Hospital staff in New York have to prove they are vaccinated against Covid this week or face losing … [+]
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Dr. Stephen Thomas, an infectious disease physician at SUNY Upstate Medical University, discusses the challenges involved in persuading hesitant people to get vaccinated—even those who work in healthcare facilities.
Hospital staff in New York State have to prove they are vaccinated against Covid this week or face losing their jobs. It is possible hundreds of employees will refuse to be vaccinated and resign their positions. Earlier this week, Northwell Health fired two dozen employees for not complying with the vaccine mandate, according to Newsday. Environmental and food service professionals, nurses, medical technicians, and physicians are all prepared to quit.
As an infectious diseases physician and researcher involved in Covid vaccine trials, I am often questioned by both the vaccinated and unvaccinated. Many of the vaccinated are baffled, unable to understand why their unvaccinated colleagues are so intractable. I don’t propose to understand why every individual would forfeit their job instead of getting vaccinated, but I have observed some common threads.
“The vaccines were made too fast and are not safe.”
As I have written previously, the Covid vaccine development process was fast for three main reasons:
1) We had more than a 25-year head start on developing Covid vaccine technologies such as mRNA and adenovirus vectors
2) Pharmaceutical companies and the government risked billions of dollars to complete large scale vaccine manufacturing while the vaccines were still being tested
3) There was so much Covid circulating during the trials, it was easy to quickly show a protective difference between vaccine and placebo.
The Covid vaccines available in the U.S. have been some of the most intensely studied and investigated vaccines ever. Despite the scrutiny, study after study has led to the same conclusion: Covid vaccines are safe and the risks which are associated with vaccination pale in comparison to the risks associated with contracting the disease.
“These vaccines will make you infertile.”
Numerous women have told me they are thinking about trying to get pregnant, and they refuse to be vaccinated because the vaccine will make them infertile. One infertility theory promulgates the idea that a protein in the placenta is genetically similar to a protein in the SARS-CoV-2 virus. If you receive the vaccine, it will instruct your immune system to attack your placenta, making you unable to carry a child.
A comparison of the two proteins tells us this theory lacks plausibility. If the theory was plausible, both vaccinated and naturally infected women would be at risk of infertility. With over 6 billion vaccine doses given globally (>389 million in the U.S.) and over 232 million infections (>43 million in the U.S.), we have not seen an infertility signal. The CDC’s vaccine adverse event reporting system (VAERS) has less than 10 infertility claims associated with Covid vaccines among more than 565,000 reports, and it is unclear if any of those claims have been verified.
“I am pregnant and the vaccine will harm my baby.”
The clinical trials testing Covid vaccines did not include pregnant women; this is not uncommon and is a source of ethical debate. What appears not up for debate is the fact pregnant women who get Covid have a higher risk of severe illness and death compared to their non-pregnant peers. There is also mounting evidence infection during pregnancy leads to worse outcomes for the child.
When Covid vaccines became available, pregnant women began rolling up their sleeves. U.S. vaccine safety registries, such as VAERS and v-safe, have collected information on over 160,000 pregnant women who were vaccinated. Analyses of these data have failed to find any obvious safety issues among the women, or their babies. Additional analyses of real-world data corroborate these findings, which is likely why the CDC, American College of Obstetricians and Gynecologists, and the Society for Maternal-Fetal Medicine all recommend Covid vaccination for pregnant women.
“The vaccines don’t work, look at all of the breakthrough infections.”
The breakthrough infection issue is not an issue of vaccine performance, but one of expectation mismanagement. The majority of vaccines are not designed to prevent infection, or even prevent mild disease, they are designed to address a public health threat. In the case of Covid, the threat comes from human suffering caused by severe disease and death, and breaking the health care system with surges of infected patients.
Breakthrough infections were discussed as part of the booster vaccination debate by advisory committees to the FDA and the CDC. The conclusion of both meetings was that the Covid vaccines available in the U.S. prevent people from getting severe disease, needing hospitalization, and dying. Even in the states with the highest rates of hospitalization and death among vaccinated people, unvaccinated people still make up more than 95% of the hospital admissions and Covid- related deaths.
“No one is going to force me to get vaccinated.”
Covid has shone a light on the difficulty of trying to convince people to sacrifice a bit of individualism for the common good. Encouraging social distancing, wearing masks, and now vaccination has not been easy, as evidenced by the ~35% of eligible Americans who remain unvaccinated.
When a colleague throws down his or her principled gauntlet, I usually ask, “Why now?” People working in the medical field, and many others, have always had to comply with a long list of employment requirements to include having specific education and training, following codes of conduct and policies, and, of course, having received all the required vaccinations. Why do Covid vaccines represent such an uncrossable line in the sand?
If unvaccinated health care workers walk off the job it will place a temporary burden on hospital administration and their vaccinated colleagues who stay to “hold the line.” But the enduring impact will be on the communities who rely on their medical institutions to care for them. Hospitals diverting patients to other hospitals, long wait times in the emergency room, no elective surgeries, and dangerously overworked staff will impact clinical care and patients will do poorly.
Throughout much of the pandemic, medical professionals have been lauded as heroes. With thousands of nurses, doctors, and others contemplating whether to accept or deny vaccination, I think Bob Dylan expresses my sentiments best: “I think of a hero as someone who understands the degree of responsibility that comes with his freedom.”
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