Can Storytelling Help Overcome Vaccine Hesitancy?

[THEME MUSIC] Welcome, everyone. I'm Dr. John Whyte, Chief Medical Officer at WebMD, and you're watching Coronavirus in Context. Today I want to talk about vaccine hesitancy, and I also want to talk about the challenges in getting some of the treatments that if you actually have COVID. So to help provide some insights, I've asked Dr. Vin Gupta. Dr. Gupta is a critical care pulmonologist and affiliate assistant professor at the Institute for Health Metrics and Evaluation. Dr. Gupta, thanks for joining me.

John, thanks for having me.

You know, let's just put it out there. We all know that minority populations, brown and black persons, are not getting the vaccine at the same rate as other persons. What do we need to do to fix this?

Well, a few things. In the platforms I've had, I've tried to address this head on and I know others have as well. I think first and foremost, we need to make this as real for people as possible. Of course people from black and brown communities have been disproportionately impacted by this virus, but there's a lot of fear. There's a lot of anxiety about the vaccine for a lot of reasons. And I think while acknowledging that, we have to be as direct and upfront about the impacts of this virus, and why it's really important for people who may be healthy right now to receive the vaccine.

And I think put it in as stark of terms as possible, because there's a lot of confusing messages out there, Dr. Whyte, as I know you know. People don't know, they get confused about effectiveness and all these numbers that are getting thrown around there. And so what I try to do, and I know others have, is lean in on storytelling to try to make it as clear what the purpose of vaccination is, which is to keep you out of the hospital. And why specifically if you come from one of these communities where vaccine uptake is lower, why it's vital that individuals from those communities receive the vaccine.

You know I heard a comment the other day, someone said it's like getting a biology lesson everyday. It's hard to keep up even for clinicians, physicians. So what do you say to the patient who says, Dr. Gupta, I don't trust it?

First, that's hard, and I think we have to recognize that we're starting from a hard place. But it doesn't necessarily mean that person isn't reachable. And so what I try to do is, if they don't trust the vaccine it's probably a reflection of a lack of trust in institutions, and we're building that back. As we speak, our leaders are building that back, but it's going to take time.

And so what can we do in the interim? We can build trust in motives, John, and that's where I think folks like you, myself, and others, our colleagues, can really talk about, in the clearest terms possible, why a vaccine is vital to receive. So building back trust in motives. It's to keep you out of the hospital, it's to avoid you exposing a loved one who may not yet have received the vaccine from contracting the virus. And then yet again, trying to really reach people where they are emotionally.

And I think the only way you can do that when there is that upfront obstacle is by storytelling. And for me, I reference, for example, cases where I've actually seen people who were perhaps not wearing a mask the way they should have, or travel for the holidays when it wasn't absolutely necessary, expose loved ones who are more vulnerable. And their loved ones ended up in my ICU, or the ICUs of my colleagues. Those stories can reach people. And I think we have to start there.

All right so the power of storytelling. We've spent a lot of time talking about vaccines recently nationally, but we haven't always addressed the issue of therapeutics. Those persons who get COVID, and then may not get monoclonal antibodies, may not get remdesivir. We know there's disproportionate care that way. How do we address those issues of combating COVID when people get it, particularly from marginalized populations?

Well, this is where, not only is there a lack of knowledge or hesitancy about everything related to COVID, there's just simple information asymmetry, John. People just don't know. I can't tell you how often people just don't know where to access, for example, a monoclonal antibody therapy. If they've heard of it, they think it's only available in some cases to those who are rich or connected, because that's the narrative that's been built up around this at scale.

Celebrities, politicians, not someone like them. So how do we address that? How do we make them aware of it? You've been involved in trying to figure out what sites should people go to. How do they learn about it?

Well, it's leveraging platforms to get clear information out there. So I think number one is addressing the information asymmetry head on. Clearly saying go to combatcovid.hhs.gov which is what I do whenever I, for example, may be on a news show. Directly giving people actual advice, directly saying go there if you meet these specific criteria: if you're 55 and older have a preexisting condition, recent diagnosis of COVID-19 have mild-to-moderate symptoms. Go to that website to learn more, not just about where to get a monoclonal antibody therapy, but about clinical trials more broadly.

That's right.

And because it's important that we have diversity in the individuals who benefit from these therapeutics and vaccines, but also in the upfront research. To actually build that downstream competence, we need people to say, OK yes somebody from my community was actually part of the research and development of this vaccine or therapeutics, so they can say, OK, this actually does work for me. That study population was representative of everybody, not just a certain demographic.

But we know that's not usually the case. We talked to Dr. Collins the other day, who said there is structural racism. He and Dr. Woodcock talked about one of their lessons learned is that we don't have a research enterprise in the community. It's primarily in big academic centers. What are we learning from this pandemic that we're going to take the lessons learned and actually improve diversification of clinical trials? Because we're really not there. We did OK in the vaccine trials, but that was because of an enormous effort. Are we going to see that sustained in other trials in heart disease, in diabetes, in mental health?

Well I hope so, I hope we take away key learnings. And my answer was going to be rephrasing what you just said so well which was, these information on research trials, clinical trials, is generally the purview of academic medical centers. So if you don't know, or if you don't get your care, at an academic medical center, then you're not going to know how to enroll in these trials, or it's going to seem confusing, or you might have skepticism on it.

So yes, actually embedding information where people, especially where we can actually access a more diverse population, and embedding accessible, easily understandable information about these clinical trials, the importance of being involved in these trials, incentivizing participation directly at the point of care, is going to be key. And so you're seeing some of these changes now. Federally qualified community health centers, for example, being brought into the fore as a site for information dissemination. More of that, John, is going to be vital in the hopes of getting a more representative study sample from a demographic standpoint moving forward. We need to information disseminate more than just at quartenary care academic medical centers.

And you studied the health system. We often talk about cost is what keeps people from getting care, but it's important to note to our listeners that there is no cost for the vaccine. If they ask for your insurance information, it's to bill your insurer perhaps for administrative cost. But if you have no insurance, there's no cost to you for the vaccine at all. There's no cost for monoclonal antibodies. The government has purchased that. So how does this play into it? We always used to say it's cost, it's cost, it's lack of insurance. But insurance is not a factor in terms of vaccination, and in terms of some treatments, such as monoclonal antibodies and others. So how do we address this?

Well, on the monoclonal antibody side, I think it's a different conversation with vaccines in terms of barriers to uptake. On therapeutics, monoclonal antibodies, I've been personally frustrated at what I've seen has been a double standard on the utilization of these therapies, versus say remdesivir or convalescent plasma before it. There was a willingness amongst my colleagues, other front line providers, to say, OK, we're in a pandemic we're learning as we're going. Oh by the way, these therapeutics probably aren't going to harm you, they may help you.

That was our mental model for most of 2020 as therapeutics were rolled out, trial, and either proven to be efficacious or not. And yet suddenly with monoclonal antibodies, there's, in my view, a much higher burden of proof that's being imposed on their utilization by some provider groups. And so that's a proximal bottleneck here, where some providers are just not willing to prescribe it because they don't think the data is compelling enough. Well I look at the data, as do some of my colleagues in pulmonary critical care medicine. I look at the data and say, wow if we were to give this early enough in the course of illness to a high risk population, there's a lot of emerging empirical data and anecdotal data suggesting we'll keep you out of the hospital.

And oh by the way, there's no harm signal. So why wouldn't we give these therapeutics that are not going to harm anybody, may help them, when they're already on people's shelves? There's a lot of money that's gone into the research and development. It's philosophical, and it's ethical in my view. That's what this debate turns around, those issues. What's your medical philosophy? What's your ethical philosophy in terms of how you practice medicine? But in my view if the risk-benefit augurs more towards benefit than risk, we should do it.

Well finally, let's talk a little more about data. You're at IHME which has been at the forefront of modeling and predictions. Tell us what you're optimistic about, Dr. Gupta.

You know John, what I'll say here is that we are modeling that the most likely course of this pandemic is going to be essentially a nadiring of hospitalizations and deaths almost close to zero. Not everywhere, in most parts the United States by the end of June into early July, as a function of seasonality, warmer weather, less viral transmission. Viruses don't like humid, hot air. And also vaccine uptake, hopefully to the 80% range or thereabouts.

That's giving us a lot of optimism. I will say in the same breath here that with that optimism comes some degree of caution, that if the variants continue to take root, if we change our behavior as a nation too quickly. We're seeing in pockets across the states, and we don't mask right now as we're waiting more vaccination uptake, then that potential progress could be reversed. And there is a scenario where we are very much in the thick of this well into the summer. So I'm hoping we can stay vigilant for the next few months, because the likely scenario here is that there's a fair degree of normalcy by the middle of the summer.

OK I am going to end on that optimistic note because we don't get that enough. So Dr. Gupta, I want to thank you for sharing your insights, taking the time to talk about how do we address hesitancy, whether it's for vaccination, or barriers to treatment, and even clinical trials. Thanks for the time today.

Thanks, John. Thanks for having me.

And if you have any questions, please email me at [email protected] or you could post on Facebook, Instagram, or Twitter. Thanks for watching.