Rethinking Vaccine Outreach

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Brian Lehrer: Brian Lehrer, WNYC. By the way, Alison also has Chris Thile today, and I know there are a lot of Chris Thile fans out there from live from here, and he's got a new solo album which I'm looking forward to hearing. Chris Thile among the other guests who I mentioned with Alison at noon. Each week during the vaccination era, S. Mitra Kalita, founder of URL Media and Publisher of the news organization, Epicenter-NYC, which was named after New York City being the epicenter of the COVID epidemic, has been joining us as she helped connect harder to reach or harder to convince New Yorkers with vaccines.

Last week, some of you will recall she told us about the national initiative, VaxFest, and the hard work that goes into planning the events within communities to improve access. Today, we'll share stories of helping or convincing people, one at a time, to get vaccinated. Joining Mitra this week to discuss how the script for vaccine outreach is changing person by person, individual by individual, is Dr. Ayrenne Adams, a primary care physician and Clinical Leadership Fellow with New York City Health and Hospitals. Thank you for joining us, Dr. Adams, welcome to WNYC, and Mitra, welcome back.

S. Mitra Kalita: Thanks, Brian.

Brian Lehrer: Let's get right into some individual stories, Mitra, and then we're going to open up the phones and invite callers to tell us theirs along these lines. Can you tell us about the lead singer in a wedding band who refused to get vaccinated? What happened there?

S. Mitra Kalita: I hesitated to share because if this person is listening out there, Brian, you have wide reach on your show, I preface this story by saying all of it is with great love for the individual. Epicenter has been getting a lot of emails and phone calls narrating situations of who's not getting vaccinated. We've gotten dozens of these over the last two weeks or so, which just points to a shift in exactly what you just said, that the vaccine outreach is really becoming individualized.

We got an email from someone saying, "Listen, this is a performer. We're getting booked again. People are getting married again. They're holding weddings, again. It's great but people are asking us for proof of vaccination and we have this one person that doesn't have that. What would you do to convince her?" My first question was, do you know why? This is like back and forth, just to be clear, this becomes a back and forth.

The person said, "I just think they're very mistrustful of both the vaccine itself and how quickly this all came together, but I don't know much more than that. I said, "The next question is, are there other points of entry besides you working with this person? Is there a church? Is there a neighborhood? Is there a family member?" Together, we went on Facebook, LinkedIn, a few other social platforms, just to see who do we have in common with this person. Sure enough, I found somebody in common who then I reached out to and I said, "Listen, confidentially, I just want to let you know what's going on. Do you mind getting involved?"

This person who's a big advocate of vaccines has also helped many of his friends and family secure vaccines, said, "I totally get it. I'm so happy to do this. I won't trace this back to you." He's begun this-- I don't even want to call it a campaign because that implies pressure, but kind of a, "Hey, just checking in on you. We haven't talked for much of the pandemic. I just got vaccinated. It's great. I got to see my aunt, my uncle, my parent," sharing the positivity as we've been talking about week after week. I don't have an update, Brian, as to whether she has gotten vaccinated. I share that because I think we love instant results and for some of these folks, that might not be what we get.

Brian Lehrer: Congratulations to anybody getting married this first weekend in June coming up. It does make me cringe to think of a wedding singer of all people, we know how it has spread from singing in the past among choruses and things like that in a crowded indoor hall if it is a crowded indoor hall. That's the thing,

S. Mitra Kalita: I think that's why, Brian, people are asking for proof of the vaccination. There are safeguards while people like myself and friends around this individual, there are safeguards to protect against what you're describing.

Brian Lehrer: Listeners, with that as a jumping-off point, do you have a story to tell of you or someone you know helping someone decide to get vaccinated, and doing it probably with this kind of love and gradual approach and respect for their humanity and the choice that they've made so far like Mitra obviously does so well and was just describing there? 646-435-7280. Who has a story to tell or do you know someone you're still struggling to convince and need advice on how to do that? We have two people with plenty of experience here so give us a call whether you want to tell a story or ask for advice on how to talk to somebody who you're working on to try to get vaccinated. 646-435-7280.

As we always do in these conversations with Mitra, it's not just hesitancy, so also on access. Maybe you're offering to watch a friend's kids if they feel sick the next day, or offering to give a neighbor a ride. Maybe you even successfully just helped cover for somebody or arranged to cover for somebody so they can go get their vaccine or just enhance their access in some way. We'll take those stories too. 646-435-7280. 646-435-7280. Dr. Adams, let me turn to you. I'm sure you can relate to Mitra's approach of working one person at a time. For you as a physician, I'm curious if you have a story like that that you would like to share?

Dr. Ayrenne Adams: Definitely. I definitely do and I definitely wanted to highlight, Mitra, with a couple of points that you made that I think are so important when you're talking with people, whether it's me talking with a patient, or even if you're talking with a friend. Really asking why the person had that concern about the vaccine and really thinking about who is that trusted messenger, who is a person the person might resonate with when they talk about the vaccine? Then recognizing that you do not automatically get the result of them getting the vaccine. I think the story that I have really captures a lot of those points.

Like you mentioned, as a doctor, I've had many conversations about the vaccine. Every patient that comes into my office, I ask them what their thoughts are about the vaccine. One story that really stands out to me is that one of my patients, she's in her mid-40s. Unfortunately, she's homeless, or she lives in a homeless shelter. Probably in maybe March, when they expanded the criteria for some of the medical comorbidities, she was eligible to get the vaccine.

We talked about the typical things that we talk about at our clinic visits, and at the end, I asked her, "The COVID vaccine is available now. I was just curious, what are your thoughts about it?" I could see her facial expression, even under the mask changed a little bit. I could really tell that she wasn't feeling as comfortable. Just like Mitra mentioned, the first thing that I made sure to do was ask, "Well, what are your concerns about it? What are you thinking?"

Really, when it came to be- [soundcut] was very scared about the side effects of a vaccine. She had two children and so she was worried if she were to get sick from the vaccine, that would affect her children affect her ability to take care of her children. I talked with her about those concerns. I shared the data for, there's a lot of people that have been tested and gotten the vaccine and that things have been okay, but she still wasn't sure. She actually did not choose to get the vaccine after that visit.

I saw her two other times in clinic. Once it was a phone visit. The third visit was in person. The second time I talked with her on the phone, she still was not convinced to get the vaccine, she was so worried, but then the third time when I saw her, we talked about her other medical concerns, and I brought up the vaccine again and she actually decided to get the vaccine. Our clinic luckily has a vaccine in-clinic and so she was able to get the vaccine that day.

I think it highlighted for me, and I think it's something, especially now that we're seeing a lot more, is that many people may not decide that first time that you talk with them to get the vaccine, but those continued conversations, continuing asking those questions, making sure you're being empathetic and not judging their concerns, eventually can make people feel more comfortable and eventually they may choose to get the vaccine for themselves.

Brian Lehrer: Good story. Mitra, I'm going to go back to you for another one because I see you also got a call from the partner of a homebound senior who refused to get the vaccine and he only spoke Spanish. Instead of just encouraging the partner to try to convince him, you came up with a different approach. Can you share that with us?

S. Mitra Kalita: Sure. In this case, this was a couple. The wife got her vaccine and we helped her get the vaccine and so she knew us through that. She said, "My partner won't get it. Our son had COVID. If anyone knows the devastating effects of this virus, it's us. It's a really rough year and he won't get it. He is being very stubborn about this," and so we asked the question, what's keeping him from getting it?

She said, well, he's old, so some of it is that he's confused. He's homebound, so he doesn't want to go to the vaccine sites. He doesn't really want to go anywhere, but he is definitely skeptical. I asked the same question. Is there any other institution, is there any faith? What are some other ways that we might approach him? She said, well, he is very religious. I said, well one of the churches we've been working with has a Latino pastor. I think you mentioned this senior only speaks Spanish.

I said, one of the churches we've been working with has a Latino pastor, and the culture of this church, which we're familiar with, it's right here in the epicenter in Jackson Heights, has been great through the pandemic. They do contact tracing. They put out word on vaccines, their vestry, their pastor himself, everyone's vaccinated. When you meet them, they say, we just got our vaccine. It's a culture that they've created in this church.

Incidentally, Epicenter is doing an event with them in a few weeks. I said this pastor would be great to talk to your husband. She said, well, let me just check on whether he would be open to that. This one, Brian, I have good news. This morning, I got an email from her saying, yes, he has agreed to talk to a pastor about getting his vaccine. I'm in the process of setting that up. I'm hoping to do that before the weekend.

Brian Lehrer: Yay. Great story. Daniella in Brooklyn, I think has a question for Dr. Adams. Daniella, you're on WNYC. Hi there.

Daniella: Hi. How can you get over a fear when a relative had passed from the vaccine with a heart attack just a few days after? I mean, that's pretty scary.

Dr. Ayrenne Adams: Thanks, Daniella, for the question. I think that definitely highlights a lot of the concerns that people have about the vaccine. I think what you're getting at is that individuals, whether they have side effects from the vaccine, or if maybe some event happens from the vaccine, and we may not know if it was from the vaccine or something else that happened, that can obviously cause fear for the people around that person. I think in situations like that, typically, what can be helpful and again, is asking what their main concerns are. I would guess a lot of the concern may be related to that family member about what happened and what they saw.

Typically, in situations like that where I have somebody that might be worried about whether it's somebody who had really, maybe they had a really high fever and got really sick, or maybe somebody who had a medical event that happened after the vaccine and they may not be related, typically, what I do in that situation is that I acknowledge that it's normal to be worried, acknowledging the concern that people have is really important, but then I offer additional information that we have.

For the additional information that we have is that we millions of people who have gotten the vaccine and they have had either minor side effects or none of those side effects. Typically, I think the key takeaway is that acknowledging the concerns and real fears that people have, but then offering the additional information that we have that strengthens our feeling that the vaccine is a safe and effective thing to get to help protect ourselves against COVID, but great question.

Brian Lehrer: Melody in Greenwood Heights, you're on WNYC. Hi, Melody.

Melody: Hi. Oh my gosh, I'm a huge fan. I can't believe I'm on the air. I just wanted to share a story about my mother who has become a holistic healing and health fanatic over the past few years. She was very hesitant to get the vaccine. She's also, however, a musician and she has had a few in-person gigs booked for this summer and she was really struggling with this. While it took every bit of impulse control to not just yell at her and say, "Are you out of your mind? You have in-person gigs. You have to do this," I tried to listen with an open heart and I found some articles.

There was some natural health journal that I found with an interview with an immunologist who actually said, "Yes, the vaccines are safe, we should all be getting them," and I sent it to her and it worked and she got a vaccine. She just had to come to it and I think be heard and exactly everything you're saying, there are just ways to approach it.

Brian Lehrer: Mitra, anything you want to say to or ask Melody?

S. Mitra Kalita: Yes. I think that's great. I like that you solved it with information. I do think that for many people, and I mentioned this earlier, the speed at which these vaccines were developed has been an issue. One way that the script is changing is to actually correct this idea that COVID hit and suddenly we had Pfizer and Moderna, the mRNA vaccines. These have been in development for years.

I think it's important also for us just to even correct some of our own scripts that we might've been using because I think all of us are just so happy that in under a year, we got from pandemic to vaccine. It is quick, but on the other hand, for the scientists who've been working on this, this has been their whole careers, this has been years in development, and that definitely starts to make people also feel more comfortable.

Brian Lehrer: Melody, thank you very much for that story. Glad you got on the air. Here's one, Dr. Adams, coming in via Twitter. A listener asks, "My colleague won't get vaxed because she's concerned about post-pregnancy effects on a baby. Any advice?" Asks this listener.

Dr. Ayrenne Adams: Yes, and that's actually a great question. I know something that I've been working on when I talk with people is that I've seen quite a few individuals who are either interested in becoming pregnant, who are pregnant, or who are breastfeeding, who are worried about will the vaccine affect myself, will it affect my baby? Those are definitely questions that are very common.

Typically, in those situations, what I say is, one, what the person already did, they figured out why the person is hesitant, and then getting the additional information. A good thing related to that is that a lot of the professional organizations of doctors and healthcare providers that take care of pregnant persons and take care of individuals who breastfeed have looked at this to figure out, is it safe for us to give vaccines to individuals who are pregnant, who want to become pregnant in the future, and individuals who are breastfeeding?

All of those societies have actually recommended that if a person is pregnant or if a person is breastfeeding, or if they're wanting to become pregnant, they should be able to get the vaccine if they want to get the vaccine. We actually have some data that's coming out among individuals who were pregnant when they received the vaccine, looking at if there are any differences in the outcomes of the women, outcomes of the pregnancies, and outcomes to the fetus, they were not seeing any worse outcomes to the individuals who were pregnant or to the fetus for individuals who received the vaccine compared to pregnancies that typically happen when people are not getting the vaccine.

I think related to that, what I would do is I would definitely provide information. I think also looking at the CDC, looking at information that that person could read from scientists that talk about that, but the data that we have so far is really recommending that individuals are pregnant, wanting to become pregnant, or are breastfeeding, they should get the vaccine if they're interested in doing that.

Brian Lehrer: That's an interesting comparison. What do you compare it to? Do you compare it to nothing or do you compare it to women who aren't vaccinated and the outcomes of their babies, and then you can see in that aggregate number that there aren't differences? A listener tweets something similar asks, "Have your guests talked to their patients or clients about how to do a cost-benefit analysis? I find a lot of people weigh the vacs against doing nothing instead of against getting COVID, which is not the right way to evaluate risk," writes this person. In other words, just weighing it against doing nothing as opposed to weighing it against COVID. You like that one, Dr. Adams?

Dr. Ayrenne Adams: Sure. I think what that gets at is I know, for at least me, when I talk with patients or just when I talk with anyone in general, I really do try to make it a conversation of what are they looking at, what's important to them, and really trying to come to a decision together. I think when you think about cost-benefit and you think about, I look at it more like the pros and the cons, typically, I'll use that when I'm having conversations with people.

I think one thing that's important when speaking about the COVID vaccine is that sometimes if I have conversations and I'm talking about the risk of COVID, it's important not to frame it in a way to scare the person since sometimes using fear and scare tactics typically is not as helpful to make somebody more confident in a vaccine. Typically, what I do is if somebody initially is hesitant and I think about pros and cons, I might ask them, what do they typically do during the day? Are they around people that are going out quite a bit?

Then I also sometimes will, if they're concerned about the side effects, talk about how often you might worry about side effects. I might compare that to when people do get COVID some of the side effects that they might have. I think what you're getting at is important to make sure that we're looking at the pros and cons for each person and helping them come to the decision of if the vaccine makes sense for them.

Brian Lehrer: Let's do one more for Mitra. Two minutes left in the segment. Yusef in Newark is not convinced. Yusef, you're on WNYC. Thank you for calling in.

Yusef: Hi, Lehrer. Thank you so much. Actually, the question was if you would know someone that, or someone you convinced. Actually, I'm someone that needs to be convinced. I'm still not convinced with everything that the doctor is saying. My problem and my concern is the saftyness of the vaccine. The doctor said people are fine. That's today. What is down the road? Do they have any data, do they have anything to base on telling me that, okay, you'll be fine? How can they convince me on this?

Brian Lehrer: Yusef, thank you, and Mitra, I know you get this question all the time, which is it hasn't been studied for all that long. It was, after all, Operation Warp Speed, as a certain former president called it, and so how do people know about long-term side effects? How do you address that common question?

S. Mitra Kalita: There's two areas. One, Yusef, I'm happy to put you in touch with doctors as well as scientists that can talk to this specific area where you're thinking about the long-term benefits of getting the vaccine. Whenever there is a scientific question, Brian, you've heard me week after week, I do try to find the resource, or I've done three-way calls with doctors and scientists, and the person who's concerned and I'm happy to do it with Yusef.

The second thing I would say is that we're in a moment right now where we do have pretty adequate research comparing the vaccines against the variants of the virus. I don't want to scare Yusef, but as somebody who's has dozens of members of her family who have contracted COVID overseas, specifically in India, the variants and not being vaccinated is actually a scarier proposition to me right now than what Yusef's concerns are. Meaning, if you think about--

Brian Lehrer: Again, what to compare it to, and I'm sorry to say that has to be the last word.

S. Mitra Kalita: Okay thank you, Brian.

Brian Lehrer: It was a very clear last word because we are out of time for the show. S. Mitra Kalita, founder of URL Media and publisher of the news organization, Epicenter NYC, and Dr. Ayrenne Adams, primary care doctor and Clinical Leadership Fellow with the New York City Health and Hospitals Corporation. Thank you both so much.

Dr. Ayrenne Adams: Thank you for having me.

S. Mitra Kalita: Thank you, Brian.

 

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