Those who need the vaccine the most are ‘most resistant’ to accepting: Doctor
The US is buying 100 million additional doses of Pfizer's COVID-19 vaccine. Dr. James Hildreth, CEO and President of Meharry Medical College and an infectious disease expert, discusses with Yahoo Finance Live.
- But let's at least move on to the state of the COVID crisis for now, where the number of cases is increasing across the country. Obviously there is a lot to talk about, especially with the types of communities that have been disproportionately affected in this country.
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We have Dr. James Hildreth with us. He is director of Meharry Medical College, where he is CEO and President.
Dr. Hildreth, thank you very much for coming to see us this morning. I wanted to ask you - you have focused again on who is affected in the middle of this crisis. As we have seen that the increase increases over the course of winter, are these communities still disproportionately affected? And what are the obstacles that will arise when we look at this vaccine? And just the public knowledge of how to get vaccinated and what it could mean for a society in the United States here in 2021.
JAMES HILDRETH: Thank you for having me. Unfortunately, the differences and inequalities, as well as the burden of disease, of COVID-19 have not changed. Minority communities, color communities, are still disproportionately affected by the pandemic.
One of my main problems is that those communities in need of the vaccine the most are among those who are most resistant or are reluctant to accept the vaccine. One of our greatest challenges is to dispel the myths and increase the uptake of the vaccine in these communities. And that's exactly what we're trying to do as we speak.
- Dr. Hildreth, how can you convince minorities that this vaccine is safe? Because we keep hearing that if 75% to 80% of our population does not receive this vaccine, we will not achieve herd immunity. What specific things can these communities do to get people vaccinated?
JAMES HILDRETH: The first thing we have to do is acknowledge that there is a rationale, a reasonable rationale for the hesitation and suspicion that I believe goes back to 1619. So the first is to acknowledge that there is a basis for hesitation.
Next, we need to identify trustworthy messengers. This is something I learned from my work on HIV: when I was trying to develop prevention messages to get the communities to protect themselves, the messages were fine, but when the messengers were not trusted, they were they are not very effective. So we need to identify trusted messengers and opinion leaders and familiarize them with vaccine acceptance and get them to involve the community. And that's the approach we're taking with regards to COVID-19 vaccines.
- Dr. Hildreth, Julie here. Nice to talk to you again. I know we have had so much discussion about health differences this year. It has come to the fore in a way we've never talked about. And I have personally seen how much more mainstream this issue has been.
But it's something you've been watching for a while. And I want to know - you know we saw the administration being forced to take on this role to talk about until you validated and discussed the subjects like the Tuskegee experiment, like if you resorted to all the experiments, which were carried out. But can this dynamic be sustained? And what does it take to continue this in the new administration?
JAMES HILDRETH: Well thank you. I believe it can be sustained. And one of the things that gives me a lot of hope is that there are large public and private organizations that are picking up on this mantle to make some significant changes. And for me that gives hope that the pandemic will lead to some significant changes in our attitudes towards health in this country.
As a reminder, we spend $ 3 1/2 trillion on health care annually, but we're not even in the top 10 healthiest countries. So we had to think about how we would spend those dollars on prevention, the wellbeing of young children, especially the habits they develop when they are young.
So I am very, very, very hopeful that the pandemic, as bad as it is, will lead to some really significant changes in our attitudes towards health and see health equity as a national priority rather than an afterthought that I am thinking has been the case for quite some time. So I am very encouraged.
- Well, that's good to hear. Let's hope it works. As I turned to the vaccine very quickly, I heard you at the VRBPAC meeting, specifically about the vaccine supply and the bottlenecks / limited supply there and the ability to use it with people I had in mind already got the virus. Is there currently more clarity about this?
JAMES HILDRETH: So the real question we debated at the VRBPAC meeting was whether or not the placebo recipients should be offered the vaccine. And in my opinion it would be unethical not to offer them the vaccine because they are the very ones who made it possible for us to get the vaccine in the first place.
So the compromise will be to make a blinded crossover. Those who received the vaccine will be given a placebo. Those who received the placebo will receive the vaccine. This way the test can take two years and we get some very valuable information about the protection period and other data related to security.
In my view, up to this point we have taken a population based approach to the pandemic which assumes that the risk is the same for the entire population. It is certainly not the same in the population, which means that a more focused approach would be appropriate.
And I think the vaccine distribution should be based on those who need it most. And that would, of course, be health care providers, assisted living facilities, and minority communities that have such a high burden of disease that they are more susceptible to disease and death.
So I hope this will happen. And I think the CDC committee that makes recommendations on distribution is also focusing on that. So I am again encouraged that the vaccine distribution plans as opposed to responding to the pandemic itself are what they should be. And I'm very excited about that.
- And Dr. Hildreth, I think, maybe just to clarify, when you talk about those who got the placebo, I think Julie was trying to do something with people who already had COVID-19? For example, let's say they showed symptoms. Should these people - may they skip a dose? Could you ... you know what is the approach to the operations here for these people?
JAMES HILDRETH: Oh. Yes. Yes. So i'm sorry. The point is, people who become infected can be re-infected, which means that the immune response they made is insufficient to provide protection.
But how the immune response works, when you first see something that you haven't seen before, it's primarily what you're reacting to, which in most cases is insufficient for protection. The next time you see this, you'll give a secondary answer that is orders of magnitude larger than the primary answer.
So the idea would be that if you have already been infected with COVID-19, you have given a primary answer. A single injection of the vaccine may therefore be enough to trigger a secondary response and provide protection. And if it did, the tens of millions of people who are already infected may need a single dose versus two doses. And that would take the vaccine a lot further. That was the point I wanted to make in the meeting.
- Well. Thanks for the clarification. Dr. James Hildreth of Meharry Medical College, thank you for being with us.
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