollout the vaccines, that some of those issues can actually make? some of the hesitancies that you spoke about here, more profound?

29:19
I’m sorry.

29:20
Can you repeat the repeat, the last part of the question.

29:25
I had an intranet glitch here.

29:28
I was wondering what you, what you thought in terms of the US. Having kind of current supply issues in various states and different policy changes and recommendations, kind of contributing to some confusion. People, you know, trying multiple times that are 75 and older to get vaccines, only to get their first appointment, and then to have them cancel because a lack of supply? How do you, how could that potentially plan to kind of long term willingness to, to engage with this process and get vaccinated ultimately?

30:02
Well, I think people, if, you know, they’ll come once and if they don’t have the vaccine, and then if, I think, we need to try to make sure, at least in the second time, that they’re invited in the vaccines, are there. I know it’s a challenging situation everywhere. But we do see that in a number of countries, when people, people give it a go once twice, and we want to, as much as we can have willing people, we want to be there with the vaccine. And, and I know when supply things come up.

30:36
Which are challenging everywhere in the world right now, to try to, how can I say this?

30:46
People do lose confidence, if they go, or attempt to go multiple times, and the vaccines are not there, they, at some point, are going to give up and lose confidence. So, I think that the more we can, on the one hand, you know, we have to be honest with the situation, but at least have something to offer during those times.

31:09
Or, I tried to, yeah, I tried to make sure it’s a difficult question, but I do think that we should make sure that we’re not sending out notices to the extent that we have.

31:27
Aye.

31:29
When we don’t have vaccines, but obviously, there was an intention to have the vaccines, but maybe maybe having something else to offer. So we, I think the important thing is to keep people engaged in those interims while you get the supply. I think that’s actually important.

31:47
Great, thank you so much. And, Amy, this was speaking a little bit to your kind of setting of expectations.

31:53
Point, did you want to add, add something to that?

31:56
Yeah, I just wanted to briefly add, you know, there are big public campaigns. We at Duke Margolis are working with the Kobe Collaborative and the Ad Council and they are building a big public media campaign to get people understanding the safety and efficacy of the vaccine. We are also aware that HHS has a $250 million campaign to inform the public about the vaccine. And, I think there’s a lot of conversations going around about the timing of all of this, when should we roll it out, and when it is appropriate?

32:23
Because I do think, doctor Larson’s point, you know, you don’t want to push people to want to get, and there’s a lot of people that want to get the vaccine.

32:31
If you can’t respond. And so that’s my, just my point I just wanted to make, again, is, you know, setting expectations with giving people the timeline along with the ability to understand how the vaccine can be safe and effective. What is coming down the pipeline, I think is important.

32:47
Great. Thanks so much, Amy. And with that, doctor Thompson, I’m going to turn it over to you.

32:53
Well, thank you very much. And I really appreciate it.

32:56
Let me continue on with the theme that that Heidi talked about, which is a sense of what we do now as not only extraordinary implications for this moment but also for for the next historical moment. Because there will be another pandemic. I was fortunate to be the Health Commissioner in Washington, DC. During the height of the aids epidemic. In the 19 eighties, the biggest challenge that we face then was distrust, was distrust of health care researchers, distrust of the system of clinical care and distrust of the health policy movement. A lot of that was because of the Tuskegee Syphilis study of which are everyone, I’m sure is well aware of the horrors of that experience, but those remained prominent in the 19 eighties. And frustrated our ability to respond from a public health perspective to the HIV slash aids crisis in the black community. And, I’m speaking now through the context of the African American community today. What is the number one problem that we’re facing as we fight against the covert vaccine? It is the disease of distrust.

33:56
And so, once again, we have to realize that there is a larger context that has to be addressed. How could it be that, in 40 years, we’ve made so little progress is being able to give the african American and other communities of color confidence in the system so that they will follow the best guidance and advice? So, remember, please that this issue of distrust is important even today Robert Kennedy junior. a horrible initiative that he is having targeting black people with this anti vax movement because it Medical racism, the new Apartheid learn how you can come back government, coercion, and medical abuse of color.

34:34
And so he’s pushing this kind of nonsense. And there are many, many others who are pushing this targeting the black community with their misinformation, we have to remember that lies cost lives. We did create something to try to overcome this kind of distrust, And it’s called the Black Coalition Against Covert. It is a model that builds upon several things. Number one, we must have grass roots community engagement. If we’re going to fight these kinds of challenges, government cannot do it alone. At the federal, state, or local level, it must be community based organizations. As well as our faith leaders, Influencers who have the voice of credibility, who can speak with credibility to their community, people from the community who can translate and transmit science messages in their own vernacular in ways that can reach and cut cut through. Secondly, you must have tried trusted science and clinical care voices.

35:24
And so, we are very much focused and had to fight to find, who were the African American physicians and scientists who were a part of this, of the development of vaccines.

35:34
So, so it was, but it’s very hard, unfortunately, throughout NIH, to find enough people of color who are really involved. But those that we did, we worked hard, doctor Gary Gibbons at the National Heart, Lung, and Blood Institute, and very privately doctor Kismet Kia Corbett, who worked in Tony fauci’s lab to help develop the modern a vaccine. We have, she has been all over the black community moving forward with showing people that there are people of color involved.

36:02
And then we have now been partnering with organizations like Black, doctor dot Org, the largest online forum, so that we’ve been able to take Black voices, such as our For Black medical schools, Howard …, Morehouse, and Charles Drew. The National Medical Association, and the National Black Nurses Association, All of them coming together, organized by us in one, legitimate firepower, one giant fish, to speak to our Black community through community based or Zoom. events that have been reaching 300,000 people at a time. Teaching now, said, there is a huge desire for the black community to hear from trusted voices, trusted, black physicians, and scientists Are Polling, tells us that we’ve gone from a couple of months ago, where it was 60%? No, I will not take the vaccine to. Now. Our polling is telling us that it’s down to 30%.

36:51
The 30%. And so the, the 70% who are saying, I’m not in a no category, are saying, I need more information, and I’m ready to go. So we really need to make sure now that the ready to go is available. And so we now have to make sure that there’s fairness inequity in these dissemination sites. We are seeing gaming in the system at the local level that mirrors the same kind of voter suppression mean spiritedness in communities that we saw during the election campaigns, now being very similar in the access to vaccines. And so we’re going to have to have our community based organizations involved, our faith leaders involved in setting up vaccines centers, in partnership with health delivery systems in their community, overcoming the transportation challenges, overcoming the problems that the homebound have. But we’re going to need funding to do this, and funding is a very big part of it.

37:45
Unfortunately, what we see too often is major white philanthropies and other organizations with which our government already has a preexisting funding mechanism. They get the dollars. And what happens is that the african american community has been taxed with doing the work we do. But having to do it with very little resources, and people sort of taking those community based organizations for granted. And so, I hope that we will not do that.

38:09
Finally, I will indicate that there is a very strong effort going forward now, to ensure that community based organizations have the evidence and the science basis for how to do mass vaccination efforts in partnership with local public health departments, local hospital systems, and physicians. So that we will be able to ensure that best practices are being used. and, therefore, making best use of taxpayer dollars and making sure that we are as efficient as possible.

38:38
I will conclude by saying, what happens today? What happens now, will be a predicate for what happens in the context of the next pandemic, which is surely on its way. If we do not turn around this disease of distrusts, people will continue to die unnecessarily. I cannot emphasize enough distrust, leads to death.

39:00
Doctor Toxin, thank you so, so much.

39:02
That was fantastic, and a really important reminder for all of us, that the disease of distrust did not arrive in the United States with cov at 19.

39:13
That it has been here much longer, and for some very evidenced based reasons, and we need to keep that in mind, and factor that into our planning. You touched on something that we’re seeing in a lot of our questions, that I hope actually each of you, each of the panelists, could take a minute to address the rent, Just the simple, the simple act of trying to register right now, and saying: I’m ready, I want more information, I’m, you know, to your point, doctor Trucks, and I’m, I’m ready to go, you, you’ve convinced me with your science and your evidence.

39:51
The registration so far is so technologically heavy and so burdensome just in it of itself. It has, you know, segregated who has the ability to, you know, spend the time or take those steps to kind of go through Go through that process And leaving a lot of people really burdens but also really out of the loop if they don’t have that, have those resources. So, hey, me, maybe we’ll start with you. Are there states, are communities that have recognized that out of the gate that are already trying to address that limitation? And then, doctor texts, and I would turn to you and ask if, you know, in fact, you’ve seen some kind of community level mobilization to it, to address that fact. And then if we still have doctor Larsen, ask her, You know, if there are other countries that we can learn from who have also dealt with this, and that and the tech device, OK, maybe we’ll start with you.

40:50
Yeah, and, you know, I completely agree that registration has been a huge challenge for a lot of different populations, including the elderly, who find it particularly challenging. So, you know, we have a complicated healthcare system, and that is reflected in the complicated registration systems that we have across this country. Part of it is because, you know, each different vaccinating provider has their own system. The pharmacies have a separate registration system, The big health systems have a separate registration system. The local health departments have a separate registration system, and that has just led to, I think, just complications for people to understand, where do I go? Hat, you know, what’s the easiest way for me to sign up, and, you know, what happens after that? So, there are a couple of state.

41:31
And I say this with a caveat, because I don’t think it’s going to work in all the states couple of states like, New Mexico, Mississippi, where they have actually decided we’re going to do a statewide registration system, And they’ve been able to, because of their, you know, smaller number of providers, and just kinda the circumstances in their state, they’ve been able to convince kind of everyone to use the same system.

41:50
That’s allowed them to see across the state where we are scheduling, you know, where are people signing up, how do we know how we’re doing, And I think that has simplified the process.

41:59
Now, that is not a solution for all the states, especially the larger, more complicated states, or where you have counties, you know, running programs versus, you know, other entities.

42:09
So, but I do think there’s a, there is a question across the states of, like, how do we make this more simple?

42:14
Second piece, I would just say, is, in the data feeds, and, you know, we don’t talk about data on this call in any great length, but it is part of the process, right? That we had our immunization systems that have been up for a long time, but they are not designed to at the speed and the volume that we’re having to deal with vaccinations right now. Right. That is the challenge there. So many different feed that have to come in from EHRs are separate data input, and that has just really been complex. So, my, my hope is that we’re gonna see some progress over the next couple of weeks and months.

42:46
But I agree. I think it’s going to be a continued challenge for the public.

42:49
What we’re seeing Rachel, across the country and getting numerous reports are people of color who are in environments Where there’s very slow internet connection or just frozen out, and they just can’t get through and after waiting 6, 7 hours, you just cannot get through, but that’s not the worst of the problem. What’s also happening is that we are seeing, well, to do, white people, who are able to get through the system. And they’re even coming into the black community and getting the doses from the black community because they were able to register it when black people were not that we are seeing this all over the place. And so this is really causing a problem. And I would say that while I’m appreciative of the challenges that local health officials have tried to manage these data systems, this is not new business here. America is a data driven company. They are a gazillion companies that know how to do this work. I do not understand why we do not have private sector entrepreneurial leaders being involved in partnering.

43:42
But, secondly, and quickly, I would also say that if, in fact, we now know that we’re having these problems, the local governments are going to have to communicate to their people, saying, we understand, We get it. We know you are frustrating. Here is what we are going to do to keep you updated every day about this, and tell you how we’re trying to solve the disconnect. But what happens is, we’re leaving people scrambling, leaving people frustrated, and then watching other people slide past them.

44:08
And last thing I want to be really clear about this vaccine hesitancy issue, black folks are not in the vaccine hesitancy issue. The way that we thought we would be and are not anymore. So please don’t let any state officials give us this **** about is hard to reach us. We’re ready.

44:23
There are lines of crime: The block, and DC. When Howard University laid out, its its vaccination campaign, They had too few doses for the people lined up. Same thing in Atlanta, Georgia, and Morehouse, so it is not an excuse that, it is hard to get black folks to come take The vaccine, is the competence of the system is at stake, and this is a This is a referendum on America’s competence to execute on a very fundamental problem.

44:50
Thank you so much, doctor Tuck. Then Heidi, I saw your reaction to doctor Toxins, explanation of how some of those doses were, you know, potentially going where, you know, they were not targeted to go.

45:06
Is this a uniquely American issue Is is how have other countries dealt with this supply demand equity situation?

45:18
Well, we’re just, we’re just learning. We’re actually really in kindergarten when it comes to where we’re at in the world with rollout of vaccines, I’m in Europe, as I’m sure you’ve read in the news, is struggling to get vaccines in the UK.

45:34
The system here is a bit different, but what they’re doing is we haven’t seen that, but it’s, you know, it’s through NHS. So, it’s all. It’s, it’s a very centralized system.

45:49
And they’re basically by the different areas, you know, calling you, if you’re above 80 or a health care provider.

45:58
And if they don’t fill there, if they don’t get enough people in that range for the vaccines, they have available, they start calling people in the seventies and say, can you come tomorrow?

46:11
So, it’s, it’s quite different here because it’s very, highly controlled, highly centralized.

46:18
So we haven’t seen that kind of issue.

46:22
But I think there are people who are surely more proactively reaching out to their, their health product, their their GP practice, their NHS practice, to try to get higher on the list.

46:39
I mean, there’s always some level of lobbying there, but it’s, it’s not, I haven’t heard experiences like that, but it’s partly a very different system.

46:52
Read: one of the one of the questions that we’re getting and one of the areas where we’re still seeing hesitancy though, I think and others can confirm if this is true. It’s, it’s going down a bit is in the area of healthcare providers And hear me. I think you’ve had that in, in your side. And read the work that you all have been doing. With black doctors against Kobe and just the importance of showing, you know doctors of color, living in your community, getting these, getting these and getting these vaccines. Have you seen that really make a difference and the hesitancy for not just physicians and nurses?

47:29
But, you know, the long term care facilities, nursing home workers who may not be licensed physicians, but how, how are we doing?

47:39
I’m kind of moving that population, keeping in mind that many of them are, you know, vulnerable in their own right.

47:47
The question is really really important. I’m seeing a bifurcation here, the health professionals themselves physicians and dentists and so forth, and the advanced nurses we’re seeing them not having the vaccine hesitancy that that we would be concerned about. And I think that what many of them are doing are, as you have indicated by the premise of the question, showing themselves, being vaccinated, and making those photos and pictures and stories ubiquitous where the problem is, is below that. And it is the folks that are in the trenches, and those are a real challenge. So, much so that the Black Coalition Against Covert is actually actively, right now, about to roll out a national town hall for multicultural health professionals. Just to try to address this even further, it is such an issue that we feel compelled in the next 10 days to present a National Townhall adjust on that very topic. So, more work to be done there.

48:43
Great, thank you. Um, let me, I want to remind the audience: we have way more questions that we can get to, So we’re trying to group them, so we can address as many of the issues. But make sure to use the question panel on the, on the webinar platform to get your questions, to get your questions.

49:04
And speaking of the elderly population, I think it was, you know, 1, 1, kind of guiding principle as the vaccines began to rollout was this shared awareness, that elderly, you know, frail elderly in particular. And those in long-term care facilities should be a top priority.

49:26
But just that, one, we know that that has not, you know, that’s not so we haven’t accomplished that quite yet, but also, when we look at who makes up those populations, they are, for the most part, non hispanic white populations in terms of the population. And where does that leave the frail elderly who may not be in those settings? And does that you know, do we are there other things that we need to do? Doctor toxin, pay me, Heidi, to really address that population and wrap around them?

50:02
That’s why I think we’re really putting so much emphasis now on being able to stand up these local, community based opportunities, and particularly with the faith community. We have a long history of knowing that churches partnering with hospital systems and others, public health departments, can really stand these up. So that people who are elderly and are homebound who can’t travel far, Transportation being a fundamental rate limiting step, Rachel, that it’s important then that there will be these opportunities that are not only conveniently located, but are organized as part of community life. We have to remember to on these kinds of things, to disentangle people from their traditional sources of support and move them across town to some strange and foreign place to get this done. Does not help us with the continuity that we’re trying to get from the continuum of all the elements that we’re trying to manage that this pandemic brings. So bringing it home is really so important and there are ways of doing this properly and doing it right.

51:01
We have experience from that and that’s why we’re trying to stand these up. But again, Rachel, the key thing for us in doing community based outreach efforts here is we need the evidence on best practices. Nobody wants to do this in a haphazard, casual way. This is not time for amateurism. This is a time for professionalism. That can be achieved.

51:20
Yeah, and I would just chime in. You know, we here at Duke Margolis have been talking to to stay and employers and community groups and all sorts of different coalitions to identify what your doctor toxin just said, like, What are I would call the promising practices Right now? I don’t think anyone solved it.

51:36
A couple of things. I completely agree about the community partnerships. And, you know, states, they’re going to get federal dollars. They have federal dollars. They are sometimes slow, and getting those dollars out.

51:46
And so, a real push to be able to find those promising organization, then get those agreements in place more quickly, I think, is critical. I will say this, I think we shouldn’t forget about some of the work that was done on testing. There have been a couple of states and local governments that have done a good job partnering with some community organizations and, and, and figured out how to get testing into the right communities. We just talked to a state, Connecticut is one of them that has done pretty well on that.

52:12
And leveraging those, I mean, let’s not start from scratch. If some progress has already been made, we don’t have time.

52:18
You know, I think, you know, we have to be leveraging everything we can. At the moment, we can do that. So, the only thing I would just hope, and I know we’ll return to the question, is that, that when the funding does come out, and you make a great point, is that, again, it’s the money almost always winds up going to these gigantic big, white organizations who have the funding relationships with the state and others. And then the black groups have to come with hat in hand. Trying to beg on the back end. There has to be better co-ordination of this on the front end. And much more thoughtfulness so that you put together something where everyone is in this together. We’re all working together. And there isn’t that, again, that constant sense of distrust and black folks being an afterthought in the process.

52:58
Yeah. And I would just, I agree. And I also would add that the latin X community, as well as Native Americans, I mean, there have to be some really concerted efforts to partner in. Some states are really doing it with the tribes to make sure that we get to those folks as well. So, I wish, I mean, you embarrass me by saying, I wish I had said, and I should have said it, thank you. Well, we have an audience question that also says it, so we can all be on the right side of this. They asked specifically about efforts to address some of the subpopulations And in the US, the Native American populations, others, that are, that really, may need, you, know, targeted messages and asked if there were, No, I think it’s great to remind us, Amy, how early early we are in the process. But promising practices that other states or communities can look to to really target messages for specific populations? Such as tribes are Native American populations.

53:57
I saw, It’s hard to hear.

54:00
I was just reading, and you, number of, you may have seen it, an opinion piece, and it was by someone who was an advisor in the Obama administration for Native Americans, but it was about the, the absolute importance. one of the reasonings for Native Americans and for getting vaccines is it’s a matter of survival, I mean cultural survival.

54:30
That it’s some of the elders who were really keeping some of these communities are getting smaller and smaller, but some of the elders who are the most at risk, of covert.

54:42
That they’re a lifeline to the culture, language, and tradition subsidies, and, I think, positioning it, that way to the, Of course, these vaccines need to be available and accessible.

54:53
But I thought it was it was such a powerful framing of and it gets to the point of community and putting things in the context of community and the and the meaning for that is just was a very it really moving and really important about the contextual aspects.

55:18
one thing you said, though, that, uh, that I think is key and that is, as you mentioned, it’s sort of we’re early on, but we’re not. And one of the things that is amazing to me is that there are big federal grants that are coming out of the transom Right now as we speak in the last two days.

55:32
This is January, we’ve been fighting the community messaging fight, I know since April, April was when we started pushing this and pushing it and pushing it. And it’s just amazing to me that it took a change in administration to move things forward as fast as they are. But this is not early, This is late.

55:51
That’s totally fair, totally fair, and totally agree with you. We have enough questions to keep going all day. With 1 last 1, I, one of the things that’s so striking, everything striking that we’ve talked about so far, but when the Commonwealth Fund does surveys, or when you see other surveys about who folks trust, and who they go to, for their information, they’re going to their physician, they’re talking to people in their community.

56:19
We’re in a situation where talking to your own physician leads to your own physician, putting their hands up in the air oftentimes, and not knowing how to direct you or how to help you, And So doctor texts and these are, these are your people? How, how?

56:36
What’s the role of the physicians and the providers who are, you know, keeping in mind the incredible importance of the community that we’ve talked about?

56:45
But when patients are presenting in their offices, when they know that they’ve got patients who have the very kind of, you know, complicating factors in their medical history, that shouldn’t put them, you know, to the beginning of the line, how do we make a place for the provider voice to really, you know, stay connected to to patients and kind of help navigate this process.

57:08
Very briefly, when I was, I did serve on the National Academy of Medicine’s framework for allocation on the dissemination, and we made it very clear that a absolute top priority where people with two or more chronic illnesses needed to be available early on to be able to get vaccinated. All of those plans went out the window because of the lack of organization from the Federal, to the State, to the local level. And so what happens now is I think that the only thing I can say is to reinforce the premise of the question. It is a nightmare. They don’t know what to do. Nobody knows what to do. And that is why is going to be so important now for our State and local county health offices to be an intimate touch with the clinical community. And particularly with those of color right now, they don’t know what to do. And right now, Rachel, there is no good answer except where in some states would have made a little bit more effort than others. This is a priority. So the thesis of the question hold. I cannot give you a Pollyanna answer.

58:01
Can I just add 1 1 point to that and we need to know the supply because that is key to all of this so that planning and appropriate messaging can be provided to everybody. So, I will just end there: transparency: transparency, transparency from the beginning, from the threat from from the, from President Biden, all the way through to the health officer in small City, USA.

58:22
Transparency so that everybody will know what to predict, so they can plan, and then you, they’ll have people upset. But without that transparency of that messaging and nowhere setting of reasonable expectations, you have the chaos we have at this moment.

58:36
Great. Well, thanks for thank you so much to all three of you as an incredible conversation. I want to thank you once again, on behalf of the Commonwealth Fund and the Alliance for Health Policy. All of the resources today, there were a few questions about the signs. They can all be found on all health policy dot org. For slides, also for background materials, resource listed, an expert list, will have a recording of the webinar from today, also, up on the website soon. And we really hope you take a minute to complete this super brief evaluation survey. We really do design needs to meet the needs of policymakers, policy, infants, influencers, media, and we do that best by really connecting with you all and hearing what’s most important. So with that, I just want to say thanks again to hey man, to Heidi and to read. It was terrific.

59:30
Well, we’ll see what we can do on all these questions because we have clearly opened a Pandora’s box here. There’s an incredible demand for information, much like the conversation around the vaccine. So, thank you all for, for joining us, and thank you for spending your afternoon with us, to the attendees and wealth that we’ll say goodbye. We’ll see you next time.

59:57
Thanks, everybody.

59:58
Thanks.