COVID Vaccines Continue to Save Lives!

In the spring of 2021, many Americans were hopeful that we had put the worst of the pandemic behind us. But by August, that optimism faded as COVID came roaring back. In September, as the number of people in the hospital with COVID reached historic highs, we found ourselves again struggling with masks, vaccines, and what to do to stay safe.  And again, in November, we found ourselves dealing with yet another new variant of the SARS- CoV-2 virus that causes COVID-19.

The latest surges are fueled by two things.  One is inadequate vaccination coverage among the populations in the US and around the world. Unvaccinated people give the virus hosts where it can mutate into new, possibly more dangerous, forms. Most of the people being hospitalized for COVD-19 are not vaccinated. Up to 90% of people in intensive care units are not vaccinated. Fortunately, considerable progress expanding vaccinations in the US has been made, and the Kaiser Family Foundation reports that nearly 77% of the US population had received at least one shot as of September 21, 2021.[1] 

The other driver of the current surge is the Delta variant, a mutation of the original COVID virus that is more contagious and may cause more severe illness. The majority of people experiencing severe cases are ill with the Delta variant. Unfortunately, the virus is still mutating in infected people, and the risk of a worse variant evolving is real. The latest concern is that yet another new variant, Omicron, will be even more transmissible than the Delta variant. At this time, it is unknown whether the Omicron variant will cause severe illness and deaths at the same concerning levels that Delta has done. What we do know is that we must increase vaccination rates globally if we hope to contain this pandemic. Because we are so interconnected globally, as long as the majority of the world is unvaccinated, we are all at risk.

The data around vaccinations in the US is still somewhat incomplete, but it appears that immunization was slower to reach Black and Hispanic Americans than white Americans.  The Centers for Disease Control (CDC) reports that race/ethnicity information is collected for only 59% of people who have received shots. This data indicates that 60% of the shots have gone to whites, 10% have gone to Blacks and 17% have gone to Latinx populations. [2]  While white Americans are still the largest (and most visible) group refusing to get vaccinated, some people of color, particularly in Black communities, have also been hesitant. And even where people in Black communities want to get vaccinated, lingering issues with supply and distribution, along with real-life challenges, such as transportation, childcare, job insecurity, and disabilities due to chronic illness may prevent them from doing so.

 To give some firsthand perspective on these issues, we reached out to faculty members and friends of the Johns Hopkins Center for Health Equity for updates on their experience with the pandemic. We checked in with two Community Advisory Board members, George E Franklin III and Charlette Lee.  We also contacted JHU School of Nursing associate professor and researcher, Dr. Carmen Alvarez.  Each of them offers a different perspective on how COVID-19 has changed them, their co-workers, and their views on the people around them.

Community advisory board member, George Franklin III.

You Know, People are Dying

Mr. George Franklin, a Community Advisory Board member who we also interviewed for our last Feature Story, continues to feel frustrated that more progress has not been made fighting the virus. He notes that the town he lives in, Cumberland, Maryland, had the highest rate of infections in the state in August. He feels that politics are driving some people away from the vaccine:

I understand this is a politically charged thing. Cumberland being a red city, in a red county, it does not surprise me that a lot of people here are just not going to take the vaccine. Death does not politically care. Ha. And uh, it’s sad when you see someone on TV saying “oh my goodness they were going to get the vaccine but they didn’t and I tried to convince them and then it’s too late.”

But as a Black man, George also notes that some hesitation comes from lingering concerns about how people of color  have been treated by the medical establishment in the past:

I know people in Prince Georges and one or two in Baltimore that keep bringing up Tuskegee. And I say, listen, this is not that time. That century. Things have improved and moved on. We need to wake up and smell the vaccine. You know, people are dying.

 But even for people of color who want to get vaccinated, George feels that the rollout to certain  communities has been slow and difficult:

 Talk about health inequities: I and several other people felt like the minorities here (6% of the population here) were not being vaccinated. And having a transplant, I was adamant about getting it.  So I was signing up for every list with the hospital with health clinics.

George finally had to travel to Baltimore to get his shot.

Community Advisory Board Member, Ms. Charlette Lee.

Another Community Advisory Board member, Ms. Charlette Lee, echoed some of George’s frustration about vaccine hesitancy. She also noted the hesitation seems to be driven by old information and political resistance to public health guidelines:

 Folks like me who are pro-vaccine have a hard time understanding why folks are not getting vaccinated. So I think the community is divided. I know a few folks who have not gotten vaccinated. I guess for me, I don’t understand it. It’s like, this is life-saving. . . I think a lot of it is miscommunication. Wrong information. Bad information. Old stereotypes. Old wives’ tales. . . and you also have that small group of people fighting about masks and I’m like “are you kidding?”

 George and Charlette express a frustration over people not getting vaccinated that has become a common and much-reported on attitude among those who have gotten the shot. This frustration makes many vaccinated people support mandates regarding vaccination or mask wearing as social obligations.

Johns Hopkins Center for Health Equity faculty member and researcher Carmen Alvarez has had to manage the effects of the pandemic from the other side. As a nurse practitioner, Dr. Alvarez works with front line clinical staff who have mixed feelings about vaccination and mask mandates. She has empathy for those people who may resist vaccine or mask mandates. 

 Including Front Line Workers in Decision-Making is Essential

Researcher and Center for Health Equity faculty member Carmen Alvarez, PhD, RN, CRNP, CNM.

For Dr. Alvarez, with the exception of physicians, some of the public health mandates seem to have simply left frontline healthcare workers (e.g., nurses, midwives, community health workers, medical assistants, home health aides) out of the decision-making process related to vaccination requirements. She notes that:

 We’ve talked about healthcare workers being so essential and important and when we hear about the decisions and changes that were made within clinical settings that do not seem to consider the needs of these very essential people.

Dr. Alvarez offers pointed advice to the people who are making policy recommendations for clinic settings:

Policy makers need to be as inclusive as possible in obtaining perspectives from the various stakeholders. . . . I think it’s just really first and foremost taking a step back, thinking about not just your main client but also those that are serving your clients to make sure they’re included in the decision-making in adjusting operations. To better meet the needs of the patient. Because how do you deliver good service if those providing the service are miserable?

Ultimately, Dr. Alvarez’s experience has led her to become more of an advocate for frontline workers:

My main hope is that moving forward, healthcare leadership really partners with frontline workers to understand what their current concerns and needs are,  and works in partnership with them to create a work environment that is more supportive of the work-life balance that they need.

Dr. Alvarez was also able to provide some insights into the situation of some of Johns Hopkins overseas partners in Puerto Rico and Ghana. In these places, hesitancy and a lack of access to vaccine continue to feed the pandemic…

Despite the current surges and the lingering issues with getting racial and ethnic minoritized groups vaccinated in the US, there is some good news to report. As previously mentioned, over three-quarters of the US population has now received a shot. And while the CDC data indicates that vaccination rates among Black and Hispanic Americans have lagged over 2021, it also shows that in the last few months, people of color are getting vaccinated at higher rates than whites are. The recent trend line is looking much better for people getting access to immunization, thanks to many initiatives including grassroots campaigns and engagement of community-based organizations across the country, including The Black Coalition Against COVID-19 , BlackDoctor.org, Salud America, Unidos, The Community Corps,  and  the NIH Community Engagement Alliance Against COVID-19 Disparities, to name a few.  Although we are still living with frustration and concern, if we continue to be vigilant and engage in safe practices such as wearing masks, avoided crowded places, keeping a safe physical distance from people who don’t live in our household, and getting vaccinated (or becoming willing to learn more about the vaccines from trusted and reliable sources), there is still hope that 2022 will be a better year for many of us.

Yet, even if we do see improvements in the impact of the pandemic next year, if we truly care about health equity – when everyone has the opportunity to attain their best health -- we must advocate with our national leaders and multinational organizations, including as pharmaceutical and biotechnology companies, for people around the world -- especially those in low and middle-income countries -- to have access to the same life-saving vaccines, testing, and treatments that we are so fortunate to have in the United States.


RESOURCES

Community, Baltimore, Feature StoriesCHE Team