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    Transcript: VaccineVoices: Talking to Health Care Personnel About Getting Vaccinated

    Editor’s Note: Since this podcast was taped, more than 100 staff at Houston Methodist filed a lawsuit against the hospital arguing that a vaccine mandate subjects employees to “medical experimentation.” A judge subsequently dismissed the suit on June 12, calling the mandate “a choice made to keep staff, patients, and their families safer.”

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    Narrator: Health care workers were the first group in the United States to be offered COVID-19 vaccinations. But several months into the effort, many health care workers remain unconvinced and unprotected.

    According to a Washington Post-Kaiser Family Foundation poll, as of early March only 52% of front-line health care workers reported receiving at least their first vaccine dose at the time they were surveyed. Another 18% were scheduled to receive their vaccine. But 30% said they had not decided or were not planning to be vaccinated. And 1 in 6 said that if their employer required them to get vaccinated, they would leave their job.

    On this episode of “Beyond the White Coat,” we’ll talk about the challenges health care systems are experiencing in trying to ensure their staff are vaccinated and what can be done to build vaccine confidence.

    This conversation was recorded on April 21, 2021, and all data and information are accurate at the time of recording. This is the first of three episodes we’ll be sharing as part of an AAMC project funded by a cooperative agreement from the Centers for Disease Control and Prevention to Improve Clinical and Public Health Outcomes through National Partnerships to Prevent and Control Emerging and Re-Emerging Infectious Disease Threats.

    Janis Orlowski, MD: Welcome to today's podcast. I'm Dr. Janis Orlowski, the AAMC's chief health care officer. Today, I'm talking with Dr. Marc Boom, the president and CEO of Houston Methodist in Houston, Texas, and Dr. David Callender, the president and CEO of the Memorial Hermann Health System. In looking at both of your bios right before I started, I actually see that both of you are graduates of Baylor Medical School. Did you know each other in medical school?

    David Callender, MD: No. Marc's way younger than I am.

    Janis Orlowski, MD: Okay.

    Marc Boom, MD: I think we might've been a couple years off.

    David Callender, MD: Yeah, a couple of years apart.

    Janis Orlowski, MD: Well, it's a small world in medicine. So, when I saw the connection, I thought that was terrific. Today, we are going to talk about why health care workers are getting vaccinated at lower rates and what we can do to build vaccine confidence and why it's important. Thanks for joining me today, and let's dive right in. First of all, maybe what I'll do is, David, start with you. Should everyone working in a health care setting be vaccinated?

    David Callender, MD: Yes, we think so. Clearly, vaccination ultimately is the best way that we can control the COVID-19 pandemic. I think we also have a role to play as leaders in terms of demonstrating that the vaccines are safe and they're effective. So certainly, that plays a role in our thinking too. But vaccination clearly is the path to controlling COVID-19, and all of us in health care should be vaccinated.

    Janis Orlowski, MD: Thanks. Now, Marc, you were one of the few places that actually were mandating vaccination for your employees. And is it for your employees and for your whole medical staff? How did you get to that point and what are your thoughts?

    Marc Boom, MD: Yeah, actually, I think we were the first hospital system in the country to mandate vaccine, and there's only been a couple others that I've seen — so far — follow. But in discussions with most of my colleagues around the country and locally, everybody intends to go there. It's a matter of timing and how best to get there. We are now mandatory. There's a June 7th deadline for all of our employees. So as of today, not everybody is vaccinated, but we're getting there quickly. We started about six weeks ago with our new hires, and so all new hires have been mandated for about six weeks. On March 31st, we announced for our managers that they would be required to have at least one dose by April 15th. So that's passed, and we've gotten through that and done very, very well with that. I'm very grateful to that team. We were at 96% of our management before we even did that, and now we are about 86% of our staff and mandated as of June 7th.

    The way I see it is — and I learned this early on as a primary care physician — working in health care is a privilege, and with privilege comes responsibility, and that responsibility is caring for our patients and keeping our patients safe. So, I emphatically obviously believe that all of us in health care really have a sacred obligation to keep our patients safe, and one of the ways of doing that is through vaccination against COVID. We've mandated flu vaccine for a dozen years — as have many, many other hospitals around the country — and we really don't see this as any different. We see this as the same going forward — in fact, much more important going forward, because it's obviously so much more deadly than the flu is.

    Janis Orlowski, MD: Right. So, Marc, tell us a little bit about Houston Methodist — sort of the size and the number of employees that you have, number of docs. And tell me if you got any pushback from this mandate when the vaccine is still under the experimental use authorization.

    Marc Boom, MD: Well, let me correct you right there. It's an emergency use authorization — and that's one of the key kind of misconceptions out there — not experimental. And so, these are not experimental vaccines. They've been very, very well studied. And so, talking about Houston Methodist, we have a flagship academic medical center in the Texas Medical Center — it has academic programs, teaching programs, large research institute, etc. — and then we have six community hospitals and a seventh in the community that is a long-term acute care hospital. About 26,000 employees, about 6,000 physicians — about 1,000 of whom are employed and the rest are affiliated — and it is mandatory in all of those circumstances there. Obviously, from a physician standpoint, with our employed physicians, it's the same as other employees where we can mandate this; with our other physicians, this is actually going through our medical staffs. And we have eight independent medical staffs, and they've all made that decision to synchronize either exactly or very approximately — very close to the date that we mandate with our staff.

    Janis Orlowski, MD: Do you have exceptions, I mean, if someone just is not going to do it? Sometimes with the flu vaccine, we actually have people who are allergic and have some allergy to egg or whatever, and so there's exceptions. What's your exception policy?

    Marc Boom, MD: Yeah, and having done this long time for the flu, and of course there's many other things we require in health care. We require PPDs for tuberculosis and many other things that happen along the way. But flu is probably the most analogous situation. So, there are two exemptions. One is for health care reasons, the other is for medical reasons. I'm sorry. One is for religious reasons, the other's for medical reasons. And both of those, an individual can file an exemption. It goes through a committee process. Same thing we've done with the flu for a dozen years. So really, you don't see any dramatic differences here. In fact, you allude to egg allergy with some of the flu preparations. You don't have that obviously with COVID. We do know we have anaphylaxis, and that's an issue, so that's a very valid exemption in some cases. And then there are religious exemptions. But in many cases, we have people who have taken the flu shot for a dozen years and then they asked for an exemption here, and you can't really figure out why this would be any different, because in general, it wouldn't be. So that's been informing those decisions as well.

    The other thing we decided to do was to create a deferral — not an exemption, but a deferral. Meaning, you could postpone it for pregnant women simply because there's not that much data in terms of pregnancy. Although now, there's evolving to be tens and tens of thousands of women where we have a registry nationally and knowing it's safe. In fact, let me be clear. Our OB-GYNs are strongly recommending to all of their patients that they get vaccinated because pregnancy is in itself a significant risk for COVID. And frankly, being able to give antibodies through maternal breast milk to the infant is also very beneficial, and so they're strongly recommending it. But given that that's a very emotional subject — for understandable reasons — and that it's not as well studied, we have a deferral for that.

    We also put a deferral in place — and this is a very small number of people who are in any type of fertility treatment — significant fertility treatment — simply because those are people who many times — three, four times — are trying to get pregnant and going through IVF, etc. It's highly expensive. It's highly stressful for everybody. And they're trying to not rock the boat at all. And we understand there's not really any science behind that as much as just compassionately saying, "Hey, wait. I'll hold off a little bit. If you get pregnant, of course, then you can also have a deferral. If you don't, then we'd expect you to get vaccinated after that."

    Janis Orlowski, MD: Great. That's very interesting. Now, David, tell us a little bit about Memorial Hermann. And I know you're also thinking about mandating this potentially in the future. What's your current thoughts and where is your organization?

    David Callender, MD: Well, as Marc mentioned, it's really a timing issue for a lot of us. We've announced that the vaccines will be mandatory as we move forward. We're thinking about the timing a little differently than Marc. We want to make vaccines mandatory when we feel comfortable relaxing some of our other safety measures. And so that would mean that we would be at an extended period of reasonable community control of COVID-19 here in Houston. We could be thinking about relaxing our mask mandates and some of those other protective behavioral control measures that we've used. At that point, vaccination would be the principal approach to controlling the spread of COVID-19, and we think that's the right time to really force our employees to be vaccinated.

    In the meantime, we're continuing with our educational efforts — we're ahead of the national average, in terms of employees getting vaccinated. We put out a very extensive communication set to our employees to help them understand about the vaccines — their safety, their effectiveness — to try to answer some of the common questions that were asked about the vaccines, and we're seeing an uptick in terms of the acceptance rate over the course of the time since we started that campaign.

    Janis Orlowski, MD: So —

    Marc Boom, MD: I think I completely agree. Education is so critically important. In fact, we started messaging — both anything we could about the vaccines and educating about the vaccines and then also that we would eventually go mandatory — the better part of a year ago, as the vaccine was starting to be studied and talked about, and certainly before this time last year, and then as the summer — we started having enrollment and people in the studies.

    As each of these phases came out — significant, recurrent, repetitive communication with our team. And probably at least since the August, September timeframe, saying, "This will be mandatory, it's only a matter of when," and deciding what the right timing is.

    Janis Orlowski, MD: Right.

    Marc Boom, MD: We really felt like we wanted to lead the way because we wanted to be the safest hospital system on the planet, and we wanted to drive that forward at a time that made sense. And so, it's been very effective.

    We ultimately will not force anyone to take a vaccine. We will require it as a condition of employment, but if somebody doesn't want the vaccine, obviously that's their free choice — they won't be employed with us at a certain point. But from our standpoint, we hope that's a very, very small number of people — but at the end of the day, that's OK, because we put the patient at the center of everything. Safety comes first.

    We are scientifically based and academically based, and if somebody can't see their way to put the patient first, ultimately, and doesn't have a valid reason that we give an exemption for, ultimately they're not going to be a cultural fit, and that's OK. That's OK. There are other reasons people sometimes don't fit a culture, and if that's the case, there are other places they will fit better.

    Janis Orlowski, MD: Thanks. Thanks, Mark. From a scientific point of view, as you said, it makes sense, and we have a responsibility to make our environment safe for our community. David, as you take a look at what you've done to build vaccine confidence, what are some of the things that have worked, but also what are some of the concerns that the staff is bringing to your attention?

    David Callender, MD: Well, we've done quite a bit of information gathering from our staff, as well as from the public. There are two key factors. Number one is having consistent, accurate information that's available being passed along actively. The other is maintaining the trust of our employees and the public.

    On the safety front, we've clearly demonstrated that our facilities are safe. With masking, with social distancing, we just have not seen the transmission of COVID-19 in our facilities. We've had a few of our employees who have come down with COVID, but they've encountered it and basically contracted it in the community, not at work. So, we feel like we're safe today.

    And so, again, our approach is that while we're safe, let's do our best to get out good, consistent information; have it come from multiple sources through multiple channels; and continue to grow the trust of our employees and us — grow the trust in the public in us in terms of providing accurate information about the vaccines.

    Janis Orlowski, MD: Well, thanks. So, let's turn to that topic of what your health systems are doing to build trust in the community. What are some of the activities, what are some of the messages that you're finding useful? And Mark, let's start with you. What is your institution doing?

    Marc Boom, MD: Sure, that's been obviously a very active thing that we've been doing. I talked about — with our employees, really, so much of it is — there's two major facets. One is continual education and, really, reliance on the science and talking about the science and looking at the data that's there and doing that through trusted individuals. So senior medical staff — for example, nursing staff, obstetrician-gynecologist, when we're talking about pregnancy issues and lactation issues, etc., etc.

    We've done large town hall series with our staff; many, many Q&A’s; etc. The other side of it is very much listening, right? Listening and understanding why some individuals are hesitant to get the vaccine, right, because we're up in the high eighties — 86%, 87% now of our employees, it's a very high number. You're not going to find many places there, but conversely, that's still 12% or 13% of 2,600 people. So, it's a lot of people who are still reluctant and hesitant.

    And we hear a whole gamut of things from those individuals, and so — working with them, using our values — our values are: I care, integrity, compassion, accountability, respect, and excellence. And so — respecting them, being compassionate, and really listening along the way and trying to help them make the right decisions, but also acknowledging and recognizing that there is a point where, as a health care institution, that really needs to lead the way.

    Watching universities mandate — great, we think that is a very important thing, watching cruise lines mandate and other things. I have a hard time in — envisioning how we're going to be a health system and tell everybody, "Hey, we're not mandating, but you can go on a cruise and be safer than in our hospitals," from a vaccination standpoint.

    So, there is a balancing act there. We made the decision, obviously, sooner than some others did, but again, I think most — if not all — health care will go there because it's the right thing to do.

    Janis Orlowski, MD: David, what have you done? What is your health system doing now and what are they going to do to increase vaccine confidence in the community?

    David Callender, MD: Well, number one, we've found that whether it's our own employees or the public at large that we're considering, there are really three principal issues. Vaccine hesitancy obviously is very complicated, but there are three principal issues.

    Number one: Concern about the short-term acute side effects. "Oh my gosh, my arm is going to hurt, I'm going to feel crummy for a day, I don't want to do that. I just don't want to have that experience."

    Number two: Concern about long-term effects — and really, where we are in the clinical trials, we have indirect evidence that there are no long-term major side effects that should be of concern, but the trials aren't completed yet. And so, there still are questions. “Well, could there be mysterious long-term side effects that we don't know about yet?”

    The other is: Do these things work? “Will they really protect us? Why should I put myself at some risk, whether it be for short-term or long-term side effects, if they really are not going to work?”

    So, our information campaigns, internally and externally, have been aimed at answering those three major — or addressing those three major — concerns. So internally, just like Mark, a lot of videos from trusted people from across the system — certainly within the inpatient facilities, known faces, known colleagues — a lot of different channels used to communicate the information about, “Why I chose to take the vaccine.”

    For the public, slightly different approach — but using radio, internet, social; using multilanguage approaches; using partnerships. So, the local metropolitan transit group, providing information to them; going to multifamily housing units and speaking with managers and making information available with them; but just doing everything we can on our own and through partnerships to get out information through a variety of channels that is aimed at responding to those three concerns.

    Janis Orlowski, MD: Thanks. Now, although most of our institutions, academic medical systems do give vaccine — where we in the past have not been like the public health department where we have stood up large vaccine ambulatory sites — what are you doing, David, right now in regards to helping to get the vaccine out? And what's your strategy over the next six months?

    David Callender, MD: Yeah. We, I think — starting like Mark and many others, what can we do to get as much vaccine into arms as possible? And we used our existing facilities, our inpatient facilities, our ambulatory clinics.

    We also organized mass vaccination events, drive-through events where people could actually pull through in their car. We made those very efficient, and we got thousands of doses out. Now, we're shifting a bit. We understand that the challenge now is more out in the community. We probably vaccinated those who were willing to come to drive to change or corrupted their schedule for the day to be vaccinated. Now we need to make it more convenient, more accessible on a smaller scale. So, we're out now at churches, at schools, working with some of our nonprofit partners to create smaller venue events. So, we can make vaccine availability easier — better — for people who have struggled a bit, either with technology or with transportation to get to our existing sites for some of the mass vaccination events.

    Janis Orlowski, MD: Where are you getting the staff for this?

    David Callender, MD: We're actually using our own staff.

    Janis Orlowski, MD: So, you're pulling them from your ambulatory, from any of the different areas you're pulling them.

    David Callender, MD: We certainly have had a marvelous public response in terms of volunteerism — people who want to come forward and be engaged in helping with traffic flow, helping people process through a site, and the like. But in terms of actually administering the vaccines, preparing them — using our nurses, pharmacists, and their support personnel — those are Memorial Hermann folks that are doing it.

    Marc Boom, MD: We've also used our own staff. And what we talk about often is, this has been so much of a high throughput focus, right? We are all trying to get as many vaccines into arms as fast as we possibly can. And in the community now, broadly across Greater Houston, we're starting to see that little bit of slowdown. So, for instance, the FEMA site that stood up is having trouble filling its schedule — like Memorial Hermann, we're still filling our schedule. But it's definitely less of a backlog, less of a waiting list, less of a sign-up list. And in fact, a lot of people are sort of saying, "Hey, let me sign up, because we have direct access on the web now." And they sign up for one day out and two days out. So oftentimes we're seeing those schedules fill later.

    So, we're seeing all of the signs that suggest we're going to start hitting some big bumps. So, what we talk about often is, so we've had this high throughput strategy supplemented by a community strategy. All the things David was talking about that we've done: working with churches, working with — actually — a lot of elected officials to get things stood up in their districts, going out and being available. And those are not nearly the same high throughput or the relatively high throughput events. But none of them are massive, just simply because of the nature of how those ended up happening. J&J was a very useful tool there, so that's been a challenge, but doable — we were, prior to that, doing a lot of that with Pfizer.

    But what we talk about now is, it's going to shift very much out of a high throughput mode where we might have an MA, or whomever it is, doing 12 to 15 vaccines an hour within our structuring with other people around them. Obviously, you're doing many parts of the process in maybe two an hour or four an hour. It's going to be a lot of — more shoe leather. A lot more work to get to individuals in their communities, etc., etc.

    Janis Orlowski, MD: And speaking of the J&J vaccine, and with the recent pause in the use of J&J, how has this affected your messages? What do you see as sort of a response to the pause with the Johnson & Johnson vaccine?

    Marc Boom, MD: You know, we were actually seeing a little bit of difficulty on J&J before that already. So, when we would put together a J&J event, we ultimately utilize it, but there was more reluctance, more people — and the reluctance really was not fear of that vaccine, but, "No, no, I really would rather have one of those other ones, I'll reschedule." So, we were actually dealing with that already. So, I am quite concerned that what has happened with J&J getting paused is really going to take a demand way down for people. I hope not. We saw this as a success of the trials and as success then of the subsequent follow-up. Because this appears to be a very, very rare event — less than one in a million, most likely — that was caught on surveillance.

    And that was paused while they sort this out, but it is such a low frequency, I predict. And that just happened in Europe. It's going to get a warning on it, and it'll come back out. We, as physicians, all know every single drug we ever use has some pros and cons, right? And there are many drugs we use all the time that have much higher rates of clotting issues and other things than what they're describing here. And of course, the virus itself has way, way higher risk of clotting for individuals who are infected than the vaccine does. So, I do think also, as we talked to the public and as we talked to our employees and others, there has been a level of sophistication to understand — these are very different vaccines, and this is not what's seen in the ones that have been used the most.

    So, if you look at the mRNA vaccines, we're probably pushing 200 million doses. You can't quite parse that out from the federal data. You're way over a hundred million people who have gotten it in the U.S. alone, and there's nothing remotely similar to that. I mean, the only signal that's been there is a little bit of, obviously, allergy that happens — particularly anaphylaxis, also very rare and very treatable. So, we've used it also to amplify the message that, "Look, overall these are safe and they're well studied and they're well followed."

    Janis Orlowski, MD: Yeah. Right now, as I understand it, the J&J is just under 7 million vaccines that have been given. And as we do this podcast, the pause is still on. But at the end of this week, the CDC Advisory Committee will come out. There are a number of people who argued that the event is so rare that your risk is greater to have complications from the disease. David, what are you seeing from the pause with the J&J and the concerns that might be brought up because of it?

    David Callender, MD: Well, early returns actually suggests that there's a general relief that our vaccine monitoring systems are working. We've been pleasantly surprised that we've not seen a great deal of negative response to our work with the Pfizer and Modernas that we can directly relate to what's happened with J&J. I'd say kudos and thanks to everybody around the country who works so diligently to get out good information quickly about the reason for the pause. The frequency of the reactions, as Mark said — 6 out of over more than 7 million doses administered. And so, we've been able to talk about that. We've been able to talk about CVST, what it looks like when it occurs in the unvaccinated populations, some of the things that drive it. So, I think the fact that all of us have been monitoring what's happening — we put out good information, we're following along — actually will help us as we go forward, in terms of making people comfortable that we're monitoring what's happening with these vaccines. And we're really working hard to ensure that people can safely get them and not suffer the side effects or bad side effects.

    Marc Boom, MD: And what we all need to remember is the risk of dying in the United States so far from COVID — entire population — is about 1 in 600. 1 in 600 — that's a heck of a lot different than one in a million, even with that vaccine. I mean, those are obviously — that's a no-brainer sort of analysis, if people can do the risk analysis — it's very hard to do that risk analysis as an individual, right? And know that you're going to give yourself maybe a one in a million chance versus, “Well, maybe this other 1 in 600 won't really happen.” We know that right through the ages, it's very hard to assess those kinds of risks. And the reality is, if you're over 50, the risk wasn't going in 600, the risk was way higher than that. So, if you're over 65 or 75, it's even way higher than that.

    So, this is a very severe disease that we can push back down, down, down, if we can convince everybody to get vaccinated. And I am concerned that we're starting to see those early signs of slow down. And it's really that last 20% or 30% that we need to convince that are going to drive this home for us and get both life back to normal, but most importantly, protect everyone together so we don't have all the patients in our hospitals that we still do today. I mean, it's much better than it was, but we still have more patients in our hospital than in the worst flu season that happens just for a couple of weeks at peak. We're way above that and were that way day after day after day. So, I think that risk balance is very crystal clear.

    Janis Orlowski, MD: Right. Well, it's interesting because I look at this as a time where we have the opportunity to talk about science with the general population and talk about numbers. And I think that we have to grab this opportunity. People have talked about the American public not understanding science, not being really aware of a number of things. And we have an opportunity to talk about vaccines. We have the opportunity to talk about this pandemic in a very different way. David, what are your thoughts about this? I mean, does this change as we go forward? How do we use this crisis to help change health care understanding in education of science?

    David Callender, MD: Yeah, absolutely agree with you. And I think we've made progress

    on that front, too, Janis, particularly over the last several months — developing more consistent messaging, thinking about how we develop approaches that truly resonate with a larger number of people about the safety and effectiveness of these vaccines. It seems that that effort is growing, so that certainly is a good signal that I'm very pleased to see.

    One of the things that we've learned, too — particularly as we've gotten out of our clinics and out of these mass vaccination sites and into some of the neighborhoods — if we can make it easy for people to get the vaccine, if we're willing to listen to them and offer information that's relative to their concerns, they're much more likely to come forward and be vaccinated. So, I certainly agree that we have this marvelous opportunity to talk about the science and to make it a little simpler and use the information to deliver consistent messaging and continue to see people come forward to be vaccinated. But I think there's an important role, too, to be out there and working with small groups — and even with individuals — to deliver the message really focused on their individual concerns. To me, that's sort of the next frontier, but we're getting there now, and I think that's going to make a difference too.

    Marc Boom, MD: Last summer, I, at a certain point, sort of was reflecting on — and this was kind of in the midst of a really bad surge in Houston that we were having in the summer — and reflecting on, “What had we learned so far?” I had five key things. I don't need to go through all of those today, but the first one I put there was, “Science in real time is messy, particularly biological science.” Then the second part of that was, “But science is the way out of the pandemic — and the only way out of the pandemic.”

    So, one of the hard things, I think, for — and this was at a point in time, of course, where we were still arguing about, “Are we going to mask or not?” I mean, we were in the middle of a surge in Texas, in Houston, and we still didn't have consistent masking, for instance, and we were arguing about different drugs and all these different things that were happening. They were getting politicized in addition to the science, but also, a part of the politicization was the fact that, “Hey, sometimes we don't know. We have hypotheses, and we test hypotheses, and they're wrong, or etc., etc.”

    So that's been a blessing and a curse, right? I mean, that's been hard for the public to watch. I mean, we —as physicians — have been there, and sometimes it's really frustrating and there's things that we believed for 20 years that then get disproven, right? But for the public, that was very hard.

    But on the flip side, I think, over time — to David's point — I think the public started to really recognize and understand that, and we've gotten much more consistent messaging out there. Actually, I think, on the vaccines, we have the best consistent information we've had probably about almost anything that's happened here from the trusted sources in the country. Let's be clear, there's hesitant — that's fine, that's understandable, that can be educated. Then there's flat out wrong, right? And there's flat-out anti, and there are people who are working very actively — and who have done so for 20+ years — to undermine vaccinations, which are one of the greatest advances of the 20th century in terms of saving lives.

    I mean, it's that, it's anti-microbials, and it's sanitation — are the things that save the most lives. It's not cancer treatment and heart disease treatment. Those are critically important, but those are at the margins when you look at that last century. So, we also have to differentiate between the hesitant versus the really cynical information that's out there trying to misinform the public.

    Janis Orlowski, MD: Right. Right. I did an interview recently where I was asked to debunk myths from social media. There's evidence out there that misinformation on social media travels faster. So that's what we are up against, and we have to look at it. David, as you look at your messaging, are you using social messaging —social media — as a platform for your community, or is that not something that you see as relevant right now?

    David Callender, MD: Oh, we absolutely are. We all need to be in that space, at least from my perspective. I know Mark agrees with this, too. We're certainly being proactive in terms of putting out messaging, following that messaging and looking at responses, and then adjusting the messages as we believe is necessary. Obviously, we're also monitoring what's happening otherwise relative to vaccines, COVID-19 — and when there's misinformation, when there's myth, when there are other things that we don't think ring true, then we do our best through the social media channels to address those issues. A very important part of the communication effort, and I think we've been successful with that for the most part.

    Janis Orlowski, MD: Mm-hmm So, if you were going to take a look and say, what is the one thing that you wanted every health care personnel — not just in your institutions in Houston but across the United States — if there's one message that you'd like to give health care personnel about the FDA-authorized vaccines or about getting vaccinated, what would it be?

    Marc Boom, MD: I would say that — listen, trust the vaccines and help us get that message out there. There's actually a two-layer meaning to that. The first and obviously really important one is trust them in that they have been well studied, they are showing to be credibly safe in huge, enormous real-world experience. Right? We've now given more doses of mRNA vaccines than we would give flu shots in a year and we're going to very rapidly approach the same number of people that normally get a flu shot. These are incredibly well studied already. They are safe. As a health care provider, we have a responsibility and obligation to protect ourselves, to protect our patients, and to protect the community, so trust the vaccines, get the vaccines, and promote the vaccines.

    The other way that “trust the vaccines” works, though, is — we have to acknowledge the fact that they are highly effective. I think we've, at times, made the mistake nationally to be so hunkered down in our pre-vaccination mentality that we're not giving people enough of a carrot — enough of a reason to say, “I want to get vaccinated because when I get vaccinated, the world will be better.” The world will be better, right? So, we need to trust that they are effective.

    I tell people, of course, that's an individual decision. It depends on your own risk factors, your own risk tolerance, of course, but we can begin to do things more normally in a graduated fashion that makes sense. But if we all band together and get vaccinated, we can all go that way in just a couple of months. But it's a matter of getting across that it's not really a finish line but getting across sort of a threshold of percentage of people. So as health care professionals, help be part of the solution and make that happen.

    Janis Orlowski, MD: Thanks, Mark.

    David Callender, MD: I think that's a very important part of the message. I think I would distill it down to, “The COVID-19 vaccines are safe, they're effective, and they are an incredible tool to help us improve the health of all that we serve. Not only in this country, but all around the world.” We've spent a lot of time at meetings of the AAMC and a lot of other groups talking about our responsibility to move beyond the focus on health care, think more about health, get beyond the walls of our clinics and our hospitals and get out into the communities. These vaccines are a very, very, very important part of accomplishing that goal of improving the health and well-being of all that we serve.

    Janis Orlowski, MD: Well, thank you very much for joining us, Dr. Boom and Dr. Callender. It's been great to speak with you both.

    If you've been vaccinated, talk to your colleagues who have not. One-on-one conversations that lead with empathy, not judgment, can make a difference in encouraging more people to get vaccinated. It will make a difference in your community and nationwide. We are all in this together. Thank you.

    Closing: This Association of American Medical Colleges project is funded by a cooperative agreement from the Centers for Disease Control and Prevention (CDC): Improving Clinical and Public Health Outcomes through National Partnerships to Prevent and Control Emerging and Re-Emerging Infectious Disease Threats (Award # 1 NU50CK000586-01-00). The Centers for Disease Control and Prevention is an agency within the Department of Health and Human Services (HHS). The information included does not necessarily represent the policy of CDC or HHS, and should not be considered an endorsement by the Federal Government.

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