Coronavirus in Context: Getting the Message Right on a COVID Vaccine

[MUSIC PLAYING] You're watching Coronavirus in Context. I'm Dr. John Whyte, Chief Medical Officer at WebMD. We've been talking a lot about vaccines and when a vaccine might become available for COVID. But will people actually take it? I mean, we have heart enough trouble with the flu vaccine.

So to help provide some insight, I've asked Dr. Tamera Coyne-Beasley. She's Endowed Chair of Adolescent Medicine at Children's of Alabama at UAB. Dr. Coyne-Beasley, thanks for joining me.

Well, thank you so much for the invitation.

Let's start off with why is it so hard to get people immunized. We see with the flu vaccine, it's often less than 50%. In HPV, we have a lot of challenges in getting kids vaccinated. Is it an antiscience approach or-- or what's the problem that we can learn to help with the COVID vaccination if-- if it comes down the road?

Well, that's such an important question and thank you for asking me. But I couldn't answer that question without reminding our listeners that today or this month is August, which is vaccination month. So August is a month that's been designated by the CDC to actually talk about vaccinations across all ages.

But the question that you're asking is really important, because one of the things that we've seen not only through the CDC, but worldwide, is, uh, more-- more individuals who are actually hesitant about getting vaccines.

Now, the question you asked is why, and how can we use that information to prepare us against COVID. Unfortunately, there are-- are many reasons why, and I'd like to talk a little bit about some of them.

Sure.

Probably the very first one is that many of us don't remember the vaccine preventable diseases such as smallpox, or even something like, um, polio.

Polio.

So therefore, we don't even understand or remember the success of vaccines. So they're really a victim of their success. And because they've been so effective, we don't remember the diseases that people actually died from.

And then I think there are people who have questions about the effectiveness and safety of vaccines, even though they are one of the most safe and effective things that we have in the medical market. They're marketed more-- I mean, they're protected more and evaluated more than any medications we take or any-- any medical devices.

And then I must say, um, Dr. Whyte, there's also lots of misinformation that's promulgated, not only on the internet, but also through social media. And then you mentioned a little bit about the antitrust or the antivaccinators.

They actually really have lots of theories, or that some people might call conspiracy theories, about certain things being a hoax, or certain conditions not actually being that significant, or an infringement on people's liberties. So the important thing to do, and what we can learn as we think about providing-- or coming to, hopefully, a COVID-19 vaccine, is looking at those things that have caused individuals to be hesitant, and to work to actually make sure that we can address those issues.

But in fairness, people could say we work on the flu vaccine every year to try to get people vaccinated, and we barely can crack 50%.

Right.

You know, I want to tell you about this poll that we've done at WebMD where 27% of respondents said they would not get a COVID vaccine in the first three months. You know, let me see how someone else does. Dr. Coyne-Beasley, let me see how your response is.

Yes, OK.

So how does that help if we're trying to get people to be vaccinated, have a sense of herd immunity? That-- that's not going to be good enough, is it?

Right right. So no. To achieve herd immunity with the COVID vaccine, we need upwards of 70-- 60% to 75%, and actually, really more than that to get herd immunity. So we really have got to work really hard in understanding people's hesitancy.

One thing you already alluded to is that we won't have long term safety data, as we do with most vaccines. And so that will be, you know, part of the challenge. And so hopefully, what we'll be able to demonstrate and see is that we'll vaccinate, perhaps, some of the people who are at greatest risk first.

I want to make sure that, uh, we talk about the fact that you mentioned flu vaccine, and that's going to be really, really important. Because as we know, the COVID-19 actually really impacts the respiratory system, um, probably the most intense or what we understand the most about it.

It'll be important for people to get their flu vaccine, because you don't already want a compromised respiratory system. So while flu vaccine has been really-- you know, the uptake has been less than what we would desire, we really need to work hard to make that-- make sure that flu vaccine uptake is great as a way to actually pre-- prevent, you know, deaths that can come from getting COVID disease among people who aren't vaccinated.

And we don't want to overload the system. We know that, you know, tens of thousands of people die of flu every year. Hundreds of thousands are hospitalized. We don't want to superimpose that on, you know, a COVID pandemic.

You know, I want to talk a little bit about, um, you know, the FDA threshold for approval, as you know, is 50% effective. You know, some vaccinations are much more in terms of pneumonia, you know, shingles. And in our survey, more than a third of people said that they wouldn't take a vaccine that was 50% effective and has mild side effects.

So when we think about educating the public about what that means, and Dr. Fauci has been talking about 50% effective, do we need better terms? Is-- how do we more, you know, accurately communicate to patients and the public what's going on? Is 50% good enough?

Yeah. Well, truth-- you know, ideally, 50% would be-- we'd want something that would be better than that. But I think we really have to put in-- one of the things that we've learned as physicians, and particularly through the Vaccine Confidence Project, is that we have to stop talking about numbers, because numbers aren't really tangible to people.

And so one of the ways antivaxxers, or people who don't like vaccines, have been able to have-- be effective, is you talk about stories. But we want to talk about true stories. We want to talk about the lives that are saved. We want to talk about the grandparents. We want to talk about the young infant baby who was been too young to be immunized.

So it's really talking about and appealing to those things that are important to people. Things that they value, their family members, the things that they do in their community, and not just talking about deaths, but also talking about disabilities. Like, how it can change their lives in terms of, you know, if we're thinking about, say, meningococcal disease and meningococcemia, and they might lose limbs.

I mean, there are various aspects to, um, diseases that I think we need to talk about and humanize more aside from just using the numbers. And I think we need to have strong, consistent messages. I think, as providers, we need to be more actively engaged.

And many of us are. But it's about even calling-- you know, don't just wait for someone to come into your office. Actually calling them. We call those recall messages, to come in and get the vaccines, giving them strong recommendations, and really finding out what their concerns are, what is their hesitancy about, and trying to actually address that.

But, uh, I think that we want a vaccine as effective as it can be. If the-- the FDA approves it, it's-- it will be effective. And the-- the thing we need to think about is if you had the choice to save the life of your child, wouldn't you take it, even if it was only, you know-- and I don't want people to misunderstand. 50% effective does not mean, like, it's like flipping a coin. It's actually more effective than that. Um, when you take it--

Is it? No, I'm teasing you.

Wouldn't you take it? It's more than-- it's not like flipping a coin.

I know. I see that.

And so-- so it's not like, well, I'll take my chances.

But what about people that say it seems rushed? And in some ways, we're having great success because of innovation, but it's just like in baking or cooking. You can't cut down, you know, 30 minutes to 22 and you can't cut, you know, 2 cups of flour to 1 and 1/2. It's not going to work out. And it seems like, to many people, that it seems rushed. Do you think it-- it seems rushed?

Well, if you call it Warp Speed, it makes it very difficult for it not to seem rushed. And again, that's one of the challenges that we'll face when this vaccine comes out, aside from the fact that there is no long term safety data.

But if you're listening to the scientists, the goal is to make this-- make this vaccine produced quicker than normal. But the-- we're still-- the scientists are still very interested in making sure that there are methodical, clinical trials that look at efficacy, and look at safety, and don't cut corners.

So yes, it may be faster. And that's really because of the urgency of this disease. This disease already, in less than a year, has killed more individuals than we get from our annual flu epidemics. So it's highly contagious. It leads to many more deaths.

And so that's the urgency. But you need to balance the urgency by not cutting scientific corners. And so we are relying on our scientific community to do that, and that is the expectation of what we will do.

OK. Referring to the poll, women were significantly more likely-- there was a higher percentage of women who said they would not take the vaccine if it's only 50% effective. So how does that play into how we're going to communicate messages? Often, you know, moms, wives, daughters are the ones in the family who bring everyone else to the doctor.

Right.

So, in some ways, do we need a more concerted effort to educate women who seem to be having some concerns about the effectiveness of the vaccine?

TAMERA COYNE-BEASLEY: So absolutely. And I don't like to, you know, bi-- do gender bias at all. But the literature, it actually does show us that-- that women are generally the individuals who bring their children to the doctor and who encourage members of their families to get vaccinated.

So one of the first things that will be important is trying to get this efficacy as high as possible, right? So if you get it above 50-- the lower it is, the less confident people are going to be. So getting it as high as we can in terms of its efficacy and effectiveness is-- will be really, really important.

The other thing that will be important again is trying to work with women and find out what are the things that are important to them. And again, this is a vaccine-- it's called the Vaccine Confidence Project that's being done not only in the United States, but also, um, throughout the world, um, really looking at what are the things that actually motivate people.

And this is a new time. We can't use the things that we used to use before. Like, as clinicians, we used to say, give people the facts. Give the people facts. That's what they need. That's-- you know, that's not what people want anymore. People want a fact.

We're overwhelming them with facts.

Yeah. We're overwhelming them with facts. Don't get me wrong. They want the facts. But how do those facts relate to me and my family? What are the benefits of me doing this, and what are the harms of me not doing it?

And I don't think we focus so much on what are the harms that can come from you from not doing this, and then also placing it in a family context. So it's not just about you. And I'd like to think that we still believe in helping others, although it may not always be evident.

But what can this do to the teacher that your kid is going to go into school with and be exposed to? What are the potential, you know, ramifications of not being vaccinated for your mother, your child's grandmother, and your-- your friends and families?

And so I agree. The first thing I would really like to do is to try to find the most effective vaccine. And-- and one of the things that we have working in our favor, hopefully, is, as you're aware, there are many companies that are actually trying to manufacture this vaccine.

And one of the things I have done as part of my career has actually been involved and engaged in-- in evaluating vaccines. I do vaccine research as well as creating policies, the vaccine recommendations that come up the advisory community immunization practices.

I'm going to put you on the spot.

All right.

How optimistic are you that, if and when the COVID vaccine comes out, or multiple of them, that we're going to get to that 65% to 70% vaccination rate that we likely need?

Yeah, you're putting me on the spot, aren't you?

Mm-hmm.

So I am going to be incredibly optimistic, and I'm going to say that we are. Because this the-- this is what I believe will be the challenge. I think that we're going to have a very difficult fall and difficult winter.

And when we're-- and unfortunately, you know, I actually don't really want to predict this. But, you know, there's-- there certainly is some evidence to suggest that we may have another surge, OK? And we're probably-- your listeners are probably coming from all around the country.

And one of the things that we've known or seen as we have reintroduced young people into school, and particularly college students who aren't necessarily social distancing, that we're seeing clusters of disease pop up all over the place.

Couple that also with a-- with the normal flu season and an increase in COVID-19 diseases, I suspect that it'll appear even more urgent to people that we can get, hopefully, uptake as high-- you know, higher. Because I think people will-- will start to see even more urgency.

There have been almost, you know, 200,000 people who have died, and it is likely to get higher. And when people start having that as a personal experience, like, it's my child, or it's my parent, or it's my husband, um, or my partner, it's a different kind of experience.

And so it's my hope not that those things will happen, but that we will actually be able to achieve a higher rate of immunization than we would have with flu by itself. And again, coupling flu and other vaccine preventable diseases as making you healthier and safer against COVID-19, I think, is really important.

Well, Dr. Coyne-Beasley, I want to thank you for sharing your insights today, and I want to share with the audience that you were the very first physician, the first resident that I ever worked with on day one of my internship in internal medicine.

And many years later, I still remembered when I saw your name, because I still remember I was struck by your-- your tactical skills, your procedural skills, just your overall knowledge of medicine. But also your compassion for patients as well.

So I'm just delighted that I was able to connect with you today and to get your thoughts on what we need to do, uh, to get people safe and make them aware of the safety and efficacy of all vaccinations, and hopefully COVID-19 as well.

Thank you, Dr. Whyte. It's a pleasure, once again, to be with you.

And thank you for watching Coronavirus in Context.

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