March 19, 2021

Questions and answers

Interesting data from the CDC shows that 88% who got their first COVID vaccine between Dec. 14 and Feb 14 have returned for their second on time. This is actually really good, but we can hope for better, so the CDC recommends scheduling for the second when they get their first, sending reminders, and rescheduling clinics that were cancelled for any reason, such as due to weather. The data here in King County, WA is better with only 5% not showing up for their second vaccine. Nearby Snohomish County has a 15% no show rate for the second shot appointment. There could be many reasons for that no show, one being that they were able to get the vaccine elsewhere or rescheduled for a different day. These concerns for needing the second dose will improve as more of the one dose Johnson & Johnson vaccine becomes available.

Of course, some people may not have wanted to get the second shot for other reasons, such as fear of shots, not being able to schedule, moving from an area, or due to reactions to the first vaccine. Reacting to the vaccine is common. Symptoms can be anything from fatigue to chills and headaches, more commonly a sore arm with a rash. These all resolve within a day or two, although the rash might last longer. Interestingly, women seem to have more adverse effects than men do,.The side effects are less in older people.

More surprising news is that the vaccines are seeming to help those with long COVID-19 symptoms. Several report that their symptoms have eased since receiving their vaccine. The National Institutes of Health is starting more research into this syndrome, which is good news, since we need to understand why it seems the immune systems of those with long COVID-19 have gone awry. Why would the vaccine help? Or is it just placebo? Infectious Disease Specialists are trying to sort out this new data. This virus is still just a toddler. Still so much to learn.

But our biggest next steps are to help with vaccine hesitancy. There are lots of reasons why people are hesitant. For many it is political- they have been led by their leaders to believe that COVID-19 is either a hoax or not any worse than the flu. For minorities, it can be based in distrust of the health care system, due to past experiences. Distrust of the process is real, sometime encouraged by social media.

For others, it is fear of needles and shots in general. I don't think we should discount that. A few years ago before COVID-19, Canada developed a system to help school students accept vaccines. Called the CARD system it is C for Calm, A for ask, R for relax, and D for distract and helped students in the control school have less anxiety and fear about the vaccine they were getting.

Perceived susceptibility and perceived severity can influence hesitancy as well. True that most people survive COVID-19 and have a mild or asymptomatic case, but the risk of death or serious illness is common, especially as people age. The serious effects of the vaccine are still rare. Hard to remind people of that when we hear about the vaccine side effects so much of the time on the news. Perceived benefits and perceived barriers are not well understood- that the risks of side effects of the vaccine outweigh the benefits. Other barriers include conflicting messages about eligibility, misinformation, and stories of how hard it is to schedule the vaccine.

Many people are hesitant because these are new vaccines that were developed quickly and they understandably have concerns and questions. These are not generally being addressed. An interesting article in The Seattle Times was about a focus group of Republicans who had vaccine hesitancy. It was also in the Washington Post. They asked to be “educated, not indoctrinated”. They responded best to the scientist who said he did not have all the answers but explained how the vaccine was developed over the past 20 years, that tens of thousands participated in vaccine trials, that the FDA got rid of red tape to get approval faster than usual, and that the long term impacts of COVID-19 could be much worse than the vaccine, acknowledging that the long term risks of vaccine are not known yet. The focus group responded less well to other approaches that they felt were pandering or not honest.

I have found honest conversations with my patients make a difference. Many are worried and feel relieved when they understand more about the development of the vaccines, that they will not be harmful to them despite the meds they take or the illnesses they have, and that I recommend the vaccines for them. It also helps them to see the physicians enthusiastically getting their vaccines.

Wash, your hands, cover your nose, keep safe six, ask questions if you don’t understand.

And finally, my caveat is that this is my experience and my opinions, which are subject to change as more information is available, and not related to the organization I work for. Thanks for reading.

https://www.seattletimes.com/seattle-news/health/how-many-people-arent-returning-for-a-second-shot-of-the-two-dose-vaccines-and-do-people-have-a-choice-of-vaccine/

https://www.theverge.com/2021/3/15/22331619/covid-vaccine-second-dose-cdc

https://www.cdc.gov/mmwr/volumes/70/wr/mm7011e2.htm

https://www.seattletimes.com/nation-world/what-causes-reactions-to-covid-19-vaccines/

https://www.nytimes.com/2021/03/08/health/vaccine-side-effects-women-men.html

https://www.nationalgeographic.com/science/article/why-your-arm-might-be-sore-after-getting-vaccine

https://www.nejm.org/doi/full/10.1056/NEJMc2102131

https://www.seattletimes.com/nation-world/extended-covid-19-easing-for-some-after-vaccines/

https://www.medpagetoday.com/infectiousdisease/vaccines/91615

https://www.nytimes.com/2021/03/15/us/politics/joe-biden-vaccine-republicans.html

https://academic.oup.com/pch/article/24/Supplement_1/S42/5421503?login=true

https://www.seattletimes.com/nation-world/nation-politics/we-want-to-be-educated-not-indoctrinated-say-trump-voters-wary-of-covid-shots/

https://www.washingtonpost.com/health/2021/03/15/vaccine-hesitant-republicans-focus-group/

https://www.clinicaladvisor.com/home/topics/vaccine-information-center/overcoming-covid-19-vaccine-hesitancy-minority-communities/