Far too many Texans don’t get immunized. That’s a problem with a COVID-19 vaccine - The Dallas Morning News

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Life won’t return to normal until there’s a COVID-19 vaccine, and that poses a big challenge, especially for Texas.

Many people are already skeptical, with a majority saying they wouldn’t get a vaccine if it were available by Election Day. In that Kaiser Family Foundation poll, taken about a month ago, 62% worried that political pressure from the Trump administration would rush the process without ensuring a safe, effective vaccine.

About a decade ago, many believed the H1N1 vaccine was rushed, too, and experts said that limited its adoption.

In Texas, where millions don’t have health insurance or a primary doctor, vaccine uptake already lags badly. According to a recent health scorecard by the Commonwealth Fund, just a quarter of adult Texans got their recommended flu and pneumonia vaccines in 2018. That put the state at No. 50, tied for last with Louisiana.

Just as troubling, Texas' vaccination rate on that metric fell by 11 percentage points over four years. If the state could just match the U.S. average, another 1.3 million adults would be protected.

“It’s always the challenge in Texas: access to care,” said Dr. Trish Perl, chief of the infectious diseases division at UT Southwestern Medical Center and an infectious disease specialist at Parkland Health & Hospital System.

Texas has over 5 million uninsured residents, nearly twice as many as the next-closest state. And 1 in 3 adults, including those with insurance, don’t have a primary doctor — a trusted voice to help with vaccine decisions.

“We’re going to have to build trust and be creative about how we do it,” Perl said, adding that it’s up to health experts like her to critically review the vaccine data and be vocal about what it shows.

She expects the vaccine rollout to start with front-line health workers who face a high risk of COVID-19 exposure. That will lead to higher adoption rates and additional data on the efficacy of the vaccine, and will also buy time to build up supplies for the larger population. If doctors and nurses are satisfied, they can become powerful influencers.

“We can be role models in all of this and really help in the education process,” Perl said. “People do trust their health providers.”

Last year, almost 97% of physicians got a flu shot, according to estimates from the Centers for Disease Control and Prevention. Over 90% of nurses, pharmacists and nurse practitioners got it, too.

By comparison, just under half the total population — ages 6 months and older — got the flu vaccine in 2018-19.

A COVID-19 vaccine is much different, involving new technology and an unprecedented accelerated timeline. But if trials follow the science and evidence shows the vaccines are safe and effective, health workers will be at the front of the line.

“It’s something I will take personally, and I will advocate for my patients to take,” said Dr. Stewart Coffman, an emergency room physician for over 20 years in Dallas-Fort Worth and senior vice president at the Envision Healthcare medical group.

Coffman and his wife came down with COVID-19 in March, and he said they had fairly mild cases. He’s 55 and doesn’t have underlying conditions, so he’s not in a high-risk group. But he wants to protect his family, patients and community — and worries he’d be vulnerable to COVID-19 again.

“Having it doesn’t necessarily confirm immunity for a long time,” Coffman said.

Envision has over 1,000 clinicians in Texas, and many are focused on increasing the uptake of this season’s flu vaccine, which is starting to become available. In primary care clinics, assisted living centers and nursing homes, they’ll promote flu shots for fall — and follow the same playbook when coronavirus vaccines arrive.

Many patients with higher risk from flu have higher risk from COVID-19. Those with diabetes, high blood pressure and respiratory illnesses are among the most vulnerable, he said, and when they’re sick, it can be difficult to tell whether it’s flu or COVID-19.

Another reason to reduce flu cases is so hospitals can preserve capacity and equipment if there’s a big COVID-19 outbreak.

What would be a successful uptake of COVID-19 vaccine? About 50% to 60% of the population is what Perl expects.

“I’d like to see 80% of people getting it because we need a lot of immunity to protect the most vulnerable,” she said.

In 2009, the H1N1 vaccine covered about 27% of the nation and 40% of children, the CDC estimated. Uptake was lower than expected, and tens of millions of doses went unused.

“A significant reason for this was perceptions that the H1N1 vaccine was ‘risky,’ ‘rushed’ through production and/or ‘untested,’ ” according to a report from the Johns Hopkins Center for Health Security.

People have similar concerns about the coronavirus vaccine, in part because of mixed messaging. President Donald Trump has repeatedly talked of an Election Day breakthrough while his top health expert said a COVID-19 vaccine would not be widely available until the middle of next year.

“I see why there would be some hesitancy, but if the approval process works the way it’s supposed to, that should offer some reassurance,” said Dr. Seth Kaplan, a Frisco pediatrician and president-elect of the Texas Pediatric Society. “The communication and information campaign is going to have to be huge because we have to reach people where they’re at.”

About 60% to 70% of patients in his Frisco practice got the H1N1 vaccine, he said. And pediatricians play an important role in boosting uptake because parents and grandparents are often in the room with their patients.

“We’re very used to educating people about the importance of vaccines,” Kaplan said.

But skepticism of science has been growing, fueled in part by anti-vaccination movements. That skepticism undermines confidence in medicine and poses an insidious threat to public health efforts.

“You may have a whole mound of evidence, but if people ‘believe’ differently, that seems to trump everything else,” said Dr. Jason Terk, a Keller pediatrician who chairs the Texas Public Health Coalition and is active with the Texas Medical Association.

Texas has failed to expand health coverage and hasn’t invested enough in public health, he said.

According to Commonwealth’s scorecard, Texas ranked 41st on state-based public health spending in 2018. Texas' spending per capita was less than half the U.S. average — and 39% lower than Texas spent four years earlier, the report shows.

Since 2004, the medical association has vaccinated Texas children at risk through its “Be Wise — Immunize” program. Over 360,000 shots have been delivered to kids and adults through the years.

“We’re trying to fill some gaps here and there,” Terk said. “But it’s not the same thing as having a real population-wide plan.”

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