15. The Importance of COVID-19 Vaccination in Adult Populations

Carl Earl Lambert, Jr., MD, FAAFP:

Sure. I could start. So greetings. Pleasure to be here with everyone else and whoever’s listening. My name is Carl Lambert. I’m a family physician and assistant professor of family medicine at Rush Medical College.

Corinne Kohler, MD, FAAFP:

Good morning. I’m Corinne Kohler. I’m also a family physician and I just finished 20 plus years working at a Federally Qualified Health Center in Champaign, Illinois. And I also work with a very diverse population.

Marian R. Sassetti, MD, FAAFP:

Well today, why don’t we start off talking about how our individual responses are of our patients has been to getting the COVID vaccine. I’m actually fairly delighted to say our population has been generally very responsive and it’s been very gratifying. If ever there was a problem in the beginning, it was just trying to manage the volume of patients who actually wanted to get in. So I’m very fortunate that we’ve had a very positive response. Of course, we’re dealing with a significant number of people who don’t want to get vaccinated, but in general, we’ve had a very positive response.

Carl Earl Lambert, Jr., MD, FAAFP:

Sure. I share that sentiment. So I think at first, for me, it was a bit of a challenge. I wouldn’t say a fight, but really a challenge. I think as a family doc, we have that benefit of the superpower, if you will, of knowing our patients best and having relationships longitudinally with them. And we can use that trust to leverage conversations around the vaccine. So at first, a lot of my time was really spent around discussing the science, the evidence, the safety of the vaccine. Even though it’s new to the general public, the concepts behind it are very much so the same and very much so comfortable with discussing. So there was a lot of discussions around that. And I’m happy to say now, a lot of my patients have been vaccinated or boosted. There’s a lot more readiness for them to do that.

Corinne Kohler, MD, FAAFP:

I would agree with both of you. I think initially one of our challenges was just the logistics of implementing vaccination. We were already a testing site and adding the vaccine in at the [inaudible] location was one of our logistics challenges. And because we were scheduling and not actually implementing them in the main clinic, it made my contact with the patients sometimes a little bit different. So sometimes they’d already been vaccinated and we were just reinforcing that and reinforcing who else in their bubbles should get vaccinated. Many times we had the discussion of the pros and the cons of the vaccines like you said Dr. Lambert and Dr. Sassetti, some of the science behind it. I think one of the things that early on as we talked about some of the challenges and hurdles was finding out where people were getting their resources and information and trying to pull in actual science into the conversation.

Carl Earl Lambert, Jr., MD, FAAFP:

That’s awesome.

Marian R. Sassetti, MD, FAAFP:

So that’s actually where we’re at now. We are very gratified that we have really gotten most of the patients vaccinated. And what we’re dealing with now is the patients who are showing up unvaccinated and all of us in practice sharing responses to frequently asked questions or hesitancy. So I’m wondering if we can spend some time on that. Generally, people feel very strongly. We’ve passed from the people who are showing up, at least in my practice, to me, have very strong feelings. And what’s interesting is that their long term patients of mine, and I’ve been able to use that relationship to just say, “This is something that I think is important. I don’t see new patients. I’ve been close to new patients. I’m just an old doc and not taking new patients at this point.”

So that relationship has become part of the conversation. I use a lot of validation, which is “We’ve been a good team. All along, we’ve made good decisions. You’ve trust me all along, help me understand what’s different about this.” And that opens up I think the idea of validating the fact that they’re intelligent people, they’re making a decision, but “Help me understand why this is different and in what ways has the advice that I’ve given you about other vaccines been different than the advice that I’m giving you about this vaccine?”

What’s very interesting is they seem to be quoting that it’s brand new, it’s experimental. One of my favorite responses is actually the first people that the vaccine was given to were healthcare providers. So if there’s some kind of disadvantage or “guinea pig” status, we were the first ones to get it. And we were all clamoring for it for the most part. What has your experience been, Corinne and Carl?

Carl Earl Lambert, Jr., MD, FAAFP:

Sure. For me, I have to share kind of a funny story. My family, during the height, like at beginning of the pandemic, they had started a Facebook group. It was filled with what I would consider misinformation and conspiracy theory things that I’m always surprised that information moves way faster than the CDC and science.

Marian R. Sassetti, MD, FAAFP:

Right.

Carl Earl Lambert, Jr., MD, FAAFP:

Someone accidentally put me in the group and they’re like, “Oh man, the doctor’s in here.” So I see this and I just take it upon myself to make this big presentation about just what is COVID, what are the vaccines, what’s the data, all these things. And it just made me think, “Man, if my family, the family of a physician, if they have these sort of fears and thoughts swirling in their minds, then it probably is reflecting what some of my patients are feeling too.” So, yeah, I totally agree so far with everything that’s been said. And there’s much that can be said about this.

But just some main points that come to mind that I would want to share is just what you just said, Dr Sassetti, is validating and meeting the patient where they are, much like I had to do with my family. I was like, “Yeah, it’s a scary time. It’s an uncertain time. We’re sheltered in. There’s this mystery virus we don’t know up from down. So I understand the fear behind the times that we’re in. But at the same time, you come to your physician, you come to a trusted healthcare profession to kind of move through that and to make sense of it all, to use the science and the data in our medical background and our relationship with you to really steer you in the right direction to make shared decisions that really are really for the benefit of your health and just the community as well,” right?

So another piece is thinking communal, right? So I think we’re in a phase now where getting vaccinated and all these things, it’s not just about you. It has to do a lot with your fellow woman, man, child, your neighbor, right? Well, what’s the best thing that you can do for your neighbor? So you getting vaccinated, it may not really be a big deal to you, but it could be the world’s difference between you and someone else who might be in a vulnerable population. That could be someone who’s over the age of 65, someone who has disabilities, or is in a long-term care facility or a newborn child, right? I have a premature infant right now so I’m absolutely thinking about him as I maneuver through the world. So a lot of times I’ll talk to patients around just thinking about how vaccination is kind of showing how you’re maneuvering through the world and you’re trying to keep yourself and others safe because I don’t think we’ll get through this just by ourselves. You have to think communally.

And then changing the narrative around what does immune strength mean? A lot of times my patients will make the argument of like, “Hey, Dr. Lambert, my immune system is topnotch. I’m good. I take vitamin C. I take elderberries. I exercise five times a week.” And I have to explain to them, “Well, that doesn’t necessarily give you antibodies, right? There’s a difference between being healthy and the traditional subs versus having protection against a particular antigen or virus. So that is what the vaccines would provide.” So just explaining that sort of narrative around like, “I love what you’re doing, but I want to add this because this piece is really going to help us to really create the protection that we’re both looking for.”

And I think finally, it’s really changing the narrative around suffering. A lot of times, patients, obviously they don’t want to die. They don’t want a loved one to die. They don’t want to have those sort of consequences. But I think about changing the narrative around suffering, right? I don’t want you to have to be in the hospital. I don’t want you to have to lose time off work. I don’t want you to have long term consequences like long hauler syndrome. Or if you talk about kids, systemic inflammatory syndromes and stuff that we don’t even fully understand quite yet. We’re just now kind of wrapping our minds around how to treat that. So there’s so much more that vaccines can provide other than just keeping you from dying. But rather, we’re trying to protect you from the full gamut of consequences that we know that this virus can cause and has caused in many people’s lives.

Corinne Kohler, MD, FAAFP:

And a lot of times you can pull off other vaccines that maybe have the same thing. I think about things like when Varicella vaccine was pretty new pulling through the fact that who’s not losing work, who’s not getting those long term consequences. One of the things that I try to talk with my patients is, “What information do you need to be more comfortable with this decision?” Really going back to those motivational interviewing techniques of “What’s it going to take you to move you from a four to a six so that when you walk out of here, maybe you aren’t going to get it today, but maybe you’re going to think about it or the next time you go into the pharmacy and there’s a big sign saying, ‘We can give it to you today’.” Finding out who in your bubble or sphere has been successfully vaccinated, sometimes that can really help them, and sometimes you have to be careful with that. But finding out who’s had the vaccine and hasn’t had the reactions that you’re so concerned about.

So if you say you’re concerned about reaction X, “Okay. Tell me about reaction X.” And you can go through that. “Okay. Do you anyone who’s had the vaccine that hasn’t had this?” And now that the COVID’s been around for a while, what we’re seeing is the milder symptoms of people who do get the virus but some cases not even becoming symptomatic and not being coming hospitalized and ill. And I think pulling in some of those experience is helpful.

One of the things that I’ve also done is talk to them about influenza vaccine and how that has impacted and such like that. So going forward, where we started with this almost 18 months ago with the vaccine, our information has changed. We now have some more boosters. We now have things that are a little bit more changing and current. So it’d be interesting to say to find out how you guys see that the situation may have changed in the last year or so on how your patients perceive the vaccine and especially maybe boosters.

Marian R. Sassetti, MD, FAAFP:

Both of you were saying so much that I agree with. One of the things that I like to bring up when my patients are skeptical, I almost join with them and say, “Look, I do think public health has made a mistake in some ways. One of the mistakes that we’ve made is not being really clear on why we’re vaccinating.” The example of chickenpox is excellent, Corinne. I say, “The reason I gave your babies chickenpox vaccine was not because I didn’t want them to get the disease. We have all gotten the disease. And of course I don’t want them to suffer. But the reason we vaccinate is not to prevent the disease. It’s to prevent the horrible things that happen with the disease. You know that there’s lots of suffering that comes along with COVID. And just like Dr. Lambert said, we don’t want you to suffer, but remember, that’s not the goal of the vaccine, the goal of the vaccine and the reason I’m so adamant about it is because I really care about you and I don’t want you getting these terrible things that happen.”

And right now, one of the terrible things that is happening that we just simply are not understanding well is long COVID, especially in children. And it’s very scary for me as a grandmother to think about long COVID or these neurocognitive developmental delays that are clearly coming about because of infections with COVID, and these children’s brains aren’t finished being made until they’re in their 20s. So when I talk to my patients about that, I think so many young parents are concerned about autism and all the rest of it. When I say, “Look, you’re right, you do know Joe Blow or someone else who got the disease. And they’re fine. What we’re concerned about just like we vaccinated everybody for, the chickenpox is a great example, you know lots of people who had it, but what you don’t know is the people who have died from it, the babies that have died, who have had meningitis, pneumonia, heart disease, and now we just don’t know which children or adults are going to get this long COVID that’s going to present all kinds of neurologic challenges and cognitive challenges.”

That really is starting to get some traction because it’s filtering into the lay literature, I think, this neurocognitive concern, and I just say, “That’s the whole reason your baby’s got all those vaccines we gave them. It’s not to prevent the disease, to prevent the awful things that happened with the disease.”

Corinne Kohler, MD, FAAFP:

I was going to just say something real quick. You made a good point, Carl, a few minutes ago about immune systems and such. I think one thing that we’ve learned about COVID is it’s indiscriminate. It doesn’t seem to matter whether age or preexisting. There are some populations that are higher risk, but we all know perfectly healthy individuals that have died from COVID or have had long term. And so our own personal health may factor in a little bit, but we know when I say is COVID, it’s not discriminatory. It will hit everybody and you need to play that into your decision making.

Carl Earl Lambert, Jr., MD, FAAFP:

Yeah. I couldn’t agree more what everyone is saying. So I told a patient… Well, two stories, but one, COVID is learning us, right? So we need to learn it, right? You don’t want it to be three steps ahead of the population. So we have to remain vigilant. And just going back to patients who are able bodied and all these different things, yeah, I’ll never forget I had a gentleman, really strong physically guy. All he had was just mild asthma, rare exacerbations, caught COVID. I did a telemedicine visit after he had came out of the ICU. He was fortunate to survive. And you could see the fear in his eyes. He’s like, “Dr. Lambert, I would wish that on no one. Everyone should get a vaccine. Because if it happened to me, it could happen to anybody.” And he’s right. He’s right.

Going to the question that you raised about where are we at right now, what’s the current situation? What can we do now to not lose traction or what has improved or hurt our situation? I think boosters has been a major game changer for us, right? I’m glad to know that we have such things in place that’s offered protection. It’s lowered the disease burden. It’s lowered the death toll. It’s being equitably put out in different places so patients can get access to it.

So all that is wonderful. And yet at the same time, I have had to warn patients like, “Hey, even if we hit a peak, don’t think that COVID has just mysteriously gone away. Even if there’s policy saying you don’t have to wear your mask, you can go or you want, you can do what you want, you have to remain vigilant.” Just for the reasons we mentioned, right? Though the likelihood is down that you can have those severe consequences, the risk is still there. And if that’s the case, if the risk is there for you or someone close to you who may be more vulnerable, then you have to be mindful of that, right?

So we have to really be mindful of the time that we’re in. We’ve had a lot of gains, but again, we still need to make sure that we’re doing things to make sure that we don’t move backwards because variance can continue to crop up as they have. And we don’t know what qualities they’ll have. Some of them are more contagious. Some of them are the same level of being contagious as other variants. We just don’t quite know. But what we do know is that if we follow consistently certain patterns that we know decrease the spread, then we as a society would be in a better place. And we can’t rely on a select few. I think Dr. Sassetti you’ve mentioned drafting, right? It can be just to select few in our community that are doing those things. It has to be everyone in the community that’s kind of stepping up, doing what they need to do, making sure they’re up to date with boosters, asking questions of your healthcare provider if you’re confused, having the conversation. All those things, it really makes a world of difference.

Marian R. Sassetti, MD, FAAFP:

Right. Yeah. I like to get philosophic when my patients let me and I have those conversations that really do say, they know the way I talk now, which is crises are invitations. What’s the invitation? You’re part of a community. You’re a good citizen. What do you think COVID’s calling forth? Yes, you have individual rights. Yes, nobody should be making you do things, but what do you want to offer your community? And then sometimes instead of telling them, just posing the question of “What do you want to offer your community? What are you willing to do? This is going to end. COVID’s going to end. What do you want to be telling your grandchildren you did to help the cause, to help your community, to help keep people safe? Do you think you want to participate in that? You don’t have to, but there’s an invitation there.” And I just like getting people to think that way.

Corinne Kohler, MD, FAAFP:

I think that for me using the analogy of a brick wall sometimes makes a word picture that people can understand. So when we’re all immunized, we have a pretty solid brick wall. And that’s going to keep hopefully the virus on the other side. But when you have people that have chinks in the brick wall or missing bricks or whatever, that’s going to allow more the virus to come through. That’s what kind of feeds our variance. So sometimes we can get into a lot of science over variance. It depends on the individual and their interests. But the fact is, as you guys have said, variance really aren’t going to go away. And the way we can protect that is having a good level of vaccination in the community. We talk about that with influenza, influenza A. The fact that yes, we need what we don’t call them boosters every year, but basically they would be similar to that because we know that this is a virus that can change over time and with selective pressure and things like that.

So sometimes I’ll go into that with them. But many times I’ll just say that, “If we can put our armour on and really have a solid front against it, we’re going to do much better at fighting this off with that.” And again, I also try to reinforce my patients and try to get my staff to buy in the fact that it’s not just you. As you’ve said, the fact is that you may even be asymptomatic, but if you’re not vaccinated, you may be pass it along to that immunocompromised or that parent that has that premature baby or whatever, or the staff member that really can’t afford to miss work. So I think reaching our adult population and getting the message out to the adult population has been one of our challenges. And I’d really like to hear how you guys have gone that message out to your population. With community outreach, how are you reaching your adult population to get them into the clinic to get vaccinated? Did you have a specific outreach issues? Were you just relying on community messaging? Did your clinic do anything specific to reach your adult population?

Marian R. Sassetti, MD, FAAFP:

Oh, yeah. So that I’m really actually quite proud of my staff that did that. So when we set up the clinic, we are offering the vaccine and early on really just kind of went algorithmically, our oldest, our most vulnerable. We literally called, literally one on one. My staff was reaching out and calling individual patients and getting them in. And then when we had more supply and we were getting to less high risk patients, we put it on our website and had a designated kind of COVID line to help our patients get themselves scheduled and on a schedule during the vaccine clinic time. I’m delighted that we don’t officially have COVID vaccine clinic times because we’ve gotten so many of our patients vaccinated. Now we are just vaccinating during our office visits. One of the things that my staff will do doing an intake will ask about whether they’ve been vaccinated or not and talk to them about getting vaccinated often on the phone as they’re making the appointment. And then it will be flagged as a patient who’s not vaccinated and will be talking to them at our visit.

Carl Earl Lambert, Jr., MD, FAAFP:

Yeah, I agree. It’s kind of like catch-as-catch-can. So whenever you have the opportunity to interface with a patient, whether it’s a phone call to make an appointment, during the appointment, before you see me, after you see me, my medical student will ask them. Patients will even ask my chart. They’ll go through the patient portal to ask, “Hey, what’s up with this vaccine?” Or, “Dr. Lambert, what do you think about that?” There was a lot of that for our practice and I was like, “Hey, I’m glad you’re reaching out about it. So here’s my answer. And absolutely once we’ve answered your question, why don’t we get you scheduled? And if it’s not our office, how about you nearby pharmacy?” So we are open to whatever works best for that given patient. If that’s in our office, if that’s during an appointment time or if it’s like in the community, we’re totally fine with that.

I know at Rush we’ve also partnered with community stakeholders to have vaccine events at different churches and just different places where people tend to congregate or working with folks in the community that a lot of folks will tend to trust. So leaning on them to also send out the message that vaccines are a safe choice to make.

Corinne Kohler, MD, FAAFP:

I think we’ve done a lot of that. We’ve used a lot of our social media. Early on we had our vaccines at an actual different location than our main clinic, literally just down the strip mall from us. We have since moved them into the main clinic and offer them as part of their appointment schedule. We also did walk-in vaccine. Early on we implemented being able to do the walk-in so that has helped. We also have not limited it to our patient population. As a Federally Qualified Health Center, we were allowed to do that. We were open a little bit more. So if somebody brought a family member with them, we could vaccinate too. So for me, one of the most rewarding experiences through this has been the ability to see maybe not just individuals, but whole cohorts and families and groups be able to come together and embrace this.

I loved what one of my mom said early on. I was seeing one of her kids at school based clinic and I asked, like, “I do all my parents being a family doc. Have you been vaccinated?” She said, “Not yet. We’re all going to get the vaccine on the same day as soon as it’s released next Monday.” It was a Thursday and it was supposed to be out the next week. So it was just that whole attitude of, “Yes, we’re going to do our part and yes, I want to be part of this.” Like you were saying, Dr. Sassetti, what can we bring to the community and how can we be a positive influencer. And I think that’s one of the most rewarding things I have seen through working with this adult population.

Marian R. Sassetti, MD, FAAFP:

Yeah. That’s a nice segue to talk about how we can help our exhausted colleagues across the state. One of the things that I think there’s a parallel process, our patients are exhausted. Our patients are worn out. Our patients are anxious. And so are we. This is this horrible pandemic that has occurred. We’ve seen Titanic suffering. We’ve lost people. We’ve watched people suffer either through illness or emotional suffering. And I’d like to say at this point, okay, we’re two years into it. Something incredible happened on our watch during our time. There’s this extraordinary partnership between bench work, hardcore science and those of us in the trenches who are able to keep people that we love from dying. How often do you get to say that on a mass level? How often do you get to say to each other, “This wonderful thing happened in the middle of this scourge of our lifetime.”

For many of us, I’m old enough to have been around when aids first came out. For many practitioners, this pandemic has caused the most suffering they’ve ever seen in their lifetime. But something wonderful happened too. And that was the invention of these vaccines. And then how quickly primary care docs, family docs across the country, across the world adopted this and literally could look into the eyes of people we loved and said, “I’m going to help you not die of this.” So I know that sounds a little modeling, but I really do think it’s time for us to start those kind of conversations. We’re tired, but something else wonderful is happening here. So let’s rest up and focus on that good stuff.

I like reminding my staff and they’ve been really responsive to the idea that they’re participating in history. They will remember this. They will remember vaccinating people, looking at them and saying to… I think I told the story before about our 82 year old woman who’s been on our practice forever who just literally started weeping in gratitude. My young staff had given her this vaccine that now she knew she wasn’t going to die. And I think those opportunities in our practice to shine a light on the great beauty that’s occurred in the middle of this scourge is super important and for us to pet each other on the back and say, “Keep going, you’re doing really important, good work.” I know that was long winded, but I kind of want to get that out there and just encourage all of you across the street. We appreciate what you’re doing, and so do your patience.

Corinne Kohler, MD, FAAFP:

So before we wrap up, Dr. Lambert, do you have any positive stories to share about how this has impacted your practice?

Carl Earl Lambert, Jr., MD, FAAFP:

Oh, wow. I mean, I just love what Dr. Sassetti says, we could probably end there. I think for me, there’s just been many, I think, small victories. So whenever I have a patient that says, “You know what, Dr. Lambert, I know a month ago I said don’t talk to me about the vaccine.” And then a month later, they may say, “You know what? I’m a little bit more open to it. Let’s talk about more.” And then a week after that, they say, “Hey, I did get that vaccine. Aren’t you proud of me?” I’m like, “Well, yeah, aren’t you proud of you?” So whenever I can have that, using that relationship to really just change minds and change attitudes, or even have a patient, now they’re the champion. They’re telling their family and their neighbors and everyone else, and they’re putting it on social media. “My doctor said this is safe and I’m okay.” So I think that’s the rewarding piece for me, right? And that’s a win because that’s another person that hopefully we can keep out of harm’s way. So that’s a reward for me.

And then even seeing students do this. So even we teach in our medical school, teach them how to talk to patients that may have vaccine hesitancy. So even observing students have these conversations. Which as a student, that might be a little scary, but to see them traverse that and to do it well and to build rapport with patients and again, change minds too, that’s been the work for me.

Corinne Kohler, MD, FAAFP:

Well, that’s probably an excellent place to wrap up. I do want to remind our listening audience also of resources that are available, both the CDC materials that are available, but also IVAC has Illinois Vaccinates and has lots of good resources that one can access. So again, thank you everyone for joining us. Thank you, Dr. Sassetti and Dr. Lambert for joining us. We’d like you to feel free to listen to any of our other podcasts. You can go again to the Illinois Vaccinates website. You can go to the IAFP website. And please join us for any upcoming episodes. This is Dr. Kohler, Dr. Sassetti and Dr. Lambert saying have a great day and stay healthy.