MedPage Today 2020.12.11

Physicians, a nurse, and a historian explored ways to minimize distrust in medicine, during a webinar hosted by the American Medical Association as part of its Prioritizing Equity series.

When the vaccine became available for H1N1, Lauren Smith, MD, MPH, chief health equity and strategy officer for the CDC Foundation and a panelist in the discussion Thursday, was working at a state health department.

While the department looked to ensure that all the healthcare providers took the vaccine, Smith said she was surprised by the amount of pushback it received.

“There are a lot of healthcare providers who said no.”

An October survey by the American Nurses Foundation found that 36% of nurses said they would not voluntarily take a COVID-19 vaccine if it was not required by their employer.

Similar results emerged from a CDC survey of healthcare workers, conducted over the last few months and shared at a public meeting on Nov. 23, according to NPR.

Healthcare providers need “transparent, accurate, and complete” information so they can “with a straight face say … ‘when it’s available and deemed to be safe and effective, I will be there” to take the vaccine. I think that’s really important,” Smith said.

Marcella Nunez-Smith, MD, who was tapped to lead President-elect Joe Biden’s White House task force on health equity earlier this week, said she gets five texts every day from friends and colleagues asking whether it’s okay to take the COVID-19 vaccine.

“Lots of people have lots of questions, as they should,” she said, and “everyone needs to get their questions heard,” especially those questions that related to safety, efficacy, and cost.

Healthcare providers have a role as “trusted messengers” in answering those questions. So it’s incredibly important to ensure that providers, particularly providers of color, have the right information to make decisions for their sake and the sake of their patients.

 

Providers also have to think about patients’ agency in approaching conversations around vaccines, Smith said. “We definitely don’t want to be coercing” people to take the vaccine.

Another panelist, Giselle Corbie-Smith, MD, MSc, director of the University of North Carolina at Chapel Hill Center for Health Equity Research, cited some unusual proposals to encourage vaccination, including the idea of paying people to take it, which she opposes.

“It just puts us in such the wrong space and just underscores why people would be distrustful of the federal government,” she said.

Another point Nunez-Smith made around promoting vaccination is the need for accurate data: “How long did it take us to get the data on what was happening in tribal communities and indigenous people and COVID-19? Do we even think we have a complete picture right now? No, we do not,” she said.

What’s needed is “not data for counting’s sake, but data for accountability’s sake, Nunez-Smith said. “In this long list of things that we need to do, we have to make the invisible more visible in our data systems.”

Margaret P. Moss, PhD, JD, RN, of the University of British Columbia’s nursing school, who is Hidatsa/Dakhóta, also stressed the need for culturally relevant communication with patients.

One young Native American man, she related, told her how he makes decisions: “Once I get a signal from the ancestors, or I hear it in my native tongue from elders, that it’s okay to do this, that’s when I’ll do it,” he said.

So, Moss agreed, it’s important to communicate with the elders, first in the hope that acceptance will “snowball.” But life expectancy for indigenous peoples is dramatically shorter than in the general population, Moss said. Tribal elders are “being picked off right now, right and left, and if they’re the ones who help make it okay, then we’re really in trouble.”

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