The best gift I received this past Christmas was, without a doubt, my first dose of the Pfizer COVID vaccine. When an email in mid-December notified me that I had been given one of Birmingham’s precious first few vaccination appointments, I felt joy and relief. Obstetricians, like other front-line healthcare providers, cannot postpone seeing patients with coronavirus until they recover. Our expectant mothers still need our care. So, I and my partners were offered the vaccine early, and we accepted gratefully. Never for a moment did any of us consider not taking the vaccine.
As doctors, we understood the science behind the vaccine’s development and the safety and effectiveness data that came from early clinical trials. Even in December, we did not share the anxiety so many felt about being vaccinated. At that time, Kaiser Family Foundation survey reported that nearly 2/3 of Americans were hesitant or had decided to refuse the vaccine. Now that over 200 million doses have been given in the U.S., we can see that its safety and effectiveness have far exceeded what we dared to hope and pray for! The COVID vaccine is an incredible gift that 1/3 of Americans are still not ready to accept. (Same Kaiser survey).
I’ve thought a lot recently about why this message did not get through. Each time a friend or family member would ask me about the vaccine, my answer was firm. “Take it and get back to your life.” I assured my daughter, who lives in New York, and my daughter-in-law, a teacher who was breastfeeding our grandson, that they should be vaccinated with no worries about their reproductive health. I recall a close friend asking whether I thought the vaccine could be dangerous. I joked, “Only if you try to get in line in front of me!” I expect that most physicians give the same advice in their personal lives.
In their professional roles, I fear that the message from many physicians and other health policy leaders has been more guarded and cautious. Does this caution come from a fear of lawsuits? Maybe, but I don’t think liability is their main concern.
Since the beginning of time, a physician would decide the best medical course of action and communicate it to the patient. They answered questions like a parent would answer a child, without a lot of medical explanation. Modern physicians respect the right of patients to make fully informed medical choices.
Yet, in fulfilling our commitment to provide patient-centered care, have we let the pendulum swing too far? Are we too reluctant to influence the patient’s decision? Giving just the facts and statistics, and then leaving the decision to the patient, satisfies the ethical and legal requirements of informed consent. But I sense that this falls short of what many patients are really looking for. Friends don’t call me to ask for statistics. They want to know what I would choose for myself or my family. Many patients—especially those who have known me for years—want the same. I give a frank answer and tell them the reason for my choice. Then I respect their right to disagree.
Today around 60% of eligible Alabamians have not received even one dose of vaccine.
Plenty of appointments are going unfilled, and locations are easy to find. In fact, you can get a shot at any of UAB’s vaccine clinics—now even without an appointment (though an appointment is still recommended at https://www.uabmedicinevaccine.org) YOU NO LONGER NEED TO GIVE YOUR SOCIAL SECURITY NUMBER!
I believe that healthcare providers and health policy leaders need to ramp up our message. The vaccine public relations campaign is failing. And it is no wonder, when the message is heavy with caution about very small risks and light on enthusiasm for the vaccine’s huge success. We need to be realistic, but doom and gloom is not accurate.
We cannot provide a 100% guarantee that a fully vaccinated person would never become infected. But we are seeing incredibly few “break-through cases,” many fewer than we expected after clinical trials. And most of these individuals have mild symptoms or none at all. We also cannot guarantee that a fully vaccinated person has zero chance of being a carrier. A carrier is a person who may be able to pass some virus to another person, though he or she does not have enough virus to be sick. The CDC has acknowledged that the chance of a fully vaccinated person spreading coronavirus this way is very low. Keep in mind, if you yourself are fully vaccinated, becoming infected from a carrier would be an extremely remote possibility. As long as we are living and breathing, we make responsible decisions to accept minor risks.
Continuing to warn fully vaccinated people that they should not relax protective measures may have its own set of harms.
Some wonder “Why get vaccinated if nothing changes?” Older people have been more motivated because their personal risk is high. Younger people, not as fearful of critical COVID illness, may be more persuaded by lifestyle benefit. Reassuring fully-vaccinated folks that they can visit the sick and elderly, enjoy public events, travel, and generally return to normal life will make the shot more appealing. Remember that normal life has never been risk free.
We will never be able to control every possible risk—variants, carriers, breakthrough cases, etc. Measures like lockdowns, masks, social distancing would suppress outbreaks for a time. But cases surged again and again because the virus was still so prevalent in our communities. In our state, the vaccine is readily available, and Jefferson and surrounding counties in the Greater Birmingham area now report low-risk for community spread of COVID (ADPH, 4-15, see risk indicator tab). But little has changed for the over-half of Alabamians who remain unvaccinated. They are still hunkered down and vulnerable. Our own vaccination is by far the best protection we can offer them. We can also tempt them with a more persuasive message. Life after vaccination is really different and better!
These thoughts are my own medical judgment. I gladly share them with my patients who ask.
Jimmy M. Sparks MD