Battles being waged to overcome vaccine hesitancy

First-year medical student Melissa Blake takes the blood pressure of a customer at Urgent Cutz barbershop in Liberty City as part of the Shop Docs program. Photo: Robert C. Jones Jr./University of Miami
By Robert C. Jones Jr.

First-year medical student Melissa Blake takes the blood pressure of a customer at Urgent Cutz barbershop in Liberty City as part of the Shop Docs program. Photo: Robert C. Jones Jr./University of Miami

Battles being waged to overcome vaccine hesitancy

By Robert C. Jones Jr.
As more and more vaccines are being administered, the push is on to convince everyone to get protected. Eliminating barriers to health care and ramping up educational efforts are just some of the ways to get more people to get the shot, University of Miami researchers say.

It’s not that McKenzi Payne wants to frighten the young men to whom she helps administer health screenings at Miami-area barbershops. But she can’t think of a better way to convince them to get the COVID-19 vaccine than to relate some of the heartbreaking stories she has experienced as an emergency room technician at Jackson North Medical Center. 

“I’ve seen what the virus can do to the human body, the way it can destroy families,” Payne, a master’s degree student in public health sciences at the University of Miami Miller School of Medicine, said one recent Saturday at Urgent Cutz barbershop in Liberty City, where she and first-year medical student Melissa Blake conducted free blood pressure screenings as part of the Shop Docs initiative. 

“I’ve seen people separated from their families in the darkest moments of their lives,” Payne said. “And I’ve seen patients walk into the ER complaining of shortness of breath, and by the time my shift was over, they were intubated.” 

She can’t say for certain if the strategy works. What’s important, though, is that the effort to persuade more people to get vaccinated, especially the young who don’t fear the virus, needs to be made, she said.

Outreach efforts 

With more than 140 million people in the United States 18 or older now having received at least one dose of a COVID-19 vaccine, or 54.9 percent of the total adult population, everyone from health care workers to community activists are employing a multitude of strategies to combat the last few pockets of vaccine hesitancy, racing against time—and the variants—to dispel the rumors and persuade doubters that the inoculations are safe and effective.

Through a National Institutes of Health-funded outreach project, Dr. Olveen Carrasquillo, a Miller School physician and his team, have taken to the radio waves and the internet to spread the message about the safety and efficacy of the vaccines. They are also conducting online focus groups to learn why certain segments of Miami-Dade County’s population are distrustful of the shots. 

“We listen to their concerns and try to meet them halfway. We still get questions about the long-term safety of the vaccines and if they affect pregnant women. But a lot of the conspiracy-fueled questions have been on the decline, and we’re happy about that,” said Carrasquillo, chief of the Division of General Internal Medicine and co-director for community and stakeholder engagement at the Miami Clinical and Translational Science Institute. 

Partnerships with groups like Health Council South Florida, the Florida Community Health Worker Coalition, and a Little Haiti-based radio station have helped his efforts. So, too, have alliances with houses of worship. “We’ve had bishops, priests, pastors, and other religious leaders on our calls,” Carrasquillo said. “They know how to address a lot of the questions we’ve come across.” 

Outreach efforts like Carrasquillo’s may be working. A new poll by the Kaiser Family Foundation shows vaccine hesitancy rates dropping among all U.S. residents, with the most positive changes occurring among Black people. About 55 percent of Black adults said they had been vaccinated or plan to get a COVID-19 vaccine soon, an increase of 14 percentage points from February, according to the poll. The rate approaches that of Hispanics (61 percent) and whites (64 percent).

Barriers to health care 

But vaccine hesitancy shouldn’t be confused with barriers to health care that make it difficult for some segments of the population to get vaccinated, cautioned Sannisha Dale, a health psychologist in the University of Miami’s College of Arts and Sciences. Lacking adequate transportation to get to vaccination sites, not having home WiFi to log onto the internet to make a vaccine appointment, and not being able to take time off from work are just some of the challenges marginalized groups face in getting a COVID-19 shot, she said. 

“People at the margins are used to communicating the challenges they face in their daily hierarchy of needs,” Dale explained. “And when they’re questioned about their interest in getting something, and they’re required to respond with a simple ‘no,’ their answer appears to simply be a lack of interest, but it’s not. In reality, behind that no is a long answer, part of which is having access to those services.”

More initiatives to bring vaccines closer to marginalized communities such as mobile pop-up clinics are needed, she said. “Unless we are intentional about how we get vaccines to communities, there’s still not going to be the level of uptake that’s particularly ideal in communities that have experienced the most casualties around the virus,” Dale said.

Dr. Erin Marcus, a professor of clinical medicine at the Miller School, echoed those sentiments, saying that more needs to be done to make it easier for some groups to get vaccinated. “In Miami-Dade, we don’t have a super robust public transportation system,” she said. “There is Metrorail, but if you don’t live along those lines and you can’t get access to it equally, the bus system can prove difficult to navigate.” 

Health care workers, she believes, need to be role models in reassuring others that the vaccines are safe. She admits that she is a bit of a proselytizer in that regard. From an Uber driver to a woman she met at a local post office, Marcus always has the same message for anyone with whom she strikes up a conversation: get the vaccine. 

“It’s important that health care workers lead by example,” she said. “So often, if I’m with a patient or just having a conversation with someone, I will point to my ID and I will point to the sticker that says COVID-19 vaccinated, and I’ll say, ‘Look, I got it.’ ” 

A pause in the Johnson & Johnson vaccine because of concerns over blood clots fueled fears of additional vaccine hesitancy. But if anything, the temporary suspension, which has since been lifted, can “serve as reassurance for some who worry that the vaccine development and distribution process was hurried,” Dale said. “A pause shows that there is constant monitoring to ensure vaccine safety. However, I think the key thing that the moment calls for is ethical journalism and reporting the actual numbers versus catchy headlines that may exacerbate the number of rare cases and fuel skepticism.” 

There have been about 17 cases of clotting that occurred in about seven million doses of that vaccine, and those cases were among women between the ages of 18 and 50. “These were extremely rare events,” Carrasquillo said. “But media really blew this up. My sense is that the media hype will pass.” 

One statistic that is concerning: the number of first responders who have mixed feelings about the COVID-19 vaccines. In a national survey of more than 3,100 firefighters and emergency medical services workers, Miller School researcher Alberto J. Caban-Martinez found that more than half of the respondents said they were uncertain about (24.2 percent) or had low confidence (27.6 percent) in the vaccines. 

The study results were published online Feb. 1 in the Journal of Occupational and Environmental Medicine. 

Caban-Martinez, associate professor in the Miller School of Medicine’s Department of Public Health Sciences, attributes those numbers to what he calls a “fatalistic culture” among some first responders. “Many felt the nature of their work puts them at high risk of contracting the coronavirus because they’re in the community taking people from their homes and transporting them to hospital and clinical settings. Their feeling was, ‘We’re going to get it anyway. Let someone else receive the vaccine,’ ” he said. 

Since that survey, the number of firefighters reporting that they intend to get the vaccine has increased, according to Caban-Martinez, who is planning to update his study.

Reaching herd immunity 

Good news comes in the fact that 99.6 million of the total U.S. population, or 30 percent, is now fully vaccinated, according to data from the Centers for Disease Control and Prevention as of April 29. But along with that news, is a softening demand for the shots, as more and more states report a slower pace in their vaccination campaigns.

And that is why the push to vaccinate more people is important, as the nation strives to achieve herd immunity, said Dr. Roy E. Weiss, professor and chair of the Miller School’s Department of Medicine and the University’s chief medical officer for COVID-19. “The way in which we’re going to be able to return to normalcy both in our professional lives here at the University and in our private lives is to get to a number of approximately 90 percent of people being vaccinated,” he said. 

“Why do I say 90 percent?” Weiss continued. “We don’t know exactly what the number is, but we do know that with the variants and other challenges, that if we strive for that number, we’re likely to be able to reach a safe situation where there would be herd immunity and people wouldn’t be getting very ill. It’s just imperative for everyone to take that responsibility to protect themselves and to protect their co-workers and colleagues in society by getting the vaccine.” 

Dispelling some of the myths surrounding the coronavirus vaccines, Weiss pointed out that vaccines have been used for decades and are the primary weapon employed to fight infectious diseases. 

“When you think about other things that have cost human lives and high economic tolls, think of polio, think of diphtheria, think of smallpox,” he said. “The devastating effects that these diseases have had have all been essentially eradicated due to the use of vaccines. They’re safe and they’re effective.” 

If you haven’t received the vaccine and you’re hesitant—or you just want more information—join a virtual town hall at 6 p.m. on Tuesday, May 4. A panel of medical experts will share updated facts and address your questions. Register here.

Video messages from University of Miami medical experts on the vaccine in English and Spanish.