Hearing people out when they say they hesitate to get a COVID-19 vaccine and leaving the door open for more discussion are ways for doctors to have nonjudgmental conversations about the important issue.
Those recommendations are part of a consensus statement from the Black Physicians Network on COVID-19 vaccination.
The statement was released Jan. 16 and came from the BPN’s Technical Advisory Committee, made up of Drs. Robert Harrison III, Mark Brown, Linda Clark, Melissa Dundas, Vivian Lewis and Brandy Young.
“We decided it was important to talk about the COVID vaccines, their safety, efficacy all those questions people have,” said Dr. Linda Clark, president of BPN. “Many of us find ourselves out there answering questions on our own, but we think it will be much more powerful as an organization to take them on and have some consensus among ourselves, what we believe and think and what we should promote so we can speak as an organization and not just as Linda Clark.”
The genesis for the consensus statement came from the questions that BPN received during its community education on COVID testing and then as vaccines started to become available.
Clark said the committee researched what has been written and took that information and their own questions to three of Rochester’s leading infectious disease specialists: Drs. Angela Branche, William Valenti and Edward Walsh.
“We all have our specialities,” Clark said of the pediatrician, family medicine, emergency medicine and ob/gyn practicioners who are part of the committee. “It was very collegial. My background is preventive medicine and public health. Listening to the adolescent medical doc, I’m like, ‘Oh, yeah, I wouldn’t have thought of that.’
They vetted their information with the infectious disease experts.
“The power of the Black Physicians Network is we can call of these contact and they’ll meet with us on a Saturday,” Clark said. “We want to make sure to use whatever connections we have to make sure our community is well-informed.”
She said the group did not include in the statement when it is appropriate for someone who had COVID-19 to get vaccinated.
“We can always reconvene,” she said.
The statement on the vaccine was the first from the Black Physicians Network. Whether statements will be issued as a formal series or as the need arises has yet to be decided.
People can use the “contact us” page of the Black Physicians Network website, https://bpnroc.org/contact-us, to send questions about topics they’d like to see addressed.
Here is the BPN’s Technical Advisory Committee consensus statement on COVID-19 vaccination:
General considerations when discussing the vaccine with patients and community members:
- Acknowledge hesitancy and concern as legitimate without being judgmental, patronizing or condescending
- Try to convey information in a way that is understandable and relevant, depending on the people you are serving. (e.g. adolescents may require a different approach)
- The various research groups did a good job getting demographic representation, including Black and Latino participants in their studies
- Acknowledge what we do not know
- Don’t assume that the person understands the potential severity of COVID-19
- Lead by example – get the vaccine and be able to discuss your experiences with it
- Leave the door open to further discussion especially when people are initially reluctant to get the vaccine
Specific TAC Recommendations / Responses to Questions
Is the vaccine safe?
The COVID vaccinations are considered very safe and well-tolerated. The messenger RNA. mRNA, vaccines (made by Pfizer and Moderna currently) are designed to teach the body how to recognize the “spike” proteins on the SARS-CoV-2 virus and mount an immune response to it. This mRNA never enters the nucleus of the body’s cell and is eliminated when it has completed its mission. The body does the same thing when it is infected with the coronavirus. The body uses messenger RNA to manufacture this spike protein and learn how to mount an immune response to it, making antibodies. So the mRNA is not really a foreign substance to the body – our bodies are used to using them to fight viruses.
There are other vaccines, still in development, that will use the adenovirus to teach the body how to make the spike protein. Everyone is already exposed to adenoviruses in life – the human race is used to it. These viruses do use DNA. The vaccine being developed by Astra Zeneca has adenovirus that is not infectious to humans and can’t replicate in the human body. The DNA never enters the nucleus – it does its work outside of the nucleus in the area called the cytoplasm. Johnson and Johnson also utilizes an adenovirus (26) that has been used a long time to make other vaccines, like for preventing Ebola.
Who should get the vaccine?
Everyone over 16 years of age should get the vaccine. It is easier to avoid diseases – COVID may cause severe illness in some people and milder disease in others. It is not always easy to predict who will get severe disease, however. We recognize that age and certain underlying conditions, such as heart disease, obesity and diabetes, may impact the course of disease, but additional factors, like race and ethnicity may also play a role in severity of disease. Why take a chance when the disease can be avoided?
Immunity from getting the disease may only last a few months. If someone has previously had COVID, they are eligible and should be encouraged to get vaccinated.
Who should not get the vaccine?
Anyone who is allergic to the vaccine or any of its components should not get the vaccine. Children are not yet approved for vaccination.
Pregnant women and those who are breastfeeding may be eligible for vaccination and should discuss their decision with their doctor(s) or health care provider. Similarly, those with autoimmune diseases, like Lupus or rheumatoid arthritis, or on medications that affect their immune system may be able to get the vaccine and should discuss that with their doctor.
Who should not get the vaccine at this time, but with more study may be able to get it?
Children under the age of 16 should not get the vaccine at this time. This is only because the vaccination has not been studied yet in children. Pfizer will be studying their vaccine in 11 to 15 year-old children soon, and then in younger and younger children later this spring. Moderna plans to study their vaccine in 12 to 17 year-old children and then also age-deescalate their study population.
What can we say, with surety, about the short-term side effects of the vaccine?
Most effects are similar to other vaccinations –injection site soreness, short-term body aches, headache, fever, and fatigue. Many of these effects are from the body mounting its immune response, as it is instructed to do, so that it can be prepared to fight off COVID-19. It may seem worse than other immunizations because the body is seeing this for the first time. In rare cases, severe allergies (e.g. difficulty breathing) are seen- very soon after vaccination. For this reason, people getting the vaccine should be observed for 15-30 minutes after injection. There are systems in place to carefully monitor the effect of the vaccines.
What can we say, with surety, about the long-term effects of the vaccine?
We do not know how long immunity will last with the current COVID vaccines, however, we do know some of the long-term effects from COVID infection. For example, there are young people who are suffering from strokes, developing reactive airway disease (like asthma), heart disease and injury to the kidneys to name a few. It is not clear what the long-term implications will be from this damage to the body.
Some people suffer from severe fatigue for a month or longer, cough and wheezes for months and long-term headache syndromes. Certainly, those who have severe illness resulting in hospitalization, abnormal changes on chest x-ray, ventilator use, being placed in the prone (on the belly) position, and other intensive care measures remain ill for quite a long time. Medical professionals and researchers only have 9 months of experience with this new coronavirus, and we do not know what the long-term effects of the disease will be. However, at this point, there are no obvious long-term effects of the vaccine; our experience with other, similar vaccines suggest that it will be quite safe.
What additional questions need to be answered about the vaccine?
As previously noted, we need to understand whether it is safe and effective in children. We also need to watch the vaccine over time and ensure there are no serious consequences to its use.
Will mutation affect the efficiency of the vaccine? How soon?
Viruses like this one often mutate. There are two major strains circulating that are of concern from the UK and South Africa at this time. They are able to transmit more efficiently and appear to be more infectious. At this point, these new strains seem to be similar in their severity. There are concerns that the mutated strains may not be as susceptible to the vaccines currently being used and those under development. That is under study. Meanwhile, the more people we get immunized now, the safer we can all be.