In April of last year, I along with my entire family — my husband, my three children, in-laws and at least one of our four home health aides — came down with Covid-19. The domino effect of household transmission was like a spark that set our house on fire. It was one of the most frightening experiences of my life — and I am an infectious disease epidemiologist who responded to the Ebola outbreak in 2014.
I am facing a new challenge at home and at my job, helping lead the pandemic response for New York City’s public hospitals: vaccine hesitancy, especially among health care workers.
As of early March 2021, surveys showed that nearly half of frontline health care workers remained unvaccinated, even though this group has been eligible for a Covid-19 vaccine since December 2020.
I have faced this issue in my own home; my husband and I employ four home health aides around the clock for an ailing family member. By late February, several weeks after private home health aides had become eligible for the vaccine, only one had opted to get vaccinated. In April a second aide decided to get her dose after much cajoling, and a third just agreed to do so this month. One remains unvaccinated.
One might reasonably ask, why haven’t we mandated vaccination as a condition of employment? There are a couple of reasons. For one, all the adults in our family have been vaccinated. I have also been confident that our home health aides could be persuaded, with conversations that addressed their concerns and help making their vaccination plans happen.
These kinds of conversations are critical right now, because an unvaccinated health worker can present a real threat. At a nursing home in Kentucky, one unvaccinated health worker who contracted the virus recently set off an outbreak of Covid-19, including 22 cases among residents and employees who were fully vaccinated. One resident died. The tragedy underscored the importance of vaccination among people living and working in proximity to each other.
Studies have also shown that health care providers are some of the most trusted sources of information on vaccines in the general public. If frontline health workers remain unconvinced and unprotected, it’s an obstacle to getting everyone to full vaccination.
Low vaccine confidence among health workers stems from the same concerns any other person has about vaccines. A March 2021 survey from the Kaiser Family Foundation found that the top reasons for reluctance given by health workers include concerns about the newness of the vaccines and their possible side effects, which are common reasons for waiting to be vaccinated.
I’ve found these same concerns to hold true among my fellow frontline workers and the home health aides I employ. They worry about how well the vaccines will hold up against the variants, and many of them lack confidence in what they view as a profit-obsessed pharmaceutical industry. Distrust of the medical establishment is rooted in structural racism, discrimination and personal experience.
That’s why voluntary approaches remain our best strategy right now. For example, hospitals and other health care facilities can use an “opt out” system, in which all unvaccinated staff members are automatically given appointments and can opt out if they decide to. Incentive programs like giving people time off, money or gifts can also help. Another approach is to tell health care workers that they either have to get vaccinated or agree to routine testing.
For those who regularly interact with health workers who are hesitant to get vaccinated, there’s a lot we can do as colleagues. Just asking questions like, “The last year has been really hard for all of us. Do you want to talk about your experience and what you think about the Covid-19 vaccine?” can go a long way.
The other night, I asked my home health aide who is not yet vaccinated if she wanted to share any concerns. She mentioned her worries about serious allergic reactions. After validating her concerns, I said that such reactions are rare, comparable with those from other vaccines, and are treatable.
Another aide recently mentioned to me that the Johnson & Johnson vaccine had lower reported effectiveness and therefore didn’t seem worth getting. I responded that all current Covid-19 vaccines are extremely effective in preventing hospitalizations and death.
A common myth I hear among health workers in the hospitals where I work is that because many of them were infected with Covid-19, they don’t need to get the vaccine. In this situation I let people know that even those who were infected should get vaccinated, since protection conferred by infection is variable and may wane overtime. Vaccines offer more durable, reliable and better protection against variants.
These are not one-time conversations. The dialogue has to be continuing and consistent. There hasn’t been one specific moment that felt like a breakthrough in my conversations with the health aides at home or with my colleagues at work. I don’t know what ultimately changed their mind. But I know these conversations matter. Just because some people say they don’t want to get vaccinated now, it doesn’t mean they won’t do so later. And I’m not willing to give up.
Syra Madad (@syramadad) is the senior director of systemwide special pathogens for NYC Health + Hospitals, the nation’s largest public health care system, and a fellow at the Belfer Center for Science and International Affairs.
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