Vaccines: New Developments and How to Address Vaccine Hesitancy (Recording)
Published: September 25, 2024 Revised: December 13th, 2024
This webinar was recorded on December 5, 2024
People living with severe asthma or other chronic lung conditions may be at a higher risk for severe illness from contagious viruses such as the flu or COVID-19. In this webinar, learn about new vaccines available, new vaccine guidelines and how to address vaccine hesitancy.
Speaker:
- Purvi Parikh, MD
Medical Director, Allergy & Asthma Associates of Murray Hill
Clinical Assistant Professor, Department of Pediatrics and Department of Medicine at NYU Grossman School of Medicine
Dr. Purvi Parikh is an adult and pediatric allergist and immunologist. She is currently on faculty as Clinical Instructor of Medicine and Pediatrics at New York University School of Medicine. She completed her fellowship training in allergy and immunology at Albert Einstein College of Medicine’s Montefiore Medical Center. Prior to that, she completed her residency at The Cleveland Clinical Foundation in Cleveland, OH. Dr. Parikh is board certified by the American Board of Internal Medicine and the American Board of Allergy and Immunology.
Dr. Parikh is passionate about health policy and sits on the health and public policy committee for the American College of Physicians. She is also the Allergy and Asthma Network’s national media spokesperson and has made numerous press and TV appearances on our behalf.
This Advances webinar is in partnership with the American College of Allergy, Asthma & Immunology. ACAAI offers CMEs for physicians for this webinar. If you are a member of ACAAI, you can obtain CME through the member portal for Advances webinars.
All attendees will be offered a certificate of attendance. No other continuing education credit is provided.
CME is available through ACAAI for this webinar.
Sponsored by the American College of Allergy, Asthma and Immunology
Transcript: While this transcript is believed to be accurate, errors sometimes occur. It remains your responsibility to evaluate the accuracy and completeness of the information in this transcript. This transcript is not intended to substitute for professional medical advice.
Lynda: Thanks for joining us. We are going to get started in just a sec. Hello, everyone. Thank you for joining us today. I am Lynda Mitchell, CEO of Allergy & Asthma Network. Welcome to this afternoon’s webinar. We are in for informative session with Dr. Purvi Parikh, today’s presenter. I have a few housekeeping items to go through before we get started. All participants will be unmute for this webinar. We will be recording today’s webinar and posted on our website within a few days. You can find all of our recorded webinars on our website, allergya asthmanetwork.org. This webinar will be one hour in length and include questions at the end. We will take the questions during the session, so send them to us through the Q&A box, and at the end of the session we will get to as many as you can before we conclude today’s webinar. This is a partnership with the American College of allergy, asthma, and immunology. It offers CMEs for physicians and attendance credits for all others. You can create a free ACAAI.org account and get credits through the member portal for the webinars. All attendees will be offered a certificate of attendance today as well. No other continuing education credit is provided. A few days after today’s webinar you will receive an email with supplemental information and a link to download the certificate of attendance if you didn’t catch it on the session. We will try to also add a link to the certificate in the chat. Let’s get started. Today’s webinar is about vaccines, new development, and how to address vaccine hesitancy. People living with severe asthma and chronic lung conditions may be at high risk for severe illness from contagious diseases such as the flu or COVID-19. Vaccine hesitancy was worsened by the pandemic and needs to be addressed by meeting people where they are. In this webinar, Dr. Purvi Parikh will define vaccine hesitancy, discuss ways to work with vaccine-hesitant patients, and talk about new vaccine guidelines. It is my pleasure to introduce our speaker, Dr. Purvi Parikh. Dr. Purvi Parikh is an immunologist. She is crummy on faculty as clinical instructor of medicine and beget cash currently on faculty as clinical instructor of medicine and pediatrics at NYU school of medicine. She completed her training at Albert Einstein College of medicine’s Montefiore Medical Center. Prior to that, she completed her residency at the Cleveland clinic foundation in Cleveland, Ohio. Dr. Parikh’s board-certified by the American Board of internal medicine and the American Board of allergy and immunology. Dr. Parikh is passionate about health policy and sits on health and Public policy committee for the American College of physicians. She is the aller — she is the Allergy & Asthma Network media spokesperson, so you will see her representing us in the media quite a bit. She has made numerous TV appearances on our behalf and other media opportunities. Thank you for being here, Dr. Parikh. I will turn it over to you now.
Dr. Parikh: Thank you, thanks so much for the gracious introduction. This is a very timely topic. We had to picked many months ago, but especially now given our current political climate, we don’t know where things will go with vaccine hesitancy and even given the past five years as well we have been seeing this trend, unfortunately. We will talk more about that today. Next slide. Wanted to give the disclosures. I’m the speaker, obviously. I speak for Genentech and I’m a consultant for GSK, and there is no relevant financial relationships that would put me in conflict with today’s presentation. So our objectives today are kind of to go over the determinants of vaccine hesitancy and to prepare practical strategies to help overcome vaccine hesitancy, and also recommend appropriate vaccines based on the current guidelines, because they keep changing, and even for us as physicians we need to constantly be on top of these changes. So what is vaccine hesitancy? According to the World Health Organization, there actually is a formal definition. Vaccine hesitancy is a delight and acceptance or refusal of vaccines despite the availability — delay in acceptance or visual of vaccines despite the availability of vaccine services and supporting evidence. The term couples refusal to vaccinate, delaying vaccines, excepting vaccines but remaining uncertain about the use, or using certain vaccines but not others. It is not a black-and-white term by any means and it does not mean someone is necessarily anti-vaccine. It is important to make that distinction, because a lot of vaccine-hesitant individuals may not be fully anti-vaccine.
The World Health Organization has classified this is one of the top 10 global health threats, as vaccine hesitancy can the two epics of infectious diseases and deaths, which we have seen with a COVID-19 pandemic, but even more so now we are seeing resurgence of diseases we haven’t seen in 30 years or more, such as measles, there is a polio case in New York last year. It is concerning. We don’t want these things to come back. Vaccine hesitancy is especially a risk for asthma patients prone to vaccine-preventable respiratory diseases as well as high-risk groups such as babies, immunocompromised, pregnant women, and those over 65. This is one of those things were other people’s decisions affect everybody else.
Anti-vaccine and vaccine hesitancy are different. While some individuals may be completely against all vaccines, the vaccine-hesitant crowd is a lot more complex and nuanced and not necessarily against vaccines. This is a good thing, because there is a chance to meet people where they are, and many vaccine-hesitant people have gone on to receive vaccines there hesitant about. This is a population that is amenable to change. So my personal experience during the COVID-19 pandemic was that a lot of vaccine-hesitant people could be convinced to get the vaccination, they just wanted more information. And more importantly, they wanted their fears and concerns addressed. The most important thing I noticed was that they needed a trusted messenger to address those fears and concerns. I spent a lot of time educating on the COVID-19 vaccine. I was even involved in the clinical trial to get the vaccine approved. And I found that one of the easiest ways to change someone’s mind was to find out what bothered them, what they were fearful of, what they were concerned about, and give them the reassurance, but it had to come from somebody they trusted. Many of those hesitant people that went on to receive the vaccine, many were in high-risk groups, many were my patients and family members and friends. That’s what I learned personally through that experience, and it could be applied to today’s situation and to any vaccine, not just the COVID-19 vaccine. So might — I also had the opportunity to go with the U.N. foundation’s vaccine initiative called Shot At Life to Zambia — I think there is a typo on the slide — I went in 2015, 2016. This was a really unique experience, even though it was pre-pandemic we still had vaccine hesitancy then. As you all know, it’s not something new. But I learned and saw interesting things. There, there was virtually no vaccine hesitancy. You would think, why? Many areas of Zambia, they have less resources than we have in America or other westernized countries, and moms would walk three to four hours in sub-Saharan heat to get kids vaccinated, because they saw what happened when outbreaks occurred and measles outbreaks would wipe out entire villages. They saw the downside of vaccines very closely and it was personal for them. Often these clinics operated with solar power, they didn’t have consistent electricity, and there were many areas even in the middle of the night it would be using the flashlight on their cell phone, the nurses would be, to treat patients. An area like this, how would they get the message out about these vaccines and where they would be available? The really interesting thing was the government relied on SMS, text messaging, vaccine campaigns, and they had a very well organized clinical national digital registry to organize the data. And you think, oh, how can an area of the world that has very little solar power — I’m sorry, very little electricity, relies on solar power, has very remote areas, how can they transmit SMS? Interesting thing, even though some of these villages may not have had running water or electricity, everyone had a cell phone of some sort. Even if it one of those old-school Nokia brick non-smartphones, they were able to receive SMS messages. There vaccine rates were very good, actually, close to 98, 909%. — 99%. That was an interesting and eye-opening experience and why vaccine hesitancy is so low there, you see the consequences of not having them.
The COVID-19 pandemic unfortunately has worsened vaccine hesitancy, and as a result we have seen a drop in childhood immunization. It is not only that people aren’t getting the COVID vaccines, but they stopped getting other vaccines, too, and especially stop vaccinating their children. The influence of COVID-19 on trust in routine immunization, health information sources, and pandemic preparedness in 23 countries showed this occurred. There was an article that was published in “Nature” in 2023, and also new data showed from UNICEF that there was a decline in confidence in childhood vaccines. After 44 percentage — up to 44 percentage points in some countries during the COVID-19 pandemic. Even those countries had virtually little vaccine have his agency –vaccine hesitancy, like in Zambia, for example, their hesitancy went up because of the COVID-19 vaccine. Unfortunately as a result, people became skeptical of flu shots. There is an article about it, but I’ve seen that even in my own practice, I had certain patients that never missed their flu shots, this year they were skeptical to get it everything they had read or heard about the COVID vaccine. These were unfortunate unintended consequences from vaccine hesitancy during the pandemic. So if we look at vaccine data, w e can see very clearly what has been going on. If you look year by year, starting with 2020, 2021, 2022, 2023, you can see that the willingness to take available vaccines depending on the average, in 2020 there was very good willingness to take it, but then as time went on, the willingness to take the updated boosters slowly was declining in average. And then if you go to the next slide, the kind of willingness to take recommended booster was even less so — oh, sorry, can you go back one more? I meant the next graph, I miss spoke.
The willingness to take the next booster or the booster when it was available unfortunately also started to go down. And then when we asked patients how they felt about if the vaccine was safe and effective, luckily a majority of people agreed, but many were unsure and didn’t have an opinion, and then there was an increase in people who kind of strongly or somewhat disagreed. Unfortunately some people formed very strong opinions against this. Vaccine hesitancy has caused eradicated diseases to reemerge. Measles can we have seen multiple outbreaks over the last few years. Unfortunately Candida saw it — Canada saw its first measles-related death in 40 years, which is very concerning. Measles is extreme the contagious. If we got COVID is contagious, measles is even more so than that. That is why it is so scary. Just to share with you personally, I am a new mom of a nine-month-old. My child isn’t yet eligible for the measles vaccine. Whenever I hear this, it really is stressful to me, because we can’t even get the vaccine yet for another three months, so these outbreaks are potentially dangerous to children like him, immuno compromised, pregnant women, you name it. Even some asthmatics who may not be able to respond to the measles vaccine. That is very concerning. 2024 had already seen by made double the measles cases — by May double the measles cases and all of 2023 for the whole year. It is rapidly progressing, and this is a big concern. Polio, which we thought we would never see again, I thought I would never see in my lifetime, last year in Rochester, New York, there was a polio case diagnosed, in a community of unvaccinated individuals or vaccine-hesitant individuals. That concerns us, what else will emerge that we thought we didn’t have to worry about anymore? So what causes vaccine hesitancy? Determinates of vaccine — determinants of acting hesitancy is complex. A systematic review and meta-analysis to look at these factors was done across 185 countries, and they focus mostly on COVID-19 vaccines, because that is the most recent and readily available data, and it revealed there was an association between vaccine hesitancy and not having influenza vaccines. If you were already skeptical of the flu vaccine, those people are skeptical of the COVID vaccine. Mistrust in vaccines, which makes sense. Then there was complacency, where people thought, well, this won’t affect me.
Especially now complacency is much more so than the early days of the pandemic because at least then many people were motivated to get the vaccine because they wanted to get out of lockdown, they wanted to go to their favorite restaurants or shows or other places. There were a lot of vaccine mandates, which I know are controversial, but that motivated people to get initially vaccinated, even though ironically a lot of those of mandates have made people hesitant. Everything is a double-edged sword. But now people are complacent because there is and strong motivation, people of kind of forgotten about COVID even though it is still very much around. Interestingly enough, being female was an association with vaccine hesitancy, and I’m not quite sure why, myself being a female. I’m very pro-vaccine. But for some reason there is an association there, and I don’t know if that is because women are reading more of this misinformation or have more access to misinformation. I’m not sure. Or because women are of childbearing status and there is a lot of hesitancy because of fears of it affected reproduction in which we know is not true. Pregnancy was associated with vaccine hesitancy, and I saw a lot of that during the COVID pandemic, even a pregnant women were much more at risk of not getting vaccine as well as their fetuses being much more at risk. They were the most hesitant group, and we saw a lot of bad outcomes in individuals who underwent the vaccine. Safety concerns, obviously. There is an association of people who take a traditional herbs, or nontraditional medications, there is a stronger association with vaccine hesitancy. And then among those living in an urban setting, with higher education, low income, were also associated with, interestingly, higher vaccine acceptance. That kind of echoed with things to which I saw in Zambia, that it didn’t necessarily mean wealthiness didn’t make a difference on who is accepting or not. Education sometimes made a difference, but not always. It depends on personal experience and personal environment and access to information. It was proposed by a working group that these factors can be classified into five domains that shape people’s decision-making regarding acceptance or rejection of vaccines. Environmental, that is huge. Personal. Social.
Those three are really very important. The people you surround yourself makes a difference on how you will decide whether or not to take one. Your personal experience of the vaccines and who you socialize with, and that could include online, not just in person. Social media. Safety was a determination. In other vaccine-related factors, like some people don’t like needles, some people don’t like how they feel, maybe get bad side effects from vaccines. Those things were also determinants of hesitancy. Environmental factors. We — in this study looked at different environmental factors. Social economic level made a big difference. Education, income, occupation can impact vaccine hesitancy. Lower socio-economic status often associated with higher levels of hesitancy. Interestingly enough, even people within the health care space, there was big disparities depending on what you did in the health care space. If you look at physicians, nearly 98% based on data from the AMA had taken the COVID-19 vaccine, but if you look at nurses, for some reason it was significantly lower, even though both individuals are in the health care space, both individuals were side-by-side treating COVID-19. I found that really interesting. And very similar data exists with the flu vaccine even pre-pandemic.
I don’t know exactly why, but that is kind of the data that is out there. And then access barriers. Financial challenges, geographic constraintss, lack of awareness of available vaccines can also hinder vaccine uptake. That is happening now because there isn’t as much public information about, let’s say, COVID vaccines oir flu vaccines. People don’t even realize that there is new boosters available, for example. Even some patients I see on a daily basis, I asked did you note that there is a new COVID chart out, did you know you qualify for this RSV vaccine, they are surprised. A lot is lacking in terms of education, and maybe being able to go and get a vaccine. People might not be able to take time off work, what have you. Complacency — again, people are burned out, tired of the pandemic. The need for vaccination feels very low, and their perceived risk of vaccine-preventable disease may seem low. But that is — vaccines are a victim of their own success. That is primarily due to successful vaccination programs that people become complacent, ironically. And then again, there is a lack of information or misinformation. It’s bad enough that a lot of the public awareness campaigns are no longer there, there is not good education out there for the public to see about newer vaccines or vaccine guideline changes. On top of that there is a lot of misinformation. There is a lot of things that is out there that are untrue. People aren’t getting good information, but they are getting a lot of bad information. Resistance to vaccine mandates and government policies. If you tell someone that they have to do something, they don’t want to do it. That is part of the problem. Some of these mandates are important because we need to protect the general community. Initially when we had thousands of people dying every day from COVID, the mandates — I could see why they made sense. There was a large public health risk and a rush to get everyone some level of immunity.
When you have children who had communicable diseases, there have to be mandates inside schools because you could be putting other children at risk. They are very vulnerable with their developing immune systems. Some make sense. A lot of these policies make sense. Unfortunately when people are forced to do something, that makes them more hesitant and less likely to want to do something. These requirements ironically promote hesitancy among individuals who perceive these measures as impinging on your own personal freedoms or autonomy. And then there is a lot of personal factors. There is a lot of individual beliefs and preferences. Health risk perception and medical interventions can shape a vaccine hesitancy, with some individuals preferring natural immunity or alternative health practices, cultural and religious beliefs are very important and we need to take these into account when we counsel our patients. Many — they may influence attitudes towards vaccinations, with views contrary to their cultural or religious practices. There may be concerns about the use of certain animal-derived ingredients or perceived interference with natural immunity. And then perceptions of risk. This is really important, because many vaccine-preventable diseases, the relative risk of a vaccination can influence their hesitancy. Patients or individuals may underestimate the severity of a vaccine-preventable diseases or underestimate the risks associated with this overestimate the risks — overestimate the risk associated with vaccination. They would say, “oh, I don’t want to get a blood clot,” or “I don’t want to get myocarditis,” but they didn’t realize that if they should get COVID, the risks of those two things are significantly higher. Those are examples of the risk perception being skewed. The same thing goes for our old vaccines, for childhood-preventable diseases, because the vaccines were so effective in reducing childhood-preventable diseases, people think we are not at risk anymore because everyone is vaccinated. They don’t understand the risk could return if we stop vaccinating. All of these things are very important. So personal issues — this one is probably one of the harder things to address, trust in health care providers and institutions. This is why the trusted messages are really important.
The trusted messages don’t have to be doctors, but there are many studies out of the pandemic that people trusted their own personal physician’s advice on the vaccine much more than what Dr. Fauci would say or the Surgeon General would say or any other public health official would say. Previous negative experiences — we can’t discount that. If someone has had an adverse reaction to an unrelated vaccine, it will still affect how they feel about all vaccines. An historical trauma and discrimination. There is a history of exploitation or mistreatment within health care systems that can contribute to vaccine hesitancy, particularly among marginalized or minority communities. We saw this a lot in the Black or African-American community, they had justified mistrust in the health care system because of things like the Tuskegee experiment and other things where they had been exploited or mistreated. As a result of that there was a lot of hesitancy in that group even though they were at higher risk, all people of color were at higher risk of morbidity and mortality from COVID-19. A lot of what we did was work with trusted messengers in these communities, and work side-by-side along physicians that they trusted, religious leaders they trusted, to kind of dispel a lot of this mistrust and this trauma. You may think — and it gets passed down. You may think that your grandmother’s beliefs might not influence a grandchild, but it does because the police — but because the beliefs are passed down to the mother and father and then the child, so it is generational trauma. So social factors, this is also very important in the day and age of social media and social networks. Even though we were all isolated from one another, the exchange of information which maybe more so than it usually is because everyone was stuck on their phones with their computers. Your social networks and peer influences make a big difference. Opinions and attitudes of friends, family members, social networks, along with your peer discussions, because someone in your friend group might say, “oh, you shouldn’t get that vaccine, I heard XYZ.” Media and information sources. This is a double-edged sword, because sometimes the media is very helpful in bringing light and attention to things, but then there is distrust of the media as well.
It depends on how people view the media. In the same goes for social media, too. There is a lot of very good information out during the pandemic, a lot of health-care providers used social media as a tool and did a great job of disseminating very helpful information to combat vaccine hesitancy. But then the flip side there was a lot of misinformation as well that we had to work against. We found, and studies have found, that the misinformation travels faster for some reason that the good information. I think there is a saying that lies travel prices fast as the truth or something like that — twice as fast at the truth or something like that. Stigma and discrimination. Certain vaccines can be perceived — identify individuals as part of a stigmatized group, so people may avoid the vaccine to avoid being labeled. We see this a lot in asthma as well. A lot of times people do want to come to terms with their diagnosis or chronic illness. It is not just asthma, it can be any chronic illness. They shun treatment, because I don’t want to be associated with that label. That plays a role as well. So we mentioned — we went through misinformation, disinformation. Social media is one of the worst because it is in everyone’s hands. The Internet is one of the worst places, too, because even if you are not on social media, there is a lot of fake websites that look very realistic, they look like trusted medical information. And then safety considerations. We touched on this, I want to necessarily rehash it — won’t necessarily rehash it. A lot of people have concerns that what they are taking is harmful and that it will do harm to women and fertility.
That was one of the main things — I was the trusted messenger amongst the group of childbearing women because even a lot of my own friends and family members who were afraid to take a vaccine, I would tell them, listen, I’m taking it, I have the same concerns as you I wouldn’t take something if that was true. And then vaccine efficacy. There was a lot of questions around that, but as a medical community we have to do a better job of explaining to people what vaccine efficacy means. And once you do, most people understand that a vaccine doesn’t make you bulletproof. It doesn’t make it so that you never get something. I wish, that would be wonderful. What happens is if you do get it, you are much less sick and you are much less likely to pass it on to somebody else who could get very sick. If you explain it that way, people understand what efficacy means. People had this misconception that, oh, I still got COVID after the vaccine, it must not work. No, Republican view out of the hospital, it shortened that — it probably kept you out of the hospital, it probably shorten the duration of your illness. These are messages that get lost when people think about vaccine efficacy. And then the ingredients. This has been a huge thing. It’s coming back into the news again. People are very hung up on certain ingredients. Preservatives, a juvenile’s — preservatives, adjuvants. Many of these are things that people are eating and drinking on a daily basis and have no idea. One of the main preservatives in both COVID vaccines, or all three, is in toothpaste. People say there a cyanide can arsenate — people say there is a and arsenic in all this. There was a great graphic showing that a lot of the things people are worried about and vaccines are also in an Apple that people will not think twice about eating. The misinformants blow these things out of proportion and people don’t realize the risks or the perceived risks. Again, safety and vaccine-related questions, a lot of this we went through.
There are concerns specific to various vaccines, so many people will be comfortable with some but not all, or they want to space them out. This falls under vaccine hesitancy, even though they might not be completely against it. They may limit how many vaccines they take or they might skip a booster, and academic downstream consequences. –that can have downstream consequences. How do we address this? How do we fix this problem? Which is here to stay, unfortunately, and growing. There is a lot that can be done. Because health care providers play such a critical role in addressing these barriers, people trust the doctor or nurse or physician assistant or nurse practitioner they interact with the most. You guys already have the relationship. I’ve heard it, I’m sure many of you have heard it, patients will say “I don’t know about this vaccine, but doc, if you tell me to take it, I will do it.” And I say yhes, I recommended for you, myself, and for others. The COVID-19 pandemic highlighted the role of physicians in advocating for vaccines, but I would go one step further and say all health-care workers. Some people may have a closer relationship with the nurse at their practitioner’s office. Every member of the health care game can be influential. And a can work negatively, too, because I’ve instances where I’ve talked to patients and they said “the ultrasound tech told me I should not get a vaccine because it will give me a heart attack.” It drives me crazy. You can go both ways. Everyone has influence full to everyone who has patients has influence. A recent study of close to 2000 U.S. adults including minority and rural populations to mistreated a strong link between trust in on — demonstrated a strong link between trust in one’s physician and vaccination rates. Imagine if the whole health care team was on the same page. Those who had previously declined vaccination were more likely to accept if they trusted their health care provider. That was my own personal experience primary care providers were particularly influential due to the very close relationship. Of course, allergists are, too, because we have very long-term relationships with patients. We see everyone from childhood through adult blood. Many individuals view their primary care doctors as the most effective messages regarding vaccines, with the significant portion expressing willingness to receive vaccines during routine visits.
Pediatricians play a huge role in this. Those are the ages for childhood vaccines that doctors are very important. OBGYNs, same recent. — reason. And because pregnant women are such a vulnerable operation, it is important, everyone on that OB team. Educating health-care workers about the reasons for vaccine hesitancy can lead to significant advanceds. A lot of doctors and nurses come up to me and say I want to convince people, but how can I when they are against it. There are ways. People just want to feel heard and they want their fears address. I find it helpful to ask what exactly bothers you. When they tell you, then you can tailor your message so that. If someone says, “I’m afraid I won’t get pregnant,” I Kenneth Lay that is not true –I can explain that is not true. Many populations saw an increase in fertility after vaccination probably because it protects them. People bring up a whole slew of things –blood clot, myocarditis. I explained that those are more likely if you don’t want the vaccine. People just want to be heard and they want their fears to be addressed. It is essential for physicians and clinicians to begin with a thorough understanding of the causes of residency enter brainstorm strategies to address the concerns. That is the main thing. Again, this is the same thing, but understand the root cause. By knowing that it makes it so much easier to address people’s concerns. Collecting information to gain insights about perceptions is very helpful. One group of people may have totally different concerns than another group of people, and understanding those concerns can make a huge difference.
Monitoring social media and websites within communities can provide collateral information and help in early identification of a potential challenge in beliefs. This practice can identify a potential rumor as misinformation, allowing timely action. And then align the intervention with the root cause. Again, these conversations should be based on what the problem is. Just spewing facts at people — oh, this is safe, this is effective — you have to tailor your message to who you are talking to, whether it be a woman or an older man, parent of a caregiver. Each person has a different concern and a different fear. That tailoring is really important. Interventions don’t have to be something complex. It could be as simple as active listening, discussions and education regarding the risks and benefits. A population that mistrusts the health-care system or remembers previous adverse effects or trauma related to vaccines requires a complex intervention to gain trust. This can include enforcement of regulatory initiatives on vaccine safety or implementing reporting systems for adverse effects. Tailoring your message is really important. You are kind of the expert, you meaning all of you today, in what your community needs, because you know your community device.
My patient population might be very different than someone’s in Iowa or the South or what have you. Each health care worker knows their own community the best. And then, again, effective communication helps. If you have harsh language or people feel like they are not being heard, they kind of shut down. This seems like common sense, but a lot of those things like I mentioned before, active listening, addressing people’s concerns, hearing their concerns really goes a long way. It helps them get their guard down and drop their barriers to connecting. This is true for anything, but especially for vaccine hesitancy. And then some practical strategies and current vaccines. I wanted to take the end part, and then we can focus on questions to go over what the current vaccine recommendations are in some practical strategies. So, again, I mentioned this already, sorry if I sound like I am beating a dead horse. Don’t lecture, berate, or isolate people. You want them to have a positive experience with a get — so they get vaccine. I hear so many times I got to hurt — I had XYZ and now I don’t want vaccines. You don’t want to force something down somebody’s throat. Find out if the patient is experiencing fear. An trusted messenger. We did a lot of vaccine outreach during the time at the NYU vaccines into and we partnered with religious organizations so we would have town halls with churches, mosques, temples, and we would do both virtual and in person. This went along — a long way because of someone’s pastor or rabbi said I trusted these doctors, people are much more open to our message. They don’t know us if we just started showing up and lecturing them. Religious messengers are important. It doesn’t have to be religions for that there is a lot of community leaders. I did a Facebook Live with a councilman in Harlem because his area was very vaccine-hesitant and high risk as well. That was very well attended because they trusted him. If he vouched for me, they trusted me indirectly, if that makes sense. Among those who attend religious services, most trust clergy as source of information about COVID-19. This is definitely true. If somebody is religious, they are going to trust their religious representative the most. It’s nice to see this, but the doctors still were the most trusted, 84%, but second-most were clergy or other religious leaders in their house of worship. This is why we partnered with a lot of these individuals, and I found it very effective. The news media is the least trusted. Politicians are kind of down there as well. Makes sense to me. So, practical strategies, again. Here communication, engage with communities, tailoring to communities, legislation and policy can help but sometimes backfires, redirect social media with reliable information, address misinformation and disinformation. Again, education, the cornerstone of mitigating vaccine hesitancy. You have to come back fears and misinformation with facts. It is imperative to offer compelling evidence that underscores the necessity of vaccines and really helps people understand the risks of COVID-19. And diverse channels — we already went through those. It is facilitating and supervising dialects spiritual leaders go along why just go a long way. –facilitating and supervising dialogues with spiritual leaders go a long way. Clear communication, the factors and techniques we mentioned. Community engagement. Again, build trust with disenfranchised communities and acknowledge what their fears are. Those trusted messengers. All communication should be evidenced-based, because you don’t want to lose credibility by making wild claims which may or may not be true. Make sure, one, you go in as a trusted messenger and you give good quality information. Vaccination programs are also very helpful, because when things occur in home turf, people feel more comfortable, more relaxed, they see their own communities and family members engaging and they are more likely to engage as well. And again, studies proof that this is true. 2023 study on vaccine-hesitant students found reasons such as fear and apprehension rather than outright opposition to vaccine.
These are people who need good, clear information. And they also found in other areas outside the U.S., like in India, for example, that comprehensive approach to amplified loud voices, identifying local concerns, advocates, they achieve successful and for intervention to bring about long-term change. Other evidence-based guidelines are community preservation, reinforcement techniques such as incentives or mandates, sometimes they work in your favor, sometimes against. Those partnerships with those trusted champions and messengers. Legislation and policy — before the COVID-19 pandemic, vaccination mandates played a crucial role in vaccine uptake, especially for pediatricians and pediatric cohorts and college students. Now, again, those mandates have gotten a bad reputation, but they are so important especially for young children in that vulnerable age group. Requiring vaccines for school enrollment consistently improved vaccination rates among children. Majority of parents will comply. However, mandates for adult vaccinations are relatively new, and I don’t think they work as well as they do with the pediatric group, unfortunately. These most recent widespread mandates were implemented after the H1N1 pandemic and of course during COVID. They did increase at all vaccine uptake — adult vaccine uptake, but in some ways they may have increased vaccine hesitancy. Legislation and policy. Again, a lot of things are very helpful, like the vaccines were free of charge during the pandemic. That really helped. Now when people want to get vaccines and they hear, oh, your insurance will cover it, or someone doesn’t have insurance and they hear the vaccine is $200, $300, that will be a barrier. Unfortunately a lot of those policy frameworks that are now gone were helpful. This should apply to all vaccines. It should be covered fully by all insurances, in my personal opinion. If you don’t have insurance, the government should have funds available to cover it, because this is not a personal thing. It affects the whole community. An outbreak anywhere is an outbreak everywhere. Next slide. And this — I know we kind of belabored this, that you have to have things to counteract misinformation that you find online. And again, this is some more tips. One approach that was demonstrated during the pandemic at Cleveland clinic were pregnant doctors, nurses, pharmacists shared reasons for receiving the vaccine, that increased uptake in that group specifically. I have personally experience with that as well. When people see that my health care workers doing it, they are in the same boat as me, they are more likely to increase the uptake. And of course addressing misinformation and disinformation. And there is a lot especially in the reproductive health space and the pregnancy space. There is a lot of misinformation from fertility to the microchip , you name it. A a lot of crazy things that I had heard. But the problem is a lot of people believed it because they thought they were getting this information from reliable sources. Other than disparage people for believing these things, you have to show them — rather than disparage people for believing these things, you have to show them by the information is not correct. Research and innovation. Investing in research, especially to include vulnerable groups, that would make people more likely to take something. “Now, but — up until now, most participants are Caucasian. Including vulnerable groups like people of color, children, pregnant individuals is crucial to counter vaccine hesitancy.
The scientific community must acknowledge its role in vaccine hesitancy, especially among underserved populations. We need to do better at addressing the epidemiologic and socia economic factors — socio-economic factors. I’m going to skip over this so we can get to the current guidelines. Yeah, I’ll skip over this. And then again it’s really important to incorporate vaccination to prenatal care. This is a high-risk group, especially for any of you who work in the OB world. You play a huge role, because every pregnant woman sees their OB and OB office the most, monthly or weekly. This is extremely important. This is — I want to touch on this before we go to the questions. The current guidelines for immunizations for people with respiratory disease, this is important. The CDC currently recommends that everyone who is at least six months of age o or older should receive an updated COVID vacciner. The current vaccines available, there is Pfizer and Moderna, both have updated vaccines, mRNA vaccines we heard about through most of the pandemic. Novavax is also available. This is adjuvan ated, protein vaccine similar to shots people received in the past. This is great for vaccine-hesitant people because a lot of the misinformation is around mRNA vaccines and then being experimental. Novavax is the old tried-and-true technology that people know and trust. Elana my patients I’ve been — a lot of my patients I’ve been able to get vaccinated by telling them about the Novavax vaccine. Unfortunately, many people don’t even know that it exists.
That is an option you can give your vaccine-hesitant people. It is helpful to those people who had adverse reactions to the mRNA vaccines, such as allergic reactions, or if they’ve been the unlucky few to get myocarditis or very severe side effects. It is nice that we have a non-mRNA option, and that one is also updated. That applies to the current strain. That is age 12 and up, the Novavax. And then for the flu vaccine, CDC recommends this for age six months and up, as always. This should be updated every year. The ideal time to get the vaccine is end of September, October. That should carry you through the entire flu season. If you get up a little early, that’s all right, or a little late, that’s all right. It generally lasts at least six month or more for most individuals. And now there is the new players on the scene, as of last year. The RSV vaccine is that when I get asked about a lot because I have a lot of immunocompromised and asthmatic patients. The CDC recommends a single dose of any FDA-licensed RSV vaccine for all adults age 75 and older and adults 60 to 74 who are at increased risk of RSV. What does that mean? Those at increased risk of RSV could be people with asthma, COPD, heart disease, cancer, anything that would put you at higher risk of a respiratory vaccine would qualify for GSK has one, Moderna has one, Pfizer has one. Eligible older adults may receive any of the licensed R.O.C. vaccines — RC vaccines, and adults can get them at any time but the best time is late summer and early fall before the RSV season starts. This when you don’t have to get every year. I believe the immunity lasts a minimum two to three years, maybe longer. One break that you get. The RSV vaccine is not annual, as I mentioned. If you have been vaccinated, you don’t have to get one again every year. Pregnant women also should get the RSV vaccine between 32 and 36 weeks of pregnancy, because the cool thing is that immunity transfers to the newborn, and the newborn’s protected their first six month of life. I received it myself when I was 32 weeks pregnant. Infants should get a monoclonal antibody between birth and eight months for RSV before the first RSV season, or up to age two F they are high-risk. My son got his RSV vaccine as well, six months old, because my immunity wore off by that point so I wanted to make sure he was protected. So vaccines work, to summarize. They work they are one of the greatest public health innovations can even though they are getting a bad rap today. Overwhelming data on safety and efficacy. One of the few preventative health interventions that are effective within weeks. We do so many things for prevention, exercise, taking medicines from eating right, and of it works in a few weeks except for vaccines. I get asked a lot from immunologist how to boost my immune system. This is the best and fastest way to do it. Everyone, not just health-care workers, can combat hesitancy. Be kind, empathetic, compassionate, meet people where they are. They are much more likely to attract flies with honey, as they say, than vinegar. It is all in our best interest to combat hesitancy. An outbreak anywhere is an outbreak everywhere. We are protecting each other. Sorry there was a bit long, I had a lot to say, but I will open it up for questions.
Lynda: Thank you, Dr. Parikh. Really appreciate it. I’m sorry I’m sitting here in the dark, the sun went down. We have questions, but I wanted to comment, we had special webinars for the Black community and Hispanic/Latino community during COVID, and we actually did an evaluation of vaccine hesitancy before and after, and found that when those trusted messengers from the communities in which these folks lived were actually talking to their community and explaining the safety of vaccines and that it was OK to take the COVID vaccine, they were more apt — it showed in the evaluation data — to do that. With the Hispanic/Latino community, we started doing webinars in the Spanish language so the doctors talking to those attendees were hearing it in their native language for them do you want to comment on that?
Dr. Parikh: Yeah, I think that is excellent. I agree. I participated in some of those webinars, and I thought they were really impactful, especially when people see a doctor that looked like them and speaks the same language as them, it goes a really long way. They were just wonderful, and I’m glad you all have continued with the webinars even for non-vaccine-related topics, because they hesitancy carries over into all aspect of health care paid a lot of fear people have about vaccines may apply to asthma medications, too. It was a great series of webinars.
Lynda: Thank you. I have some questions here. Earlier in your presentation you said something about nurses and LPNs — I’m sorry, nurses were less likely to be pro-vaccine. Can you comment on that?
Dr. Parikh: Oh, that’s a good question. I don’t know so if it is more so one type of nurse. I can get the data, the study ot you. We will send it out afterwards. They did show the uptake among nurses was somewhere between 50 to 60%, whereas physicians — physicians I know was closer to the 90s. I didn’t see a breakdown of LPN vs. RN. That would be interesting. That might be a difference as well. I found interesting that people working on the same health care team might have a very different view of the same intervention. It’s really important to connect with people about why they have that view. Again, most of the nurses I work with take the vaccine. My view is very different then someone else who may work with somebody who was very much against it. I found it very interesting that there was such a disparity even amongst health-care workers.
Lynda: Understood. Great, thank you. If the CDC is not considered a trustworthy source by people, are there other sources that you can recommend that people go to to gather information?
Dr. Parikh: Right, I completely hear you on that. CDC and NIH, they had a lot of erosion interested during the pandemic. I like a lot of hospital websites are very good. The Johns Hopkins Hospital had great information all throughout the pandemic that I found very helpful. And also organizations like the Allergy & Asthma Network. People trust organizations where their peers are there, other patients and families may be there. American College of allergy, asthma, immunology, and the American Academy have great information to combat vaccine hesitancy. There is a whole myriad of groups like that. American heart Association information. Vaccines affect almost every chronic medical condition. You can definitely find patient advocacy groups that have great information that are much more trusted than the CDC or NIH right now could Lynda: One more question, because it is 5:00.
Dr. Parikh: Sorry.
Lynda: That’s OK, it’s a great presentation. Is the COVID booster still to be spaced a year apart? Are they still called boosters? I noticed you just refer to them as vaccines.
Dr. Parikh: They are technically still called boosters, for the reason I called them vaccines is some people may not be up-to-date with their boosters or may not of received initial vaccination. Unless you are a baby or child, you don’t have to go through the initial vaccination even if you are never had the vaccine. You can start with the updated vaccine like if you are an adult for example. That is why I use the terms interchangeably, but there technically boosters, and they are annual for most people. There are some high-risk groups that might need it more than every year. For example, people who are severely immunocompromised can get it every six months. The same goes for the flu shot with cancer patients undergoing chemotherapy or what have you, certain groups of elderly that have chronic issues, severe lung disease. If you think you are in that group or know someone in that group, it is best to discuss with their doctor if they are someone who should be getting it more often, because there are certain high-risk groups where it is recommended more often.
Lynda: Great. With that I will say thank you so much for this wonderful presentation. It is packed with good information. Really appreciate your time on that. Can’t imagine what it took you to pull all that together. In the process of planning our 2025 webinar, please look for emails from Allergy & Asthma Network for upcoming webinars next year. In a few days you will get an email from Zoom with a list of additional resources related to this webinar topic and other things that might be of help to you. Thank you again for all of us at Allergy & Asthma Network. Join us every day, where we work to help people breathe better together. Have a good night, everyone.
