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This interview and episode was recorded and produced prior to the November 16 announcement that 

Moderna's vaccine candidate mRNA-1273 was associated with 94.5% efficacy

 in preventing COVID-19 in preliminary phase 3 COVE trial data. Though the candidate and the mRNA platform is discussed throughout the podcast, more updated coverage of mRNA-1273 will be made available on ContagionLive.com throughout the coming weeks.

In matter of 2 weeks, a series of significant clinical, public health, and otherwise factors greatly influenced the current state of 

From promising preliminary phase 3 data from Pfizer and BioNTech, to record surges in new cases and hospitalizations across the US, and to a Presidential election laden with public health policy implications, the makeup of COVID-19 pandemic response is entirely different from what it was weeks ago.

It is only bound to change even more greatly in just a couple more weeks. Before the US Food and Drug Administration (FDA) is able to weigh on the potentially first COVID-19 vaccine to submit an Emergency Use Authorization (EUA) and kick off an unprecedented distribution and real-world monitoring process, it’s crucial to assess where things stand now, and what’s coming up.

This week’s Vaccine Race podcast features an interview with William Schaffner, MD, professor of Preventive Medicine and Medicine at the Vanderbilt University Medical Center.

Schaffner discusses his own impression of the new Pfizer preliminary data for candidate BNT162, whether the current US rate of 150,000-plus new daily cases could pressure the FDA to further expedite a vaccine, what vaccine distribution, storage, and immunization will entail, and what a new administration would (or would not) mean for COVID-19 response and vaccine development.

The Vanderbilt Professor of Preventive Medicine shares thoughts on the first potential COVID-19 vaccine, at a time of record new daily cases.

Vaccine Race: The Pfizer Vaccine with William Schaffner, MD

, as the global-scale infectious disease meeting has been forced to resort its comprehensive clinical agenda to a virtual format due to 

As an acknowledgement to the great burden of COVID-19—and in spirit with the meeting’s great collaborative efforts—the first 24 hours of the annual meeting are dedicated to discussions around the pandemic, titled “Chasing the Sun.”

 will provide around-the-clock IDWeek 2020 coverage over the next days, we kick off our content in a similar fashion: the second episode of our limited series podcast Vaccine Race.

In this episode, senior editor John Parkinson sits down with Mei Mei Hu, co-chief executive officer of vaccine development company Covaxx, and honorary member of Time Magazine’s Next 100 List of 2019.

Covaxx’s investigational COVID-19 vaccine, UB-612, is the first multitope peptide-based vaccine capable of activating both B-cells and T-cells.

about her company and its creation of this interesting candidate, and provided some firsthand insights into getting a vaccine through the development process.

Stay tuned for more IDWeek 2020 content, and a new Vaccine Race episode, throughout the week.

ID Week

A vaccine developer joins for a firsthand discussion on the development, research, and distribution process.

Vaccine Race: Mei Mei Hu on Developing, Researching a COVID-19 Vaccine

Findings indicate that while the severity of health impairment decreases over time, 18% of unvaccinated participants still experience symptoms up to 2 years after infection. 

Long COVID Lingers: Prolonged Symptoms and Recovery Patterns 2 Years After COVID-19 

From outbreaks to breakthroughs, these are the biggest infectious disease headlines from the past week.

Weekly Roundup: The 5 Most Impactful Infectious Disease Stories You Need to Know

How does the diagnosis rate of mental health disorders after COVID-19 compare to that of other respiratory infections?

The Hidden Impact of COVID-19: Deterioration of Mental Health After Hospitalization

The FDA's decision to approve Abrysvo was based on data from a Phase 3 clinical trial, which demonstrated the RSV vaccine's efficacy, immunogenicity, and safety in adults aged 60 and older. 

 A Milestone in RSV Prevention: FDA Approves Pfizer's Abrysvo Vaccine for Older Adults

The Omicron variant caused the most symptoms in pediatric patients. However, there were no differences in adverse outcomes by COVID-19 variant.

Impact of COVID-19 Variants on Symptom Severity in Infected Children

 is so common that most people catch it at least once a year, usually writing it off as a “cold.” However, for vulnerable populations, including infants, older adults, and immunocompromised persons, the stakes can be much higher.

“RSV causes a lot of fluid buildup in the lungs,” explained Iona Munjal, MD, a senior director of vaccine research and development at Pfizer. “When babies breathe, they breathe through lung tubes that are many times smaller than ours. So fluid buildup can almost completely occlude their breathing airways and really fill up their lungs with a lot of inflammation and fluid.”

Worldwide, there are currently no approved RSV vaccines for infants. However, last week, the US Food and Drug Administration’s (FDA) Vaccines and Related Biological Products Advisory Committee (VRBPAC) voted in favor of the efficacy and safety of 

, Pfizer’s unadjuvanted bivalent RSV prefusion F vaccine candidate.

By actively immunizing pregnant individuals, RSVpreF is intended to prevent medically attended lower respiratory tract disease (MA-LRTD) and severe MA-LRTD caused by RSV in infants from birth to 6 months of age.

“Likely, a mom would have to get vaccinated each time she got pregnant,” explained Munjal. “Then she produces these antibodies, they are passed to the infant, and then the infant could be protected for that RSV season.” RSV antibodies are not very durable, which explains why people can and often do contract it every year.

Ultimately, Munjal emphasized vaccines as a preventative measure. Efficacy data from the phase 3 

fficacy) clinical trial for RSVpreF found 

 at preventing medically attended severe lower RSV-associated lower respiratory tract illness.

“If we can cut down, for example as we saw in the efficacy, on over 80% of severe RSV disease in the first 3 months of life, that could be a gamechanger to how pediatric care is conducted.”

With the PDUFA data now confirmed for August 21, 2023, Munjal expressed her gratitude to all the trial investigators, but especially to the trial participants. “We had over 7000 moms that consented to participate in this trial and that was really, really powerful. Not only for the health of themselves and their infants, but also the contribution to science.”

“As a pediatrician, we really, really feel that this will be a major change to what we see in infants annually,” Munjal said of the potential impending approval of RSVpreF. She explained that there are many things she would like to discuss during a health checkup, such as how a baby is feeling or behaving, but this is all overshadowed by an RSV infection. Munjal believes the RSVpreF vaccine could change this, saying, “We think potentially this could be a game-changer, that you’re really going to focus on the health and the good health of a child rather than focusing on their intermediate illness.”

Pfizer's RSVpreF vaccine candidate has shown promising efficacy in preventing severe lower respiratory illness caused by RSV in infants. With the potential approval of RSVpreF, pediatric care could undergo a significant positive change.

“A Gamechanger to how Pediatric Care Is Conducted”: RSVpreF Vaccine Could Reduce RSV in Infants by Over 80%

Last night, the US Food and Drug Administration’s (FDA) Vaccines and Related Biological Products Advisory Committee (VRBPAC) voted to support the efficacy and safety of Pfizer’s unadjuvanted bivalent 

After reviewing all available trial data, VRBPAC voted 14 to 0 in favor of the efficacy of RSVpreF and 10 to 0 in favor of the safety. Through active immunization in pregnant persons, RSVpreF prevents medically attended lower respiratory tract disease (MA-LRTD) and severe MA-LRTD caused by RSV in infants from birth to 6 months of age. 

With this recommendation from VRBPAC, RSVpreF is one step closer to FDA authorization. The vaccine candidate was granted a Prescription Drug User Fee Act (PDUFA) goal date of August 21, 2023, upon which the FDA will likely decide whether to approve Pfizer’s RSVpreF.

 interviewed Iona Munjal, MD, senior director of vaccine research and development at Pfizer. Munjal was on the front lines of the RSVpreF 

fficacy) phase 3 clinical trial, and as a pediatrician, she has high hopes for the vaccine’s ability to alleviate the burden of RSV in infants and young children.

“For infants, RSV remains the number 1 cause of inpatient hospitalizations due to respiratory illness,” Munjal explained, “and to this date we have no treatment, so it’s a really frustrating time for parents.”

The world’s first RSV vaccine, GSK’s Abrexvy, recently received FDA approval

 to prevent RSV-induced lower respiratory tract disease in adults 60 years and older. However, there is still no vaccine for the pediatric population.

, such as breathing and feeding, can be lifesaving. But, Munjal says, “Vaccines, like the Pfizer RSVpreF vaccine, really represent a potential substantial change in the number of infants who would come down with that really scary illness.”

RSV was formally identified in the 1950s, but 

 seriously stunted further RSV vaccine development. Munjal added, “For years, we hadn’t really understood the protein on the surface of the virus. This F protein that we’re using as the target, we didn’t know its structure. So until we understood it, we couldn’t use it effectively.”

RSVpreF is a maternal vaccine, meaning it is administered to pregnant individuals to ensure babies are protected from birth. “Rather than having babies get the antibody through a shot, you can actual utilize one of the oldest forms of antibody gifting, which is the placenta,” said Munjal.

Munjal noted moms naturally pass antibodies onto their babies when they themselves contract RSV, “But the levels that we cause them to make of antibodies after vaccination are many fold higher than what you’d get from a natural RSV cold.”

“This is a really exciting time for us,” said Munjal, noting that infants, parents, and pediatricians like herself will all benefit if RSVpreF is approved.

This was part 1 of an interview with Dr. Munjal. Come back soon for part 2, in which she discusses why 

 disease is so severe in infants and shares key data from RSVpreF clinical trials.

RSVpreF receives strong support from the FDA's VRBPAC, with positive votes for efficacy and safety. The vaccine shows promise in preventing severe respiratory illness in infants, and an FDA authorization decision is expected in August 2023.

FDA Advisory Committee Affirms Safety and Efficacy of Pfizer RSVpreF Vaccine

This is part 2 of Dr. Varga’s interview. 

 to watch part 1 and hear about the failed vaccine trials that paved the way for the world’s first RSV vaccine.

 now more than ever, and it’s not just because the 

world’s first RSV vaccine was FDA-approved

“I know that RSV garnered a lot of press in the past year,” said Steven Varga, PhD. “I think that was in part because of the disruption of the normal seasonality that’s associated with RSV.”

 faculty in the Department of Infectious Diseases, as well as Dean of the St. Jude Graduate School of Biomedical Sciences.

Varga explained that prior to COVID-19, RSV has a predictable seasonality, starting in the fall and peaking in the winter. At the height of the COVID-19 pandemic, when many people were wearing masks, sanitizing, and adhering to social distancing recommendations, “The number of RSV cases, as well as influenza and many other respiratory viruses, declined precipitously because we were taking measures to prevent the spread.”

As COVID-19 infections decreased, protections were lifted, leading RSV infections to return in unexpected ways. “We saw this large increase in cases that occurred relatively late in the spring and into the summer, and particularly in the geographic southern regions of the US,” Varga explained. “That’s what garnered a lot of the public attention, because it was so off-cycle, and because so many children were falling ill.”

Young children and infants are susceptible to the worst of RSV infection

; their bodies build up mucus to defend against RSV, but this can actually block their growing airways and exacerbate the disease.

“In very young children, their airways are very narrow because they’re still developing,” Varga said. “They’re much more susceptible to having their airways get plugged by that mucus, particularly in the evenings when they’re lying horizontally.”

RSV is “a ubiquitous pathogen,” Varga said, noting that virtually all children contract RSV by age 3, and adults will unknowingly experience multiple reinfections. However, because COVID-19 preventative practices kept RSV from circulating for several years, many children are now being exposed to RSV for the first time.

This led to high volumes of susceptible children all requiring treatment at once. “The issue with treatment is there aren’t good antiviral treatments that are available that are specific for RSV,” said Varga. The options are either low in efficacy or very expensive, so Varga explained that most of the provided care is supportive, such as oxygen for breathing and fluids to prevent dehydration.

Varga emphasized, “We don’t have a lot of options for treatment, and that’s why the 

 is very exciting…potentials for treating children in particular.”

As more RSV vaccines approach approval, including a 

 to protect neonates against RSV, stay up to date with 

Steven Varga, PhD, explains why infants and young children are so susceptible to severe respiratory syncytial virus (RSV) infections.

The Challenges of Treating RSV in Children…Without a Vaccine


March 24 marks the annual World Tuberculosis Day and remains an important reminder of the significance of this disease. It commemorates the day in 1882 when German physician and microbiologist Robert Koch surprised the world by telling a group of scientists at the University of Berlin's Institute of Hygiene that he had discovered the cause of tuberculosis, the TB bacillus.

Since that time, great strides have been made in understanding the bacterium and curative treatment has been developed. However, a marked difference in the continuum of care remains between what is experienced in low-and-middle-income countries (LMIC) and what is experienced in the United States. Starting with the statistics, there is a huge discrepancy in what is being seen in terms of cases and the number of deaths. 

The continuum of care is different, and in the US and other developed countries, patients have the ability to see their providers on a regular basis and see treatment all the way through—this is not always the case in LMIC.

“In the US and Europe, we have managed to get TB somewhat under control,” said Michael W. Dunne MD, FIDSA chief medical officer, head of development, Bill & Melinda Gates Medical Research Institute. “The burden of TB in the developed world has significantly reduced over time because we have good preventive measures, good treatment regimens, that can be monitored here. And that is the important point…it is more difficult to do that in the rest of the world.”

Dunne points out this is the crux of the issue and the ability to care for patients continuously over the many months it takes to cure a patient with TB. “How do we make it easier for low-and-middle-income countries to be able to get a handle on TB?”

Within the US, not only has there been a great emphasis on TB care, the type of TB being seen here is different. More than 80% of TB cases in the US are associated with latent TB infections (LTBI) says the CDC. With LTBI, patients are treated with shorter medication regimens that are 3-4 months as opposed to someone who has active TB and needs to be on medications for 6 months. Innovation is another factor that differs in the US. For example, the CDC-recommended video-directly observed therapy (vDOT) can conserve time and costs for some patients and TB programs.

Bill & Melinda Gates Medical Research Institute

 has a special focus on health care issues in LMIC. The institute is a non-profit organization dedicated to the development and effective use of novel biomedical interventions addressing substantial global health concerns, for which investment incentives are limited. The institute works through collaborating partners and organizations, coordinating and driving the full spectrum of biopharmaceutical development activities, including pre-clinical development, full clinical development (from phase 1 through to and including phase 3), and global regulatory interactions.

As part of its strong commitment to TB, the institute has 6 therapies and 1 vaccine in development. The therapies and vaccines are still in the early stages, but have shown promise says Dunne.

Dunne explains the institute, along with its partners, are trying to develop new antimicrobials to eliminate susceptibility testing and multidrug resistance. They also want to decrease the amount of time patients are on the therapy so they will more likely adhere to their regimen.

spoke to Dunne who offered insights about the challenges of LMIC and TB treatment, and information on the institute’s vaccine and investigational therapies.

On this day of commemoration, The Bill & Melinda Gates Medical Research Institute has multiple TB therapies and a prophylactic vaccine in development, and its Chief Medical Officer Michael W. Dunne, MD, remains optimistic long-term about the state of clinical care, especially in areas of dire need such as low-and-middle-income countries. 

World Tuberculosis Day: Easing the Continuum of Care Burden 

This has been an incredibly productive conversation. Are there any parting comments you would like to give to the audience to help them look at the different viral infections circulating, and the testing and treatment that can be done? JAM [Jacinda], since you’re on, I’ll start with you.

: The first thing I would say is testing is important, and we need to relay this to our patients, but we must also develop models to make the testing available and accessible to each and every person. Health equity, testing equity, and vaccine equity should be at the forefront of our minds. I think the vaccination process with COVID-19 can give us great ideas and has created a great infrastructure for seeing how it is that we can make these things equitable. I hope that’s something we consider and prioritize as we move forward.

Wendy Wright, DNP, ANP-BC, FNP-BC, FAANP, FAAN, FNAP

: I think that science has brought us lots of tools for our toolbox now. I’m grateful that I have those tools and I’m able to use them. I think we should test early and test often. I think the whole point of the test and treat program for COVID-19 needs to be taken, as Priya said, and move to flu and other communicable illnesses as well. I also believe that we’re living in a time where there’s vaccine fatigue and there’s vaccine hesitancy across the board. Things used to be really easy. I would tell a mom, this is what your kid gets, and it was, “OK. If that’s what they need, give it to them.” Now, it’s more of a dialogue. Take a breath, ask them their concerns, and come back to them with your answers to those concerns. I have families who have come to me who have said, “I’m never vaccinating,” and their kids are now 100% vaccinated. JAM hit the nail on the head. Don’t give up. Give yourself some grace, and test early, test often, and use the tools that are available for those people who are truly at risk for these illnesses. They’re there, and they’re not going away.

: Just as Wendy said, for anybody in the federal government or in biotechnology who may be listening, please try to get home testing for all of these viruses off the ground. I think it can be hugely paradigm shifting. Not only that, but we have to make sure that treatments are available for all of them, for influenza, COVID-19, and RSV [respiratory syncytial virus]. Currently, that’s a void. We don’t have great treatments at all for RSV, and so we are sort of behind the ball on that. Then something that wasn’t mentioned today, but I think we would all agree with, is the fact that we are in for a rough road ahead. It’s already started, but if we can keep our eye on a couple of preventive measures like vaccinations and masks, we will be, I think, in much better shape to get through the next few weeks to months. That’s what I would have to say as my parting shots.

: I think for me, 2 things that I always consider are the art and the science of medicine, and taking and treating your patient, the whole patient. Not just a patient who’s in front of you, but what does that patient do outside of the office? When it comes to testing and treating, how does that test and treatment option influence them individually? How does it influence their job? How does it influence their ability to earn an income? How does it influence their ability to keep their family safe, and their friends safe, and their colleagues safe? And if they’re a health care worker, how do they keep their patients safe? I think when you take all of that into consideration, it echoes the message of test early and take treatment into account, not just for that individual but also for the big picture. I preach that message to my provider team daily. Hopefully, that resonates with the listeners here.

: I think all of your advice is wonderful. I think it’s going to provide the listeners with the tools they need to give the best care to their patients. I want to thank each and every one of you. You guys have been fantastic. I also want to thank the people watching this 

. If you enjoyed the content, please subscribe to the newsletter to receive information on upcoming peer exchanges and other great content right in your inbox.

Tina Tan, MD; Wendy Wright, DNP, ANP-BC, FNP-BC, FAANP, FAAN, FNAP; Priya Nori, MD; Jacinda Abdul-Mutakabbir, PharmD; and Kevin Michael Reiter, MD, PA, provide key takeaways from the discussion on the treatment of respiratory viral infections.

Practice Pearls for Treatment of Respiratory Infections

Kevin, what are you experiencing with patients being vaccine hesitant or really antivaccine?

: We don’t do a lot of vaccinations in the urgent care world aside from flu vaccines, but we did COVID-19 vaccines in the early stages of the pandemic. Folks come to us for the vaccine, so we’re not doing a lot of the primary care or well visits where we have those difficult discussions like Wendy mentioned, those challenging discussions with vaccines like HPV [human papillomavirus] and those that are less desirable and come with other stigmas and are harder to talk about to some degree. We really don’t experience that in the urgent care world. In the primary care world where I work, it was in the underserved clinics where I did my residency, where I go back. That population is also very trusting, Central South American, migrants. We have a low level of hesitancy in that clinic for vaccinations, which is fantastic. It makes our lives a lot easier not having to have those hard conversations, folks who are not vaccine hesitant, not vaccine resistant. I have to tell you, from the areas where I practice and vaccinate, I don’t experience that hesitancy as some other folks on the call do.

Priya, what has been your experience? Being in a very large metropolitan area and seeing patients of all ethnicities, have there been issues when you are, say, in your outpatient clinic and you’re offering vaccines to individuals, and they’re saying they don’t want it?

: Great question. It’s so loaded because a vaccine conversation is not static, as you all know. It has evolved so much with time. There were times in the beginning when we would approach things almost like, wow; we have these lifesaving vaccines that are going to totally change the paradigm. I can’t believe you don’t want to take this. What is not getting through? How could you respond that way? We were sort of aghast. Then we started learning more and more about how these vaccines were working, what they were doing, and what their role became in the pandemic armamentarium. Now the conversation has shifted so much, while we know that they’ve been hugely protective at preventing morbidity and mortality, there are still so many open questions. The biggest one that pertains to the COVID-19 vaccine that still remains, especially for community members is, “Am I going to have to get this dang shot every single year?” I don’t have a great answer for that right now. I’ve been following the vaccine closely. I certainly look into what thought leaders are saying about this. I think we’re at the point where we can’t vaccinate ourselves out of this particular pandemic, but what we can do is be very open and up front with our patients about what we do know and what we don’t know. That’s generally been my approach.

Now, the same patient I saw, let’s say in March of 2021, and I was sort of like, are you crazy? How could you not take this shot? Now I visit with them again, and thankfully they’re still alive. They’ve probably survived a couple of episodes of COVID-19, but now the conversation has shifted, and now we’re all kind of back in the same boat. That barrier between the unvaccinated and the vaccinated has narrowed and the conversation has changed. However, when we’re talking about things like measles or influenza, and so many of these lifesaving childhood vaccines, I have a much more hard line in the sand when it comes to that counseling. Diseases have come back to New York state because people choose not to vaccinate. Things that we thought were gone; the last we heard about some of these things was in the Bible. Come on, that’s pretty black and white there. I would say it’s certainly illness specific, but I love having this conversation with patients, and hopefully I manage to sway some folks.

That’s fantastic. JAM [Jacinda], I had another question for you. What do you do when you are having the faith leaders talk to their parishioners about how good vaccines are, and the parishioners aren’t listening? I’ll give you an example. I saw a patient yesterday, a 17-year-old, who came with his mom. I offered them the influenza vaccine. The mom looked at her child, and asked, “Do you want this? Because I’m telling you, you should not get it.” Those were the mom’s words directly. He was about ready to get the flu vaccine until his mom said that. What do you do in those types of situations?

I think the biggest thing I’ve worked on trying to relate to the faith leaders, and I guess at this point we’ve really trained them in, is how to provide very targeted messaging, and the various patients you’ll come across. Some folks may never want the vaccine, will never get the vaccine for whatever reason, and that’s OK. The approach I always take within the community is that it’s not my job to force anyone into anything. To the community members, I always say it’s not my job to force you to get the vaccine, and it’s not your job as a faith or community leader to force anyone to get it, but it is our job to be good stewards of the information we have. One thing I try to motivate them with is, at the end of the day, you may have people like that. You may have folks who don’t want to get the vaccine when you first offer it or when you first communicate with information. I always tell them that fact-based information is the way to go. That’s the way that I go when I relay the information to the community, and the way that I have trained or taught the faith and community members to do as well: be fact-oriented. This is the number of people who are suffering from the virus. This is the number of people who are vaccinated in our particular community. This is the number of people who remain unvaccinated and are in the hospital. I work to keep it fact-based, and opinions out of it.

The other thing I talk to them about is, although people may not get it the first time, don’t beat yourself up. Give yourself some grace because you don’t know what that information you provided could save. They may go back home and say, “This person tried to give me the vaccine, and they said how many people were suffering from the virus, and blah, blah, blah, blah.” Then the family member may hear it and say, “That’s a concern to me. Maybe I’ll get the vaccine whether they get it or not.” That’s happened to me, where I’ve had people who have come to several webinars or have come to hear us talk several times about the vaccines, and then that fourth time they say, “All right, I’m here. I support this. I want to get vaccinated.” There are different steps, but I always say, don’t beat yourself up if you don’t see the reception that first go-round.

Experts address patient hesitancy around both COVID-19 and influenza vaccines.

Patient Hesitancy to Respiratory Infection Vaccines

JAM [Jacinda], in your situation where you’re working with some of the communities that have disparities and they’re not able to access these things readily, what has been your experience when you go out there and try to offer vaccines to them? Because we know that in the Black and brown communities, there’s a lot of distrust with regard to vaccines and they don’t want to receive these vaccines. What has been your message?

: Thank you for that question, Tina. When I started this work, which was not work that I knew I would be involved in as heavily as I am now, and with me being a Black woman, I knew there would be hesitation with the vaccines because I also hesitated when it came time to receive the vaccines. Some of the reasons are systemic and structural racism, mistreatment by the US health care system, and poor public health communication. I was a bit leery, so I did some education for myself. I evaluated the literature, and I then took this information and tried to make it something that was easily translated and something that the Black community could easily receive. I did this first translation of the information with a group of ID [infectious disease], PharmD friends. Long story short, I ended up heavily embedded in our processes at Loma Linda [School of Pharmacy]. We are continuing this work, but now I’ve moved and work solely with the churches we collaborated with. It was really important to identify the fact that I’m not the only trusted messenger. 

I think where Priya talked about pharmacists being integral because of the relationship that public health may have with the community, or that the public may have with physicians and other higher level providers, when it comes down to pharmacy or pharmacists, at the end of the day, the public looks at us all the same. It’s more, “You all, or those who are a part of the infrastructure, the health care system, have not done right by us, so now we’re hesitant.” I had to understand that faith and community leaders are those trusted messengers within those communities. Faith and community leaders are how we were able to gain the trust and access to the community. Those have become my major collaborative partners, but then also thinking about it from a behavioral standpoint. When we think about vaccines, when we think about testing, it’s behavior more than it is the belief in science. We have to think about the attitudes and how it is that we change those attitudes. My partners in this research are behavioral scientists because that’s important. I try to approach it from that end, but I mind my role and take heed to what it is that they provide in guidance.

Also I think about it from the perspective of I know that I’m here as someone who has to provide knowledge, so we rely heavily on education. We educate before we vaccinate. Previously we did this through the availability of webinars. We would do a webinar before we would do every vaccination clinic. The great thing is now we are moving more to in person, so we do in-person town halls where we talk about these major communicable diseases and vaccine prevention, and not just for COVID-19 specifically. Now we’ve added influenza, monkeypox, etc, to make this a sustainable model. But when we provide that education, we have a vaccine clinic right after. We are creating this infrastructure for providing information to the community, but also doing it in a way that integrates all of the trusted messengers who will be important in decision-making. Then we bring the vaccines right there in a low-barrier format to the community. We try to hit every single point of limitation that we can see.

Jacinda Abdul-Mutakabbir, PharmD, comments on building trust with community members and educating people about respiratory infection vaccines.

Community Education of Respiratory Infection Vaccines

: Kevin, in the urgent care outpatient setting, how do you convince individuals coming to you to get tested, and then if they haven’t been vaccinated, to get vaccinated against what we can vaccinate and protect them against?

: That’s a great question. I don’t think there is a problem convincing people about testing. During various stages of the pandemic, testing was all people wanted. You saw the lines wrapped around the corner and down the block for testing. Once home testing became more available, we do from time to time see folks who say, “I did my home test. I know this is just my annual sinusitis. I need my antibiotics.” If they’ve done a home test and it’s negative, I’m OK with that as long as I educate them that they need to continue to do the home tests. As was mentioned previously, it’s a sequential thing. One home test was negative yesterday, but because it’s an antigen test and we know the sensitivity is not great, and we know it’s based on prevalence and pretest probability, doing repeated tests is important. In those situations, if I’m not really convinced it’s a bacterial infection as they are, I will encourage them to do a better test, to do a molecular test. Patients in general, consumers across the country, are on edge, so we try not to push. If someone doesn’t want to do a particular test and we think it’s appropriate, we can only lead a horse to water, but we can’t make it drink. I think we encourage those folks to do repeated antigen testing.

In terms of vaccinations, I think that’s really important because we’ve seen with the bivalent vaccine the percentage rates are abysmal for folks who have taken the bivalent vaccine, at least in my neck of the woods in patients I’m seeing. I think it’s really important for us. Usually, they come to us with COVID-19, and they say, “Man, I wish I would’ve gotten that vaccine.” Obviously, that’s an opportunity where education may not influence that individual, but it may influence their partner, or it may influence someone else in their home to go out and get vaccinated, which I think is extremely valuable. In terms of flu vaccinations, with the warnings that were given early in the season, I think there’s been a fair number of folks who have heeded the warnings and gotten the flu vaccines.

What I’ve learned in my practice is with the COVID-19 vaccines, patients somewhat learn that getting the vaccine doesn’t mean they’re not going to get the illness. It has taken time, but it’s a dampened down version. That knowledge is something I always preached to my flu vaccine patients, but it really never stuck. It was a really hard lesson. I think now with the COVID-19 vaccine lessons, it’s easier to explain to patients, this isn’t a get-out-of-flu-free card. This means your symptoms will be so mild that hopefully, I’m not going to see you again. If we do, there are options. I think there’s a lot of opportunity for us to discuss vaccinations with family members and then future vaccinations. If that person is in my office and they didn’t get the bivalent, and now they’re infected with COVID-19, they may be more likely 3, 6 months, or 1 year down the line to get the next booster when it becomes available.

Wendy, what do you do with those parents who don’t want to get their children vaccinated? Because we know that even though it was fantastic that the COVID-19 vaccine was approved for use down to 6 months of age, people are not getting their children vaccinated. That’s a problem because they’re not getting the COVID-19 vaccine, and they’re not getting the flu vaccine. Now you have COVID-19, flu, RSV [respiratory syncytial virus], and other viruses that are circulating so these kids are getting really ill. What has been your experience in trying to get parents to vaccinate their children?

: Thank you for asking because my entire doctoral work was vaccine hesitancy and vaccine communication. This is truly my baby. First of all, there is information out there now that only 40% of people in the United States have received a flu shot this year, so we still have a lot of work to do. If I’m looking in my refrigerator, I can tell you we still have a lot of vaccines sitting in that refrigerator, and that is really frightening to me. As I tell parents all the time, that vaccine does no good when it sits in my refrigerator. A few things we do know that work; No. 1 is giving a strong recommendation, and that is saying something like; “I’m looking at your child’s vaccine list. I can see that they’re due for flu today. We’ve got it available. Let’s get it on board.” That’s how I speak about vaccines. I don’t say, “How do you feel about that vaccine, Johnny? Do you want to get a shot?” Because we know that gives them an out and most people won’t take it. I also am not afraid to use the mom card. I’ve used it for 25 years, and I play it every single day. “What I’m asking you to do for your child is no different than what I’ve done for my son.” I use that all the time. I also talk about the fact that an ounce of prevention is worth a pound of cure. I’m also not afraid to say every vaccine that we house in this clinic is without preservatives. For some parents, that means a lot to them. I don’t go down that road with them, but I say, “We’ve got it here, let’s get it on board.”

Experts share their approach to encouraging patients with symptoms of respiratory infections to get tested and vaccinated, and how that helps to control the spread of sickness.

Respiratory Infections

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