As physicians who practice at opposite ends of the United States and in very different communities, we watch the national race to vaccinate our fellow Americans with optimism and concern.
First, optimism: to date, more than 147 million Americans have received at least one dose of the vaccine; nearly 100 million people, or nearly 30 percent of the US population, are now fully vaccinated. We currently perform an average of three million vaccines per day. Our two states, Florida and Michigan, reach out to residents and get them vaccinated. And we have witnessed firsthand public health workers, nurses and medical colleagues who continue to provide compassionate care to the very sick, more than a year after the start of an emotionally and physically exhausting pandemic. More than 580,000 Americans have died from coronavirus; at least 3,600 of them were health workers.
This is where the alarm sets in. Even as we speed up vaccinations, an unwavering force stands in the way of community immunity.
This is where the alarm sets in. Even as we ramp up vaccinations, an unwavering force stands against the achievement of community immunity: the millions of Americans who just say “No way.”
In mid-April, Florida and Michigan were hot spots for the more severe variant of B.1.1.7 Covid-19, which originated in the UK and is now the dominant strain nationwide. This variant also sends younger and previously healthy people to our hospitals. With the coronavirus mutating to become more contagious and possibly more deadly, vaccination is more important than ever.
Yet refusing the vaccine – no reluctance, not “maybe later,” but outright rejection – could keep us from reaching the threshold where epidemiologists say we can completely reopen all aspects of society in all safety. safety and responsibly. Recent polls like this one from CNN put that number at about one in four people. In rural, predominantly white areas like rural western Michigan, these are the people who stagger in the emergency room sick and having trouble breathing, while telling nurses and doctors that neither Covid-19 , neither the masks nor the vaccines are real.
As a black cardiologist practicing in multicultural Miami and a white emergency physician in rural Michigan, predominantly white, we have encountered reluctance to vaccinate since the pandemic has existed. Some of the reluctance came from a lack of information, others from a lack of confidence, especially among underserved populations.
In September 2020, polls showed that half of blacks and four in 10 Hispanics would not get vaccinated, more than other groups. Hospitals, doctors, public health, and community groups have started to reach out and engage with black and Hispanic communities about vaccines.
Black doctors have teamed up with black celebrities and religious leaders. The Spanish public service announcements were broadcast on the air. In Miami, black doctors and nurses were occupying vaccination clinics in places like Brentwood Pool. In Michigan, Spanish-speaking health professionals have established clinics in the heart of Hispanic communities. Slowly the matriarchs of the black neighborhoods and the pastors of the Spanish-speaking churches began to get vaccinated and to tell people about it. Hair salons and grocery stores have advertised the location of vaccination clinics. The more information black and brown doctors shared, the more black and brown people trusted them and began to accept the value of getting vaccinated.
Amid a pandemic that was killing and hospitalizing disproportionately higher rates of them, blacks and brunettes began to speak publicly about vaccines as a shield that would help them stay safe, stay at work and protect. their families. And they started telling others to get vaccinated. By December, reluctance to vaccinate these communities had dropped to double digits. By the end of February 2021, the percentage of blacks and Hispanics refusing to be vaccinated had fallen to 20. In May, reluctance was not the main obstacle for under-represented communities and vaccinations; things like transportation and schedules were.
But although black and Hispanic Americans are increasingly rolling up their sleeves, one group continues to refuse vaccinations: white, evangelical and rural Americans.
We heard a rural Michigan patient call vaccines a form of government control. Another repeated the unsubstantiated claim that Covid-19 was a Chinese biological weapons conspiracy. A patient refused to be vaccinated despite the Covid-19 twice, a rare reinfection. Whites in rural areas laughed at vaccines, citing microchips and infertility, or Fox News misinformation slandering health experts for lying about vaccine efficacy data and calling vaccines a control tool social. We have heard patients accuse hospital staff of being highly paid actors who maintain the pandemic masquerade.
Vaccines have hit conservative Republican leaders with a nagging sort of anosognosia, an inability to align with reality.
Former President Donald Trump, who was quietly vaccinated in January, urged people to get vaccinated on April 22 – nearly 100 days after leaving office. Meanwhile, Republican state leaders like Florida Governor Ron DeSantis have botched vaccine distribution, while continuing to distort science. In Michigan, GOP legislative leaders are undermining vaccinations with word and deed, including holding millions of dollars hostage in federal immunization funds. The conservative base, however, says it prefers to listen to doctors rather than politicians. If the only information – or misinformation – about the pandemic comes from Fox News and OANN, then the antidote is information from a source that includes science, medicine and, most importantly, the community.
In the case of conservative rural communities, that source would be conservative rural family physicians who attend the same churches, fish the same stretch of river, and volunteer every Friday night at local high school football games. It is the doctors who take care of every stage of a family’s life. Births, broken arms, childbirth, disease management and death. They are not just trustworthy, they are family – minus the birthright of blood. Most importantly, they know how vaccines and medications work.
We work with doctors like these, doctors who are just as frustrated as we are with vaccine rejection and pandemic denials, doctors who all the time ask what more we can do to break through.
Here’s an idea: Recruit these rural family physicians to be messengers in communities with high vaccine rejection. Hold small presentations in churches and 4-H meetings, with the doctors listening, answering questions, debunking the microchip conspiracies and slowly, one by one, moving hearts and minds.
These conversations will not be easy, quick or necessarily successful. A fellow family doctor in a small rural town in mid-Michigan said he spoke to a patient, a longtime Michigan militia leader, about vaccinations. Despite her short scorn, she persisted, she listened, she scanned the cost-benefit analysis of getting the vaccine versus a virus 10 times more deadly than the flu. At the end of the office visit, the militiaman told his family doctor that he would get the vaccine.
Maybe this is also perhaps the best way to finally reach people like the elderly couple from Michigan who showed up with Covid-19 to the emergency room, refusing to be vaccinated because they didn’t think so. that the pandemic was so severe. We hope they have recovered – and we hope they reconsider getting the vaccine.
By the summer, we should know how close we are to collective immunity – if we are close to it.
In the meantime, we have a nifty variant of Covid-19 that is more contagious. We are seeing younger, vaccinated patients at only a fraction of the rate of people 65 and older. In the coming months, the race to vaccinate America will likely be more like a slog, where every hit counts and every 4-H conversation counts. One conversation at a time, every doctor has a chance to change their mind and get us back to normal. If a country doctor can persuade a Michigan militia member to change their mind and get the shot, there may be hope after all.