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Vaccination Hesitation: COVID-19 Vaccine Safety & Efficacy w/ Christina Cady
Episode 78th March 2021 • The AT Last Podcast • AT LAST
00:00:00 01:50:57

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On this episode we discuss the safety and efficacy of vaccines with guest, Christina Cady. We also discuss some of the literature related to reduced vaccination rates in communities of color. 

Show Notes

  1. Influenza vaccination rates compared by Race
  2. Influenza vaccination is widely recommended and fully covered preventative service under the ACA
  3. Data show flu vaccination rates remain low and there are persistent racial disparities in uptake of flu vaccine
  4. 2018-2019 CDC flu vaccine data
  5. Adults by race
  6. Whites 49%
  7. Blacks 39%
  8. Latinos 37%
  9. AIAN 38%
  10. Factors leading to lower rates
  11. Less insurance and less likely usual source of care
  12. Critical factors
  13. Blacks perceive a higher risk of side effects
  14. Lower knowledge of flu vaccine
  15. Less trust in the vaccine
  16. Black patients do not always receive
  17. Strong recommendations
  18. Specific offers for vaccine
  19. Decreased acceptance of new vaccine with highest level of worry amongst Blacks
  20. Perception of racial fairness and influence of race in health care settings and experiences with discrimination are associated with attitudes and beliefs about vaccinations which can influence getting vaccinated
  21. POC have more missed opportunities for vaccines, but would be more willing to accept if strongly recommended
  22. COVID-19 Vaccinations
  23. Available evidence: 
  24. 15,474,800 cases from Jan 21st to Dec 10th
  25. Hospitalization rate: 278.7 per 100,000 people
  26. Mortality: 291,522 COVID-19 associated deaths
  27. 2,740 new deaths per day
  28. In LA (recent LA County public health lecture 1/5/21)
  29. Death rate is 4 times higher in areas of poverty
  30. COVID-19 Vaccination Evidence to Recommendations from the CDC ACIP
  31. Population: >16 yo
  32. Intervention: Pfizer-BioNTech COVID-19 vaccine (BNT162b2)
  33. Comparison: No vaccine
  34. Outcomes
  35. Symptomatic lab confirmed COVID-19
  36. Hospitalization secondary to COVID-19
  37. All cause death
  38. SARS CoV-2 Seroconversion to a non-spike protein (date pending early December)
  39. Asymptomatic SARS Cov-2 Infection (data pending early December)
  40. Serious Adverse Events
  41. Reactogenicity Grade >3
  42. Do desirable effects of vaccine outweigh undesirable effects? A resounding Yes, benefits outweigh harms in most settings
  43. Pfizer vaccine demonstrated VERY HIGH efficacy (95%) post 2 dose regimen against symptomatic lab confirmed covid infection
  44. Level of evidence: High certainty
  45. Across all groups (age, gender, race, with comorbidities)
  46. Not included: children, pregnant women, immunodeficient individuals
  47. Limitations
  48. Only 2 month f/u
  49. Limited power to detect rare adverse events
  50. Vaccine effectiveness against hospitalization 100%
  51. L of E: low certainty because rare outcome
  52. Deaths uncommon
  53. 2 in vaccine
  54. 4 placebo
  55. L of E: very low certainty because rate outcome
  56. Serious adverse events very similar in vaccine vs placebo groups
  57. L of E: moderate
  58. Severe reactions (>3 grade)
  59. 8.8% vaccinated
  60. 2.1% placebo
  61. L of E: high certainty
  62. Uncertainty about vaccine by surveys
  63. Scientific articles 272, 14 included
  64. News/media, 19 included
  65. Intentions
  66. Acceptance lowest among Black respondents
  67. 25-55% for Black
  68. 37-70% for White
  69. > with higher SES
  70. > with hx of flu vaccination
  71. > with healthcare provider recommendation
  72. Concerns
  73. Vaccine side effects
  74. Uncertainty of efficacy
  75. Speed of approval process
  76. Low risk perception of disease
  77. High vaccination rates require addressing the previous mentioned barriers
  78. Access
  79. Cost
  80. Federal law states insurers provide COVID-19 vaccination for free
  81. Trump admin has said free for uninsured but there are questions about funding
  82. People need to know where to access
  83. Distrust
  84. Safety concerns
  85. What are the risks of side effects?
  86. Strategies to increase vaccination rates
  87. Healthcare providers can increase vaccination rates by pairing recommendation with offer at same time
  88. Provide info in linguistic and culturally appropriate ways
  89. Proactively address peoples concerns
  90. Use trusted individuals from the community as messengers
  91. References
  92. Artiga S. Orgera K. Key Facts on Health and Health Care by Race. Kaiser Family Foundation. 2019
  93. Quinn SC. African American adults and seasonal influenza vaccination: Changing our approach can move the needle. Human Vaccines & Immunotherapeutics. 2018;14(3):719-723.
  94. Rahimi H, Picaud Y, Costanzo S, Madhusudan G, Boissier O, Singh  kamal D. Design and simulation of a hybrid architecture for edge computing in 5g and beyond. arXiv:20090041 null. Published online August 31, 2020.
  95. Quinn SC, Jamison A, Freimuth VS, An J, Hancock GR, Musa D. Exploring racial influences on flu vaccine attitudes and behavior: Results of a national survey of White and African American adults. Vaccine. 2017;35(8):1167-1174.
  96. Maurer J, Harris KM, Uscher-Pines L. Can routine offering of influenza vaccination in office-based settings reduce racial and ethnic disparities in adult influenza vaccination? J GEN INTERN MED. 2014;29(12):1624-1630.
  97.  Artiga S. Michaud, J. Kates, J. Orgera K. Racial Disparities in Flu Vaccination: Implications for COVID-19 Vaccination Efforts. Kaiser Family Foundation. 2020
  98. ACIP COVID-19 Vaccines Evidence to Recommendation Framework. 2020
  99. Contact/Support/Questions/Comments
  100. How to contact the initiative to support, collaborate, ask questions:
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  104. Guest Contact info
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  106. Gratitude and Blessings
  107. Artwork by Jason Eisenberg
  108. Instagram: @dots_and_squares
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  110. Intro/Outro music by Willie B the Ichiban Don
  111. Instagram: @ichibandon
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  113. Production / Engineering / Editing / Content Creation
  114. Joseph “J Pash” Patrick
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  120. Gerson Sandoval
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